Jan Larsen, MD, was looking forward to the up-to-date information on current concepts and advancements in cardiovascular disease he would learn about at an upcoming cardiovascular conference. What he expected was spending a long day listening to lectures and participating in a few breakout sessions. Little did he know that, as he entered his first session, he would see a table with a collection of 150 objects and be asked to pick one that represented his background, history, or family heritage.

He walked around the table, examining the objects. He considered a pine cone, a seashell, a deck of cards, a small trophy, an army tank, and embroidery thread, before picking up an earring. He then joined the other participants, who rather than sitting in rows in front of the lecture podium, were seated in groups of eight at large round tables.

As the remaining attendees chose objects and found seats at the tables, the facilitator asked participants to take turns explaining why they chose their objects. Jan, who was the first to talk, explained that the earring reminded him of his grandmother who had emigrated to the United States from Denmark. She was an elderly woman when he was a little boy, and she loved telling him stories about the war.

One of the family stories he particularly treasured was about how her family had hidden Emile, a young Jewish man, in their barn for two weeks until he was able to flee Poland during World War II. Jan said that Emile later reconnected with the family and became a physician in the U.S. He then placed the earring in the center of the table.

The rest of the participants at the table took turns sharing their stories, placing their objects in the center of the table as they finished. The last person to share was George, a colleague of Jan’s, whom Jan had always thought of as being rather distant. George sat quietly for a few moments before beginning to tell his story; in his hands was a small piece of parchment paper. George took a deep breath, then told how his grandfather, who had recently passed away, had survived a concentration camp. He hadn’t planned on sharing that story, but Jan’s telling of his family’s bravery had moved him to tell it. Before the conference, there was no real connection between the two, but now they had discovered that they shared a common bond.

This is just one example of how stories allow participants to connect in ways that can be very powerful. When you begin a conference session using interactive experiences that engage participants, you provide a foundation where real learning, trust, and collaboration can happen. In fact, we believe engaging adult learners interactively is just as important to effective adult learning as is ensuring their safety and security.

While CME providers understand that interactive learning is preferred, it can be challenging to create stimulating activities. Here are four methods you can use to ramp up your offerings: films, live theater, hands-on learning activities, and clinical simulation.

Film Sources
Step-By-Step Guide to Creating Micro-Scenarios


Method 1:
Lights, Cameras, CME

Narratives are an excellent way to engage the hearts and minds of participants, because they allow learners to experience care from another person’s perspective.

One way to employ narratives in an activity is to use pre-existing films. There are many films, produced by a variety of sources, available for you to use (here are some sources). This option works well if you can find films that align with the content you wish to deliver. You can use film clips as discussion starters, or to illustrate points that are otherwise difficult to describe. It is a good idea to generate discussion questions ahead of time. The facilitator you choose will be key, so make sure you choose one who can engage audiences in conversations that can get to the bottom of issues and who can explore difficult topics in a non-threatening, thoughtful manner.

If you can’t find an appropriate film or if you run into copyright issues, you may need to create one from scratch that will better support the activity’s learning objectives or eliminate potential legal problems. The course director, screenwriter, and the conference planners all must collaborate to develop the screenplay. Stories may be drawn from real-world experiences, or they can be fictional accounts that highlight important concepts.

One benefit of films is that they can be used again and again. They are more cost-effective than live theater because you can show them to multiple audiences. They also allow you the flexibility to break the material into smaller segments and hold discussions after each segment or at key intervals.

Because HealthPartners Institute for Medical Education is interested in the role that culture plays in health, we have developed a number of films that have been used to better understand barriers our patients experience when obtaining healthcare. Among these are films that we have used for equitable-care programming and cultural-competency education. We also have developed films to support quality-improvement teams that are working to solve health disparities.

We ensure the films represent authentic scenarios by hiring culturally specific playwrights or screenwriters, who then meet with community members to hear stories about their experiences with health and medical care. The screenwriters then synthesize their stories into screenplays that describe one patient’s journey in healthcare. Once a script is developed, we partner with local theaters and documentary filmmakers to have the plays acted and recorded for future use. We have found that short films work best for educational programming.
Public broadcasting stations are excellent film-production resources. They have the expertise, equipment, and ability to professionally produce high-quality films. Independent filmmakers are another option. Depending on the length of the screenplay, allow two to five days for filming. Also, ensure that your filming location has appropriate light, space for cameras, and low ambient sound from outside sources.

You also can work with directors at local theaters, which is similar to hiring a consultant to manage the creative process for you. Directors can procure acting talent, conduct rehearsals, and hire stage managers, technical coordinators, and lighting/sound engineers. They also have connections with screenwriters and playwrights and can recommend good writers. Another source of writing talent is a playwright center that works with writers as they develop their scripts.

Method 2: Go Live
While film can be effective, sometimes the best way to convey a message is through the power of live theater. Drama is particularly well suited to healthcare education because it has the ability to draw participants into a person’s story and enable them to feel an experience from the actor’s perspective. The level of understanding and empathy theater brings to the activity is difficult to duplicate by traditional teaching methods. An element of mystery and suspense adds to the engagement and retention of the experience.

We have created a theater experience for healthcare professional development called BlackBox CME™ to use drama to drive high-impact learning. The experience combines drama with didactics and audience interaction to create a fast-paced and memorable learning session. We used BlackBox CME™ when the hospitalists at our institution asked us to create a live-theater retreat experience for them. The objective was to improve the physician’s knowledge of peri-operative medicine and the patient experience before and after surgery.

One of the most engaging aspects of this learning experience was a four-part monologue acted from the patient’s perspective. The show begins when lights come up on an actor playing “Howie,” a patient sitting on an exam table in his physician’s office. During the first of his four short monologues, participants learn about his life and what brought him to the clinic. Howie talks about driving trucks for 30 years and about how an old knee injury is making it difficult to drive and enjoy walks with his wife. He talks about possibly having knee surgery and his reluctance to go to the hospital. Through Howie’s monologues, the audience experiences the fears, anxiety, courage, and curiosity of a patient who realizes he needs the help of the healthcare system. Howie’s story continues as he learns he needs to have open-heart surgery before having his knee replaced. Unfortunately for Howie, during the surgery his heart stops; fortunately for Howie, he is resuscitated.

Method 3: Clinical Simulation
We didn’t just use theater to get the points across. As part of the session’s didactics, attendees used advanced clinical simulators to practice cardiac resuscitation.

There are many options for using simulation in conference settings. You can set up hands-on skill stations in conferences using adult and child patient simulators to review post-initial resuscitation management of accidental and nonaccidental trauma and poisoning, cardiovascular evaluation, and shock and mock codes. This style of learning experience allows participants the opportunity to learn by doing, receive feedback on their performance, learn from mistakes, and practice the roles they need to play to be effective team members in real-world settings.

Method 4: Interactive Learning
Other supplemental learning activities you can use include live game shows, interactive lectures, reflective learning sessions, word games, clinical simulation, and other hands-on activities.

A variation on simulation is a technique we call micro-scenarios, which we developed for use during new resident orientation. The scenarios use live acting, audience participation, and discussion in a fast-moving, interactive format. (Here's a step-by-step guide to creating a micro-scenario.)

From experience we know that PowerPoint-driven lecture presentations on ethics and professionalism can be dry and uninteresting. For the residents, we sought to address ethics issues in a way that would keep their attention, allow greater participation, and provide them with thought-provoking issues.

Key features that make this method effective are:

• ensuring the experience is interactive without being

• using humor to stimulate audience participation

• including fellow residents as actors to increase interest

• ensuring the speaker is engaging, knowledgeable, and able to provide valuable information while simultaneously stimulating conversation

• keeping the format unexpected, novel, and fun!

We present five to six case studies based on current topics as short one-minute plays. We ask staff members to play roles in the case studies, and we recruit residents to answer an ethics question at the end of each micro-scenario. We also give every resident in the audience an audience-response system keypad and ask them to vote at the end of each scenario. (See sidebar on this page for a guide to creating your own ethics micro-scenario.)

These are just four ways you can integrate interactive learning into clinical education. With a little creativity and innovation, you may be able to fashion other approaches that meet your learners’ needs—actors, dancers, musicians, poets, and theater companies are all potential partners.

As long as you engage with the emotional content of the topic, enhance audience participation, and create memorable images, you will be improving the learning experience. Be bold, and watch the expressions on the faces of participants as your CME activity engages both their brains and their emotions, making the learning more effective, and more fun.

Carl Patow, MD, is vice president and executive director of Health-Partners Institute for Medical Education, Bloomington, Minn.; Debra Bryan, MEd, is manager of program development for the Institute.

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