Crack open the brochure for a medical conference and you are just about guaranteed to find a symposium on the schedule. In fact, you may find many. What makes this form so popular among medical meeting organizers? Probably the many admonishments CME directors and coordinators receive from accrediting organizations and the American Medical Association to be sure to present fair and balanced programs. A symposium, as one veteran CME provider puts it, "is the easiest way for Dr. Hired Gunn to make his case for Drug X while his counterpart makes her case for Drug Y."
The original symposium was a cocktail party-for the ancient Greeks, a "convivial meeting for drinking, conversation, and intellectual stimulation" that came to mean a meeting at which a variety of opinions were presented. Today, a symposium is a form of discourse that incorporates a series of short formal talks-the total presentation time not to exceed one hour-presented by two to five qualified individuals on various aspects of a single subject or problem.
Like its near relative, the panel discussion, the symposium is a useful vehicle for presenting controversial subjects. Where there is significant disagreement among presenters-as when the facts of a diagnosis or course of treatment are in dispute-the symposium may be the preferred presentation method. That's because its more formal structure guarantees presenters the opportunity to put forth their opinions without interruption. Furthermore, at least in its purest form, eachdelivers a prepared presentation on the subject and does not interact with the other speakers.
Making it Work Symposium topics should be assigned well in advance so presenters can prepare. Some communication must be maintained among the presenters to minimize overlap, which can be virtually eliminated if a carefully written program, instructional objectives, and learner outcomes are defined in advance. While it is the moderator's responsibility to see that presenters communicate beforehand, a prudent CME director will offer to facilitate this process.
Logistical considerations include making sure that the speakers can be seen from every seat in the meeting room, which means either using a room with tiered seating or having an elevated platform. Since only one presenter speaks at a time, it may be sufficient to have a single lectern and microphone, with an additional microphone or microphones for attendees if a question-and-answer period is planned. See sidebar, "Variations on a Theme" for other possibilities. And be sure all participants have agreed to procedures and time limits before the event begins.
Because a symposium lacks the intimacy of a panel discussion, it can be adapted to an audience of any size as long as all the attendees can see and hear the speakers.
A Place for Divergent Opinions The symposium is an appropriate vehicle for offering a fair analysis of a controversial issue. It is the easiest way to enable the expression of divergent opinions. It allows conference organizers to exert a high degree of control over the development and exploration of a complex, and thus minimizes oversimplification or distortion of the information presented. Especially when there is a strong moderator, it is a good way to clarify various aspects of a complex problem.
For conference organizers, the symposium's format, with its structure of time limits, allows tighter control over the presenters, who are under greater pressure to make their arguments succinctly. The brevity of presentations stimulates listening and averts monotony by providing variety through pacing and the distinctive styles of the speakers. And while organizers always strive to have strong presenters, the symposium format at least guarantees that weak presenters will not speak for very long!
In fact, the symposium format encourages presenters to carefully prepare their materials and to focus on the topic, since they know they will be competing with their peers. When the topic is more complex than it is controversial, the format permits the exploration of an issue from a variety of perspectives, with attention to differing points of view, special interests, and proposed solutions and their consequences.
Outcomes Measurement? Simple as the format may be for the presentation of diverse ideas, the symposium is not without its failings. One problem is that it is very easy to violate the format. A symposium with more than five speakers that lasts more than one hour risks losing its audience's attention. Especially since a symposium is often used to present new ideas, asking attendees to process so much information in one sitting can lead to fatigue and boredom. A proven antidote to fatigue and boredom-interaction of the audience with the presenters, and even of the presenters with each other-is not available in the symposium's pure form.
In today's outcomes-oriented world, a greater problem-because it is not very easily corrected-is the difficulty in evaluating the effects of the presentation on the learners. That is because the symposium by its very nature calls for attendees to perform a synthesis of different and often competing views of a subject. In fact, it is probably a measure of the success of a symposium if attendees, asked upon exiting the event whether they plan to change their attitudes or behavior based on what they've just heard, answer, "I don't know." As adult learners, and even more specifically as healthcare professionals, they need time to reflect and process information.
The Organizer's Challenge The symposium's other great weakness derives from its strength: If this is a forum for the presentation of diverse ideas, it may be hard for course directors to obtain competent, unbiased presenters who can cover all the important aspects of the topic in a logical and dispassionate fashion. Even when a group of knowledgeable presenters is assembled, there is no guarantee that they will not change the flow of proceedings by altering the content or approaching the topic as a means to express a personal agenda. This is also one of the strongest arguments for conference organizers to insist that presenters disclose any possible conflicts of interest, and that such interests in turn be disclosed to attendees.
As mentioned at the outset, the symposium is an easy solution to the balance and fairness problem. The main challenge for conference organizer is to not overuse symposia in a program, or rather, to not misuse the format. If group consensus or action is the goal, select another format. Take care in choosing the subject or problem for discussion-does it warrant short presentations with no more than five different viewpoints?
Variations on a Theme A symposium is often defined by what it isn't. It isn't a debate, it isn't a panel discussion, and it really isn't designed for much in the way of audience participation. Here are some variations on the symposium theme that may open the form to greater interaction:
1. Allot time for each speaker to make a short statement of clarification and/or rebuttal at the end of the session. This can be especially useful when, during prepared remarks, one speaker directly attacks the findings or methodology of another.
2. Provide an opportunity for each speaker to ask one or two questions of any of the other speakers. Set time limits for questions and responses.
3. If the subject matter warrants, convert the formal symposium into a panel discussion for more interaction among presenters and further development of the topic.
4. Allow attendees to ask direct questions from the floor. This can be done at the end of the symposium, or it can be incorporated into the portion of the program with speakers asking questions of each other.
5. Form a listening panel whose members ask questions of the speakers at the conclusion of the session. This can be especially valuable when the subject of the symposium is controversial. The listening panelists must be selected on the basis of their points of view, so that all positions are represented.
While conference organizers are right to concentrate their efforts on finding strong speakers for a symposium-speaker reputation always scores high among physicians as a factor influencing their decision to attend a CME activity-it is critical to remember that the success of the event hangs on the strength of the moderator. Important tasks for the moderator before the event include the following:
* Understanding the topic and the desired outcomes of the learning experience.
* Ensuring that sufficient time is allotted to cover the topic adequately.
* Setting and explaining the ground rules for the symposium to the speakers.
Important tasks for the moderator at the event include:
* Providing an overview of the symposium for attendees.
* Establishing the credibility of each speaker, using information on their background and qualifications to speak on the subject.
* Linking presentations with brief statements to provide continuity between them.
* Clearly summarizing the proceedings or inviting questions at the meeting's conclusion, and identifying the relationship of each presentation to the whole, especially when the symposium is part of a larger program.