CME IS FOR SPECIALISTS, not primary care physicians. Commercial supporters won't fund education unless they can influence the content. That was the prevailing wisdom in Mexico — until LiveMed, a CME company that produces symposia and academic seminars, partnered with U.S.-based Pri-Med and Harvard Medical School to produce Foro Internacional Médico (FIM) this past March at the Centro Banamex in Mexico City. According to organizers, FIM, which attracted 6,000 attendees, was the first meeting of its kind and magnitude for general physicians in the Spanish-speaking world.

LiveMed had many obstacles to overcome. Although Mexico is striving to improve and standardize the quality of educational offerings for physicians and disperse these programs nationwide, CME is at quite a different stage than in the United States. There is no consensus about what CME programs should look like, or who should control the accreditation process. Often, commercial supporters have heavy influence on program content. Many of these programs only apply to specialists, leaving behind general physicians.

Starting Small

Before even conceiving of a large convention, the LiveMed Institute, the CME arm of LiveMed, based in Mexico City, partnered with Pri-Med and launched a series of 10 Primary Care Update meetings, held in nine cities throughout Mexico annually. The program began two years ago and helped build LiveMed's credibility and reputation.

One reason for the success of the series was that LiveMed focused on collecting physician feedback in order to continually refine the program. “Early on, we integrated a survey to find out if we were having an impact on physician practice,” says Angel Vázquez Hernandez, president of LiveMed. “We also discovered what else physicians wanted to learn, and we constantly improved our program offering.”

In addition, the organizers restricted commercial influence. Their standards for developing content and collaborating with commercial supporters closely resembled the Accreditation Council for CME guidelines.

Another thing that served as a building block for a larger conference was that LiveMed developed a relationship with the Ministry of Health and reached out to each individual state's secretary of health within Mexico. “We made a point to build bridges with the [medical] authorities of each state in Mexico by informing them when physicians from their community were certified through a LiveMed program,” says Pedro Vera Garduño, vice president of Intersistemas, S.A. de C.V., LiveMed's sister company. (LiveMed certified participants who completed the program by awarding them official program certificates.) This relationship-building helped develop LiveMed's visibility and credibility throughout Mexico. (For more about how LiveMed's Primary Care Updates series, see sidebar below.)

As momentum grew for the program series, the group at LiveMed and Intersistemas realized that a larger-scale congress would be well received. “Through two years of LiveMed Institute meetings, we built a reputation of having the highest quality standards,” says Vera. “More and more, we were hearing requests to put together a national program with larger reach.”

Armed with two years' worth of convincing data, Vera and Vázquez approached Pri-Med and its academic partner Harvard Medical School, and convinced them that this was a fantastic opportunity. “We were eager to help physicians in Mexico learn,” says Sanjiv Chopra, MD, of Harvard Medical School. “International education is so much easier now with more efficient travel and better means to collaborate with content development. We were privileged, honored to participate in this innovative program.”

Content Across Cultures

FIM's Mexican scientific board and a team from Harvard collaborated to develop the content, recognizing that it was critical to develop a program that would be valuable for Mexican physicians. The local board was created with input from the Mexican National Academy of Medicine and headed by José Luis Arredondo Garcia, MD, head of the Clinical Research Unit of the National Institute of Pediatrics, president of the LiveMed Institute, and a key member of the Mexican National Academy of Medicine. The Harvard team was led by Chopra, associate professor of medicine at Harvard Medical School and co-director of the division of continuing education, department of medicine, at the Beth Israel Deaconess Medical Center in Boston.

As the Harvard team started discussing content ideas with Arredondo and the Mexican advisory board, they found that many of the same illnesses plaguing U.S. patients were of great concern to their Mexican colleagues too. “In Mexico, we have been experiencing a shift in epidemiology. Our most deadly illnesses now more closely resemble the top medical problems found in the United States,” says Arredondo. “Chronic illnesses such as diabetes and obesity have joined the roster of cardiac, stroke, and liver problems to form the list of our key challenges. General physicians need to know about the latest advances in treating these top illnesses, so this is where we focused our program development.”

It was important not to alienate the participants by inviting only U.S. physicians to speak. “Dr. Chopra and I agreed on the core topics. This was actually quite easy, as the USA shares many of the same concerns,” says Arredondo. “Many of our key speakers were American physicians, who could share a new perspective with us. We are also fortunate to have many talented physicians in this country, some of whom we included as speakers. For topics such as asthma, a Mexican physician led the session because Mexico has more experience with the topic.” Local experts were also invited to be panel moderators to provide much-needed local insight into the international lectures.

To further enhance collaboration, all sessions were simultaneously translated. This was critical, as most general practitioners in Mexico are not comfortable conversing in English.

Organizers also tapped into the strong local network they had developed doing the Primary Care Update series, involving everyone from members of the Ministry of Health to key members of the local societies. In fact, Arredondo was able to convince the Minister of Health to give the opening talk — something that helped attract attendees and commercial supporters alike.

The partners agreed to follow U.S. guidelines for developing content free from commercial bias. All the commercial supporters were Mexican companies — and as the FIM organizers expected, they resisted strenuously when they were told they would have absolutely zero influence over program content. It took a lot of explaining about ACCME guidelines to make the companies understand the principle of unbiased meeting content. To help ease the pain, meeting organizers offered commercial supporters the opportunity to host a lunchtime symposia where the company was permitted to have its own speakers address company and/or product topics.

Cars, Cellphones, Cereal

In addition to pharma companies, the team at LiveMed solicited consumer product companies as exhibitors — with great success. Soliciting nontraditional exhibitors was not just an afterthought — LiveMed has a dedicated staff person, Mariana Vázquez Hermosillo, whose title is director of nonpharma sales. “We are opening the eyes of companies who had never thought to exhibit at a medical meeting before. Once they try it, they see just how incredible it is!” she says. “We offer companies access to the exact demographic they most desire — busy, successful physicians with disposable income. Just like anyone else, these elusive marketing targets buy cars, go on vacations, and need cellphones.”

Companies such as Ford, Kellogg's, Delta Air Lines, Office Max, and a variety of local mobile phone and travel companies seemed to agree. Not only did they exhibit at the inaugural FIM, many of them renewed their contract for the next meeting on-site during the conference.

Convincing the Crowd

Exhibitors, of course, are only happy if the conference draws the crowds. The organizers aimed to convince close to 6,000 physicians to spend two days of potentially billable hours at FIM instead of in their practice. The conference was designed for general practitioners, who were not accustomed to being invited to a CME meeting of such high caliber and magnitude. No one was really sure how they would react.

“It was very important to keep admission to the event within reach of Mexican physicians,” says Arredondo. “Doctors in Mexico make 20 times less than doctors in the United States — sometimes even 30 times less. If the average specialist in the United States earns $100 per visit, his or her counterpart in Mexico will earn only $25. For general practitioners, it is even worse. Primary care doctors make only $10 to $15 per patient visit. That is less than the co-pay alone for most U.S. visits. So it was critical that we take the economic differences into account.” The early-bird registration fee for the two-day conference was only $90.

To help make the conference even more affordable, the LiveMed Institute created a scholarship fund using pooled monies from all commercial supporters — a departure from the U. S. Standards for Commercial Support. The fund assisted physicians in covering the cost of attending the meeting.

To entice physicians further, FIM offered a certification of participation from LiveMed and Harvard Medical School. To qualify, physicians had to participate in at least 85 percent of the program sessions — something confirmed through the electronic scanning system put in place at every entrance and exit to the sessions. In a culture where certificates and diplomas from prestigious institutions have heavy impact, this tactic was effective.

The organizers marketed FIM through advertising in print publications, direct mail campaigns, and Internet promotions. Commercial supporters also spread the word. Telemarketing was a very successful marketing tool as well. The Mexican market is not as accustomed to promotional phone calls, and it is therefore still receptive to this approach. In the end, the marketing paid off. Close to 6,000 physicians attended the inaugural event.

High Marks, High Hopes

And indeed, the response from attendees seemed to point to a successful conference. According to the evaluations, 98 percent of the attendees found the content at FIM useful and relevant to their daily practice. Almost as many — 97 percent — stated that they felt the program was free from commercial bias, an unusual response to Mexican CME programs. Going home, 99 percent of the attendees stated that they would immediately implement lessons learned at FIM.

Of course, there were some disappointments. Organizers had tried to encourage physicians from outside the country to attend by negotiating special rates with three area hotels and providing local transportation to the Centro Banamex; however, only about 10 percent of the audience hailed from outside of Mexico. For FIM 2005, they want to extend their reach farther. They plan to negotiate hotel and airfare packages to make the meeting more readily accessible to physicians from all over Latin America. Another improvement for 2005: More Latino speakers will be added to the program to provide more focused and local context.

One ironic complication this year was the surprising success of the breakfast and lunchtime pharma-hosted symposia. Apparently, the offer of free, high-class, sit-down meals and well-respected speakers was too good to pass up for many physicians. In many instances, the tickets were completely gone in a matter of hours. This left many unhappy physicians who felt slighted that they could not get tickets to the exclusive, limited events. While this could be interpreted as success, meeting organizers are sensitive to the frustration felt by physicians who were left out. Next year, attendees will have to sign up for the symposia well in advance. If the events sell out as quickly as they did this year, organizers may try to create additional symposia opportunities during coffee breaks, breakfasts, or even evening cocktails.

As for the future, FIM organizers plan to take the show to other countries — currently, they are exploring opportunities in Brazil and Spain.

“As always, you learn how to do things better from experience. It's a constant process of improvement,” says Vázquez, during an interview two months after the event. “You never finish. A program like FIM is a live animal and it always changes. It is always a different event, even if you have done something like it a thousand times.”

Jennifer Goodwin, MM's marketing columnist, has more than a decade's experience in the international meetings arena. She has planned meetings, executed public relations and marketing strategies, and written articles in three languages and in more than 30 countries for wide variety of companies.

Beth Johnson has 15 years of experience marketing and planning events. She has organized meetings on three continents on a variety of topics, for audiences ranging in size from 10 to 6,000.

For Goodwin's and Johnson's advice about taking meetings to Mexico, see “Mission Mexico” in the 2004 Beyond Borders, a supplement to MM. Access this by visiting, click on Beyond Borders, and scroll down; or do a search for Mission Mexico.

Exporting CME Effectively

If you are interested in developing programs internationally, consider the following tips:

  • Recruit a local advisory board with top experts in the field — both in medicine and in the local culture. Involving key people early in the planning process can save you from making embarrassing or costly mistakes.

  • Focus content on topics relevant to the local environment. You may have an expert on advanced MRI technologies, but that won't do much good in a culture where many hospitals have older equipment. Make sure your content can have an impact on local practice.

  • While physicians in other countries are interested in hearing presentations from U.S. physicians, remember that the local community has excellent speakers, too. By inviting local experts to present as well, you enhance your program for attendees and for the visiting Americans, who might enjoy meeting their non-U.S. counterparts.

The Lunch Crunch

The team responsible for logistics at the Foro Internacional Médico (FIM) was faced with the daunting task of serving box lunches to 6,000 physicians. They worked with the Centro Banamex to create an indoor, self-service luncheon area in an unused wing of the center. Six long lanes of tables, the length of a warehouse, were lined up side by side covered with box lunches. Attendees would snake their way around the facility to get their box lunches, and then retire to the perimeter where bar-style tables and chairs were set up.

To alleviate the lunch crunch, and to provide commercial supporters with additional opportunities to connect with attendees, FIM allowed them to host private VIP lunches for up to 200 physicians at a time. Up to 15 such lunchtime symposia took care of feeding close to half of the attendees each day.