“I'VE BEEN GOING to CME for something like 1,000 years, and I do think lectures are getting better,” says David Davis, MD, associate dean, continuing education, University of Toronto. Which is a good thing because, as the July/August issue's cover story pointed out, docs aren't about to embrace nonlecture educational delivery systems any time soon. But, as Davis notes, “The change process is complex. I think a good lecture is a necessary — not sufficient, but necessary — step along the way.”

The key words, of course, are “good lecture.” While intuition and experience make it easy to identify what makes a lecture bad, zeroing in on what to improve can be a little more difficult. Here are some strategies that have really worked to liven up lecture-based activities.


    The University of Toronto holds an annual program called “Saturday at the University.” Davis' department once did a study on attention spans at that meeting and found that after 10 minutes, minds began to wander. “So we broke what was a full day of lecture into a series of 10-minute lectures followed by 10 minutes of Q&A.” They have two moderators to make sure the lectures stay within 10 minutes, and the moderators collect questions from the audience and read them out loud. Did such a small change make a big difference? “It's now the most successful activity we do,” he says. “You have to beat them off with sticks.”

    If your faculty isn't comfortable with frequent Q&A, you can inject a case, or ask participants to take a minute to reflect or to write down how they'll use what they just heard, suggests Donald Moore, PhD, associate professor of medical education and administration; and director, division of continuing medical education with Vanderbilt University School of Medicine, Nashville, Tenn.


    Use an audience response system to gauge whether the audience is getting it or not. And if you can't afford an ARS, make up your own. That's what one of Davis' moderators did for one activity. “We cut up strips of different-colored paper and handed out the strips to the audience as they walked in,” he says. Every 10 minutes, the speaker put up a multiple-choice quiz, with each question keyed to one of the paper colors. The audience then voted with the papers, and if hardly anyone got the answer wrong, he moved on to the next area. The only down side to this, Davis says, is that you lose the anonymity of an ARS: “If I'm the only one with a red card in my hand when everyone else is yellow, hmm. Still, it injects some interactivity.”


    Every year, Moore gives a lecture about CME as part of his university's Masters of Public Health program. “This year, I'm going to start by giving them a scenario about ACE inhibitors and heart failure — I'll just give them a few facts and then ask them to break into small groups and develop a CME program right at the start of the lecture. It should create a teachable moment because it will thrust them into a situation where they only have partial knowledge of how to accomplish the task. Then we'll go through the process, and they can pull out the fallacies and assumptions from what they created.”


    Small group discussions can be effective because they offer the opportunity for physicians to test the way they do things against their peers and the experts. But, “just as you have to have an effective speaker for the lecture to be successful, you have to have an effective facilitator if you want a small group to be effective,” says Joseph Green, PhD, associate clinical professor, Duke University School of Medicine, and founder/president of the Professional Resource Network, Durham, N.C.

    All too often, lectures that break out into small group discussions are led by whomever raises a hand. “I can't tell you how many times I've seen horrible small group activities — not well thought out, designed, or led. How can you expect that to lead to anything?” says Green. The Annual Leadership Conference for CME providers that Green co-founded, now going into its third year, includes faculty in every element of the meeting's design, and makes sure that faculty are available to the small groups to help guide, advise, or just answer questions.


    All too often, speakers talk until the end of their allotted time period, leaving no room for the Q&A participants crave. Green once had a typical grand round series of hour-long talks where this would happen regularly. “I got sick of it,” he says. “I told them that if they wanted to speak at our grand rounds, they only had 30 minutes. The second 30 minutes were dedicated to Q&A. You'd have thought I killed them, but we stuck to it.” While at first the speakers were angry that they had to change their process, they came around once they saw how the audience responded.


    For the same grand rounds series, Green further mandated that all speakers had to use cases, samples, and data from the facility at which they were presenting. By using data from the participants' own patients and facility, speakers brought their points home in ways that related to that specific audience's practice and practice environment, making it easier to translate what they learned to their work.


    If you have a speaker who's daring enough to give it a try, turn the lecture into one big Q&A. Green had one faculty member who, after seeing the results of limiting lectures to 30 minutes, decided he wanted to go all the way. He told attendees what he'd be talking about, and asked them to suggest some practice-related problems they'd like him to address. He wrote their suggestions on a flip chart, then focused on the issues they had suggested. “He did his whole talk, without slides, from the flip chart.”

Focus on Faculty Development

Moore stresses the importance of faculty development in making lectures more effective. “We have to spend time with the members of our faculty who want to do more problem-based, interactive things, but who don't know how to do it and haven't seen any role models. Even using an ARS is a new skill set. The impulse is for people who know a lot to just want to tell people what they know. There's still a lot of work to be done.”

Yes, you'll probably get push-back from your faculty, but while most physicians are comfortable giving a lecture for an hour, what's effective for the audience is when you let them dictate the specifics of what gets talked about, says Green. While faculty probably won't embrace all your ideas, he says, “take a normal lecture led by a normal, paranoid physician who doesn't want to change his or her process, and see what you can do to make it a little more effective. I've worked with enough groups to know that it can work. I've seen people do it, and it's amazing how fast they can turn around a program that was absolutely typical and make it into something extraordinary.”

The Problem: Transforming Teacher to Learner

Since docs are more used to dispensing advice than taking it, the learning role doesn't always come easily to them. A poster session at the recent CME Congress held in Toronto showed how the CME department at the University of Alberta and Merck Frosst Canada Ltd. conducted a needs assessment for rheumatologists attending a national symposium. Sprinkled in among 27 questions on specific clinical treatments were 21 other questions concerning their needs as adult learners. According to the poster: “The results of the needs assessment indicated the importance of designing a program that would effectively ensure learning retention, transforming the specialists' traditional ‘teaching’ role to that of an uninhibited learner.”

Solution: Wow them with “The Weakest Link.”

It's an accredited activity called, “Translating Evidence into Clinical Practice: Are You the Weakest Link? A Game of True and False,” which sought to translate a highly interactive format based on “The Weakest Link” TV show. The program was initially developed for general practitioners, and was so popular that the researchers wondered if it would work equally as well with specialists. After an expert committee approved 22 questions based on the needs identified in the needs assessment, the activity was designed and held as a satellite symposium at the national meeting, with an emphasis on interactivity. After introducing the learning objectives and the two content experts, the facilitator read the first statement on a screen. The 150 attending rheumatologists broke into teams to discuss it until they came up with a true or false answer, then voted using a touch-pad card system. After the Q&A at the end of the session, each team got to guess which groups were the “weakest” and “strongest” links.

A bunch of rheumatologists would never go for this, right? Wrong — they loved it. Participant quotes from the poster included: “It was the most memorable learning experience I've had at a medical conference in many years” and “I couldn't stop participating in the learning because I didn't want to be the ‘weakest link’!” In fact, in the evaluations, the only weak link in the activity, participants said, was that they wanted more time to play — um, learn, that is.

Have you had success in injecting life into lectures? If so, please share your story with MM readers by contacting Executive Editor Sue Pelletier, (978) 448-0377; spelletier@primediabusiness.com.