At the recent annual meeting of the Alliance for Continuing Education in the Health Professions, a number of key issues for both providers and supporters were discussed in sessions and in the hallways. This month, we’re joined by Nikhil Patel, PharmD, a director in the department of Independent Medical Education at Bristol-Myers Squibb, to discuss one of those issues—scope changes.

From: Cathy Pagano
To: Nikhil Patel, Scott Kober
Subject: Scope of change—how big is
too big?
During the Alliance meeting, I overheard a couple of grantors discussing the issue of changes in scope for initiatives that they have funded. Naturally I got a little closer to hear what they were saying (Yes, I eavesdropped!) since this is a common issue for us.

We often take weeks designing comprehensive education initiatives, knowing the whole time that we may not get enough funding to do much of what we’re planning. It’s certainly a frustrating part of our job. Nikhil, how much of an issue is this for those initiatives that you can’t fund in their entirety? Can you usually trust providers to do the right thing?

From: Nikhil
To: Cathy, Scott
This is something we deal with on a frequent basis. We receive a lot of grant applications seeking multi-support for large initiatives, and when reviewing these grants, we do consider what activity/activities would be implemented if full support is not received. This plays an important part in the decision-making process since it can affect the reach of the education, the material covered, and even the level of outcomes that can be collected.

Having said that, we hope that large grants specify what components would be implemented if different levels of support are granted, but in the event that they don’t, it’s vital that we are notified of the current status of the grant. This is especially important for our record-keeping purposes, communications to internal stakeholders, and, in a time when transparency is becoming even more important and reporting about it is taking front stage, we need to know what it is that we have provided support for.
 

From: Scott
To: Nikhil, Cathy
I have started to see some grantors require the submission of a contingency plan with the initial grant proposal, which I think is a good idea. It’s a good way for both grantors and funders to see how scalable their educational model is. When ample funding is not secured, at some point, you have to know when to throw in the towel. We had one grant last year where we got about 10 percent of what we were asking for, and to
actually move forward to produce anything would have been a waste of our time as well as the grantor’s funds. It’s never easy to turn down financial support, but it is sometimes the only ethical thing to do.

From: Cathy
To: Nikhil, Scott
So, Nikhil, in cases where full funding is not received, do you require the provider to reach out to you before any work is started on the initiative?

From: Nikhil
To: Cathy, Scott
That is correct. It is important that providers let us know of a change in scope using our forms so we can assess whether the educational initiative has changed significantly enough that the grant would need to be reviewed again by the grant review committee. This is necessary to ensure that all stakeholders that are part of GRC are still in agreement with providing support for the initiative as it stands after the change of scope. In some cases, funding is still provided; in others, the grant has to be declined.

It is a tough decision, but one that is a consequence of our environment today with limited budgets and the goal of supporting impactful, well-designed, and comprehensive educational initiatives.

From: Scott
To: Nikhil, Cathy
I think the most important thing for providers is to communicate with entities that do provide funding when the scope of the project goes through a significant change. I know there is the, “But what if they decide to pull their funding?” fear out there, but better that funders know upfront what is going to be different about an initiative than six months later when that fancy-schmancy online series turns into an eight-page monograph without warning. It’s kind of like the day Cathy announced that she was taking the staff out to a lavish dinner on her own dime. We all started throwing out names of the hottest new restaurants and yet we ended up at Applebee’s.

From: Nikhil
To: Cathy, Scott
Being upfront with a change in scope of an educational initiative not only helps strengthen the level of trust with the providers we choose to provide support to, but it also helps us in the grant department to be proactive with internal stakeholders, allowing us to keep them abreast of changes.

From: Cathy
To: Nikhil, Scott
I agree. It is better to be prepared than try and get away with something. I think grantors would take notice of the transparency in a much more favorable light. And speaking of transparency, it wasn’t Applebee’s, Scott. It was Geno’s in South Philly, and you ate two whole cheesesteaks.

Cathy Pagano, CCMEP, is president and Scott Kober, CCMEP, is director of content development at the Institute for Continuing Healthcare Education in Philadelphia. Nikhil Patel, PharmD, is a director in the department of independent medical education at Bristol-Myers Squibb.

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