Through partnerships with their overseas colleagues, several U.S. societies launched meetings that became powerful catalysts for changing health care worldwide.

It's become conventional CME wisdom: One-time meetings aren't enough to change physician behavior. Maybe not. But international conferences that are born of true collaborations between U.S. education providers and their overseas colleagues can have a powerful, lasting effect--not only on the participants, but on the countries where they are held.

This past February, the American Academy of Pediatrics (www.aap.org) held its first meeting in India, CME 2000, in collaboration with the Indian Academy of Pediatrics. Held in Mumbai (formerly Bombay), the conference itself was a success, drawing 150 U.S. attendees and about 500 Indian physicians, along with local bureaucrats and government representatives--a major boost to AAP's visibility in India and the surrounding nations.

But the most dramatic news came afterwards, when the Indian Ministry of Health asked the president of the Indian Academy of Pediatrics to head a national task force on pediatric health issues. The Indian and U.S. pediatrics organizations will now continue to work together to improve children's health care in India, says Suzanne Ziemnik, director, division of CME, with the AAP, Elk Grove Village, Ill.

"This was not your typical one-shot live meeting," she says. "The leadership of both organizations spent a lot of time together talking about the development of a task force in both countries to continue the dialogue. It's the most incredible outcome."

An outcome that never would have happened, she notes, without the intense collaboration that developed between the U.S. and Indian societies--a relationship built over two years, that goes far beyond the joint planning of the conference.

The partnership is an outgrowth of the AAP's new goal of integrating international programs into its strategic plan. Rather than generate revenue--"We see the [overseas] meetings as a break-even situation," Ziemnik says--the AAP aims to increase international participation at its annual meeting in the U.S., and to attract new members.

"I think it's a market saturation issue," Ziemnik says. "We're fortunate; we still continue to grow our membership domestically every year. But in terms of future growth, the opportunities are international."

A Huge Undertaking But creating partnerships overseas is a huge undertaking. "Unless you have a well-established relationship, you need a minimum of two years' lead time," she says. "There are time zone differences, communications barriers, currency differences. You need to develop financial agreements, identify faculty."

The dialogue between the two groups began about two years ago, when the AAP invited IAP leaders to its annual convention and held a mini-planning session with them. The IAP returned to the next annual convention for an update, and in the intervening months the two organizations communicated through numerous e-mails and conference calls.

To help prevent misunderstandings, the two groups forged an agreement, specifying the distribution of tasks and the financial arrangements. "We actually had no problem," says Ziemnik, going so far as to say that in the future, agreements could even be looser.

The AAP assumed the cost of marketing to U.S. attendees, and travel-related costs for U.S. faculty and staff. The IAP assessed a registration fee for its members based on its expenses; then the AAP factored in its own costs and added them on to the registration fee for U.S. attendees.

The two societies also collaborated when soliciting commercial support, agreeing which companies and who within those companies would be approached, Ziemnik says. They decided to approach Johnson & Johnson for example, because the company is interested in international outreach.

The program content also reflected the partnership between the organizations. "We didn't just walk into another country and plunk down our course. We collaboratively designed the program and utilized faculty from both countries," says Ziemnik. "We asked the Indian faculty for their perspective on clinical areas." For example, the program included sessions on malaria, because, as Ziemnik explains, "It's a problem American doctors don't usually see, but Indian physicians do."

To expose U.S. physicians to health care realities in India, the IAP took attendees to grand rounds in local children's hospitals, and to orphanages. The field trips were one of the most popular aspects of the program, Ziemnik says, and something she will plan more of in the AAP's next international venture.

Not Just an American in Paris The Massachusetts Medical Society in Waltham also made its first overseas symposium a collaborative effort. In April, under the banner of its publication Journal Watch Women's Health (www.womenshealth2000.org), MMS held a one-day conference at Le Carrousel du Louvre in Paris. Women's Health in the New Millennium drew about 750 attendees from 18 countries.

"Our objective is to change [medical practice] in both countries," says Mark Danderson, director, international business development, MMS. "This isn't about Americans telling the French how to practice women's health, but to exchange ideas so we'll learn something from the French that will change medicine here, and they will learn something from us to change medicine in France, which leads to better health care for everyone. We see this as an exchange, rather than Americans telling the rest of the world how to practice medicine."

Like the AAP program, the Paris symposium may have generated an ongoing international dialogue. Members of the World Health Organization attended the meeting, and expressed an interest in working with the MMS, says Danderson.

Though the MMS did not partner with a French society, its goal was similar to the AAP's in India--to organize a French/American meeting--not an American meeting that happened to be held in Paris. France was chosen as the destination because "a lot of the global experts in wo-

men's health are in France," says Jennifer Goodwin, president of the Goodwin Group, the Jamaica Plain, Mass.-based communications company that managed the event.

To help with the faculty selection process, the MMS set up an advisory board, with members from both the U.S. and France. They chose 26 speakers, half from France and half from the U.S. The program brochure reflected the French-American partnership--each page was divided in half with conference information in French on one side and in English on the other.

More important, the format of the program reflected its dual cultural nature: Each session featured a French and U.S. physician addressing the same topic from their two different perspectives, comparing how hormone replacement or breast cancer, for example, is handled in each country.

"The speakers [and attendees] really enjoyed hearing their fellow thought leaders," says Goodwin.

Meetings--Italian-Style Creating such an effective collaboration takes a strong willingness on the part of meeting organizers to learn about the other culture. Ten months into the 18-month planning process, the MMS brought in Goodwin specifically because, with her cultural know-how, she could act as a bridge between the two countries. Goodwin is fluent in French and has lived in Paris.

The Cochrane Colloquium (www.cochrane.org) went even further. An organization with centers in 15 cities worldwide, Cochrane members analyze the results of clinical trials and evidence-based medicine. When the program planning committee hired Alice Daum-Coen, senior vice president, director of conferences and meetings, Corporate Consulting International, based in Street, Md., as senior conference manager for the VII International Cochrane Colloquium in Rome, they asked her to move--all the way to Italy.

Daum-Coen actually relocated to Milan, where the organizing committee was based, and lived there for six months--as the only non-Italian serving on the committee. The six-day Colloquium, held in October 1999, drew 1,100 attendees from 48 countries.

Unlike Goodwin, Daum-Coen was not fluent in the culture or language of the meeting destination. She took a crash course in Italian before she left; even so, she found diving into meeting management, Italian-style, was quite the challenge. The first thing she realized was she had to become an "instant flexible manager. I had to adapt not only my style and demeanor but how I went about getting tasks completed," she says. "I learned very, very quickly never to need anything tomorrow."

Abstract Problems, Practical Solutions For instance, she knew from experience that the bulk of the abstract submissions would come in the two weeks before deadline. She helped the staff plan for the last-minute crunch, lining up reviewers worldwide.

"If the abstracts were due, say July 15, we needed them collated and copied by the next week, so 50 could go to Jane in Hong Kong, 50 to Joe Schmoe in Australia, 50 to Joe in Boston," Daum-Coen recalls.

"I was always anticipating and thinking and putting the structure in place for my staff," she says. "You don't always need to do that in the United Sates. We're a deadline-driven society. We understand the printer is waiting. In that culture, you negotiate with the printer."

Though the program book was printed in English, the editor appointed by the organizing committee spoke no English--and had no interest in learning. Daum-Coen did have a translator, and the abstracts were reviewed by the scientific committee before the book went to press, but as the "final fail-safe," Daum-Coen found her task formidable.

"There's no margin for errors. The [abstracts] have implications for a speaker's work. There's no room even for a decimal point difference in reporting the results of a study," she says.

Although the editor did a superb job, in retrospect Daum-Coen thinks she should have asked for an English-speaking editor. "I was trying to honor the system they had in place," she says.

More Than a Museum Thing While she realizes that most meeting planners don't have the luxury of relocating when managing international meetings, it still behooves them to do their research, Daum-Coen advises.

Before going to Italy, she went to her local library. "I looked at videos, went on the Web. I contacted the Italian embassy in Washington. I don't mean just [research] the museum-type things. Try as much as possible to understand their history."

Daum-Coen also has found that networking with her international colleagues in the meeting planning industry is helpful. "I am active in Meeting Professionals International. I feel comfortable asking colleagues about things I need to be aware of. The single biggest thing conference planners need to understand is, sometimes it's better to ask the questions than to always do the talking. Become as conversant as you possibly can in that culture. Don't try to go against the flow."

Redefining ROI Societies considering entering the international meeting arena need to realize, as Ziemnik pointed out, that they probably won't generate revenue, at least not initially. The ROI from international meetings is not only measured in money, but in "raising the meeting to new heights and building awareness of the organization and its role in the global community," observes Daum-Coen.

The MMS's Paris symposium did not make money, but profit wasn't the goal, says Danderson. "It was a test. Our objective was to learn how to do [international] symposia." But Danderson hopes to do more than build visibility in the future. "We want to come up with a viable program that at least breaks even or does better."

For the MMS and AAP, international meetings are one aspect of their plans to strengthen their global presence. Though its plans are not yet firmed up, the MMS is considering holding future meetings in other countries that are centers of excellence for various aspects of medicine, says Goodwin. "For example, Japan is a center of excellence in neurology; Montreal is well-known for cardiology. We will find partners to work with in [those] regions."

There are several factors driving the MMS into the international arena, says Danderson. For one thing, doctors around the world are now communicating regularly through the Internet, and they expect organizations to keep them informed of developments worldwide.

Meanwhile, borders in Europe are coming down. Under the European Union, physicians with a license in one country are allowed to practice in any of the other EU member countries, at least theoretically, Danderson observes.

There is also a growing movement among medical societies in Europe to standardize CME, and European governments and pharmaceutical companies are becoming more interested in medical education.

Later this fall, AAP staff members will meet to define their international vision, set priorities, and coordinate efforts across departments. In addition to holding more conferences overseas, the AAP plans to market its publications and programs internationally, continue translating its journals, and launch more online initiatives.

As for meetings, one idea the AAP is considering, says Ziemnik, is taking a consortium approach, where instead of holding conferences country by country, they will do a live program in Europe one year, then in Asia the next, establishing regional, rather than national, relationships and agreements, Ziemnik explains.

Making a Difference Collaborative overseas initiatives can yield a different kind of ROI for planners as well as organizations. "I've had some wonderful, exciting adventures--exciting in the sense of [participating in] conferences that make a difference in people's lives," says Daum-Coen.

Living in Italy during a time when the U.S. was suspect because of its involvement with NATO, Daum-Coen says her perspective was altered. "I really questioned my role as a larger citizen in a truly global community. I felt that very, very intensely."

She is currently consulting on the Cochrane Colloquium slated for October in Cape Town, South Africa. Though she is not living in South Africa, she spent several weeks there. After looking at hotels, venues, conference schedules, and checking a myriad of other details, she asked to see "the other side of Cape Town." The experience brought into focus the impact of health care conferences.

"Those are the people whose lives are being affected by infectious disease, HIV, all of that," she says. "When these researchers and doctors roll into Cape Town, they are affecting health care in [those] people's lives."

Ziemnik had a similar experience. She found her first trip to India "unbelievable and magical. It was just incredible to see, as a staff person, the impact of what you do in a third-world country. It really put things in perspective. I realized how fortunate we are. [Now] when I sit in a traffic jam, I think, 'Oh, well. I have a car.'

Pharmaceutical companies are not allowed to make decisions about content and speakers, or pay for doctors to attend accredited programs--in the U.S., that is, under Accreditation Council for CME rules. But there are no such restrictions elsewhere in the world. The Massachusetts Medical Society, however, enforced the U.S. regulations during its Paris symposium, even though 14 French companies (and one American company) gave unrestricted educational grants. "The separation of church and state is a foreign concept to European pharmaceutical companies," says Jennifer Goodwin, president, Goodwin Group, MMS's meeting planning company. "They are used to getting the speakers they want on the podium. We absolutely would not do that. We made it clear that it benefited them to be associated with a meeting that does have such high standards."

Faculty disclosures of financial relationships with industry presented another cultural barrier. In France, says Goodwin, "it is an insult to ask someone to sign a contract." Many of the French speakers would not sign the forms. Following ACCME guidelines, MMS published their names, as well as the names of those who did disclose.

The MMS also did not allow industry supporters to pay for French physicians to attend. Goodwin turned the obstacle into a marketing strategy. "If physicians understand that they are going to hear thought leaders speak of their own free will, that this isn't an influenced meeting, they see the value in that."