“I once sang at Carnegie Hall,” said Marcia J. Jackson, PhD, senior advisor, education, with the American College of Cardiology in Bethesda, Md. During a dinner out after a long day of sessions at an Alliance for CME annual conference about five years ago, a group of us were playing the getting-to-know-you game where you state two facts about yourself and one untruth — and everyone has to guess which is the fabrication. I don't recall the other things Jackson said, but I decided that the part about Carnegie Hall must be invented — even though I had a hunch I was wrong. And I was.

It turns out Jackson had belonged to a chorus with the University of Maryland and they performed not only at Carnegie Hall, but also at the Kennedy Center. While she loves singing, she had to give it up when her career took off, because it required too much of a time commitment — although she still occasionally plays CDs of choral music with the volume turned way up and sings along.

Fortunately for us, she has lent her clear voice and leadership skills to the health education field for the past 30 years. After earning her PhD at the University of Iowa, she began her career at the University's College of Medicine in 1975, coordinating a project that evaluated training workshops for directors of clinical cancer education programs. She moved on to several other organizations; then, after serving as consultant to the 28,000-member ACC since 1981, she joined the College full time in 1992. She began as education division vice president, overseeing five departments and a budget of approximately $16 million. She moved up to senior advisor, education, in 2004.

Along the way, she has taken on numerous leadership roles, such as chairing the National Meeting of the Task Force on CME Provider/Industry Collaboration in 1996 and chairing the planning committee for the Alliance for CME annual conferences in 2000 and 2001.

We asked Jackson about how she became a leader in the CME community and the challenges facing the industry today.

MM: What is the biggest challenge you have faced as a CME professional and how did you handle it?

JACKSON: Establishing my own credibility with the physician members at the College when I first started there. [Some of them] I think felt a certain skepticism: Who is this educator telling us how to run our program? I looked for mentors, people who were receptive to me, and began to work with them and always tried to be service-oriented in everything I did. I tried to be cautious and not make it look like I was overtly trying to run things. I did more behind-the-scenes work — it wasn't important to me to be front and center and get credit for things. To me, if there's a good idea then it's important that it get out there and [I don't have to get credit], even though I may know I was a key part in making it happen.

Also, I am a real believer in the power of the group. When I started at the College I'd walk in to committee meetings thinking, I really have a darn good idea — how am I going to get this into the dialogue? The dialogue would begin and people would go down this path, down that path; I'd think, “Oh, please don't go there.” But over the course of a six-hour meeting they'd always end up at a place I knew was better than where I thought it should be when I walked in. So, I became a real believer in let[ting] a group go.

Doctors are accustomed to divergent thinking. If they're looking at a patient during grand rounds, they're going to flush out all sorts of ideas, and the more divergent those ideas are, the better. It is because everything gets on the table that you begin to focus on what the problem might be. They took that same approach to problem-solving at committee meetings.

What is the accomplishment you're most proud of?

JACKSON: Working with the members to create a draft design for and then implement our Web site, called Cardiosource. In 1999, we established the task force that looked at strategic directions for CME at the College, and the major recommendation that came out was to have a just-in-time Web site for our members. We had to sell our board on the idea. They realized what a significant investment it might require so it engaged every bit of experience that I had as a leader in the organization, working with my counterpart, and Chris McEntee, executive vice president, and the members of that task force, to help the board envision what this would be and then to get the board to allocate the resources to make it happen.

A key part of convincing the board was having Rick Nishimura, who was the chair of the task force and also the chair of our education committee, sit side by side with me at the board meetings. He and I worked out the presentation; he made the presentation and fielded the questions because it was important that they see this from the perspective of a clinical physician. We approached the presentation as if we were presenting an idea to a corporate board. We had mock-ups of what the Web site would look like; we had the business model and the potential cost. As part of the presentation we explained why we felt the Web site expanded the mission of the organization and why it was important to do it at that time.

We put together a small group of board members who we thought would be receptive to the idea and asked them to give us feedback on the presentation before we went before the board. We also thought about who on the board might be resistant or uneasy about [committing the resources] and we tried to reach those people in advance. By the time we actually made the presentation to the board there'd been a whole lot of background work that had been done.

The board agreed to it. They took it in stages — they didn't say, here's millions of dollars — but they let us get to stage one. It was the first time I'd ever been engaged in something that was so challenging.

What is the biggest positive change you have seen in CME?

JACKSON: The move from what I would consider to be instruction to learning. In 1992, [the approach was]: What are we going to teach people? Now, I think it's moving to: What do physicians need to learn, and how can we help facilitate that learning process by assisting their individual assessment of gaps in knowledge or changes they might want to make in their clinical practice? One way to measure success is to ask: How many programs a year are we doing? How many people are participating in the programs? How many of these people, in our case, are members and how many are nonmembers? Those are important indicators of success but when all is said and done, you might have touched so many people, done so many programs, but you don't know if you've made any improvement in their practice. Through new Accreditation Council for CME requirements there's much more emphasis on making a difference and measuring the results. You could say, “Gee, we did 30 programs last year,” but if those 30 programs didn't make a difference, if people are still doing the same things they were doing before, [if they're not practicing evidence-based medicine] — then you haven't done much.

What are the three biggest challenges the CME industry faces today?

JACKSON: The credibility of CME is a big challenge. Finding alternative revenue sources — not to get rid of industry support but to find alternative sources of support. The third one is to document the impact of CME on professional practice, which relates back to credibility.

What competencies do CME professionals need now?

JACKSON: Competency in the area of evaluation will become more and more a necessity because an understanding of performance improvement or quality improvement does require some understanding of evaluation. And self-assessment, looking at your outcomes. Having some business skill: Understanding how to prepare a business plan and being able to manage the business side of CME will become increasingly important. I see that in my own organization.

If I could redo my life, I think it would have been helpful to have gotten an executive MBA. My PhD in educational psychology measurement and statistics with an emphasis on structure and design gave me pretty good grounding in measurement. I understand instructional design, adult education, and measurement and evaluation, but when it comes to reading a balance sheet, understanding principles of marketing, preparing and developing a business plan — I've had to learn all of that on the job.

What attributes have enabled you to become a CME leader?

JACKSON: That was the toughest question for me. I asked my husband. He said he thought one important attribute is that I am a mission-focused person; that I don't have a personal political agenda or hidden agenda — that what you see is who I am is what you get. I was thinking about Stephen R. Covey's The 7 Habits of Highly Effective People and I think I have those habits. I'm a good listener and I do strive to listen before I state my position. I'm also a good synthesizer of information so I can listen to a diverse discussion and pull out of it what I think are the common elements and common themes, which helps in bringing groups to consensus. And I think I have the ability to focus on both strategy and implementation. Because I do attend to details I can be a good implementer. But I also have learned through the years to be a strategic thinker.

Opening Doors

When asked about her mentors, Marcia J. Jackson, PhD, senior advisor, education, with the American College of Cardiology in Bethesda, Md., realizes they're all men: Richard Kaplan, former associate dean for CME, University of Iowa, during the beginning of her CME career; later on, CME luminaries including Dennis K. Wentz, MD, former director, division of continuing physician professional development, American Medical Association; Robert R. Raszkowski, MD, dean, CME, University of South Dakota School of Medicine; James C. Leist, EdD, interim director, Alliance Center for Learning & Change; Melvin I. Freeman, MD, medical director emeritus, vice chair continuing education, Virginia Mason Medical Center; Murray Kopelow, MD, chief executive, Accreditation Council for CME; Bruce J. Bellande, PhD, executive director, Alliance for CME.

Her list is an indicator that the leadership positions in CME have been held predominantly by men, she says. “If being a mentor means opening a door, then you have to be in a leadership position to open that door.” The CME community needs to encourage women with leadership potential, she says. It's also important for women who have achieved leadership positions to take on the mentor role. And it may be important for women who want more visibility to seek out mentors. No woman coming up the leadership ladder has asked her to serve as a mentor, Jackson says. “I've tried to reach out at various times — but probably not as overtly as I should have,” she reflects.

Once the door is open, however, an aspiring leader must be willing to walk through the door and then to deliver. “If I'd said no [to opportunities], then I wouldn't have gone anywhere, and if I'd said yes and I did a haphazard job, I wouldn't have gone anywhere either.”

Balancing Act

Although she has been successful in attaining leadership positions in the CME community, Marcia J. Jackson, PhD, senior advisor, education, with the American College of Cardiology in Bethesda, Md., acknowledges that it can be tough for women to assume leadership roles because most women still have home and childcare responsibilities. By the time she was at her professional peak in 1992, her twin sons, now in their early 30s, were grown, and she was single as a result of her divorce. While over the last few years, she has had to balance her time between her new husband and her job, “I haven't had to do the same level of balancing that [other] women do.”

Jackson faced a tough time with balancing career and personal needs when she was diagnosed in March with non-Hodgkin's lymphoma. Fortunately, it was caught early. In addition to the strong support she received from her family and friends, her colleagues also stood behind her. Her CEO even suggested that she not attend a retreat in order to safeguard her strength. The message she received, Jackson says, was: First, pay attention to yourself. The crisis gave her a new perspective on physician education. No matter how well-informed you are as a patient, “You do make the assumption that your physician is staying abreast of the current evidence regarding the best approach for your treatment, but you have no way of validating that. I support the increasing emphasis on assuring maintenance of competence.”