The crowd waited anxiously as the jury filed into the room to render a verdict. The attorney looked confident, as did the doctor who was on trial over her care of a patient’s wound. Those who had listened to the case—wound care specialists, all—were sure the jury would agree that they should bring in a not-guilty vote. Except no one told that to the jury, which had nary a medical professional on it. “They came in with the exact opposite of what the audience had voted,” says Sharon Baranoski, MSN, RN, CWOCN, president of Wound Care Dynamics Inc., a nurse consultant service in Shorewood, Ill. It was a real eye-opener, she adds. “People were in awe of how good attorneys are at taking what you say and turning it around so they can use it against you.”

Fortunately, this was a mock trial, not a real one, and the setting was a ballroom in the Gaylord Palms Hotel and Convention Center in Orlando instead of an actual court of law. It also was just one of the ways in which the 25th Annual Clinical Symposium on Advances in Skin and Wound Care, produced by Wolters Kluwer Health/Lippincott Williams & Wilkins in September, sought to use a team-based, transdisciplinary approach and innovative educational formats to bring its educational messages home to a diverse group of healthcare professionals who shared the goal of improving wound care.

While examples of large, long-term, expensive, incredibly interesting, and likely very effective CME activities abound in the literature and at CME provider conferences, the thought of trying to take on a similar project can daunting. However, as the Skin and Wound Care conference goes to show, you don’t need a million-dollar educational grant, a detailed performance-improvement process, or plans to improve health at the population level. You just need to provide CME that works.


A Team-based Approach
“When we first started this conference 25 years ago, it was pretty much 100 percent nurses who were interested in wound care,” says Baranoski, who has served as the symposium program director for all of those 25 years. Now, thanks at least in part to the increasing prevalence of diabetes, the profession, and the conference, have evolved to become more multidisiplinary.

The increase in diabetic foot ulcers and related chronic wounds spurred podiatrists to be among the first physician groups to start attending. Now, while more than half of the 2010 participants were in the nursing profession, the range also included physicians, physician assistants, podiatrists, physical therapists and physical therapy assistants, dietitians, healthcare executives and administrators, and researchers. The conference even has invited high-profile patients with compelling stories to tell, such as Ted Kennedy Jr. (the elder son of the late U.S. Sen. Ted Kennedy), who in 1973 had a cancerous leg amputated.

But to call the Wound Conference crowd “multidisciplinary” isn’t quite right, says Richard Salcido, MD, chairman, Department of Physical Medicine, and rehabilitation program director, Physical Medicine and Rehabilitation Residency, University of Pennsylvania Medical School, Philadelphia. “It’s more interactive than just having discrete disciplines coming together for a common purpose,” he says. “I’d call it a transdisciplinary conference where the subject matter crosses the interests of all the disciplines” and participants learn side-by-side as a team, not in separate-but-equal sessions that maintain educational silos for the different disciplines. The sessions instead are labeled as “basic,” “intermediate,” or “advanced,” so people can select the sessions that will be most useful based on where they are in the spectrum of wound care knowledge and practice.

What makes the conference unique, says Salcido, who is also the symposium’s course director, is that “they leave their rank at the door. Everyone’s the same once they walk in—you see physicians and nurses and attorneys and business people all interacting to improve patient care.” In fact, says Baranoski, some of the physicians who participate have become both the greatest learners and the biggest proponents of the importance of the transdisciplinary approach as they see how much they can learn from other team members who spend the most time actually interacting with patients. “They learn from each other, not just the faculty,” she says.

Credits for All
While one of the goals of CME these days is to include a team-based approach to learning, it’s not always easy to get the various team members even to show up, much less play nicely in the same sandbox. One of the ways the wound care conference organizers enticed the different disciplines was by offering CME or CE credits for the many disciplines they hoped to attract.

As an Accreditation Council for CME-accredited provider, Lippincott Continuing Medical Education Institute Inc. can designate the educational activity for AMA PRA Category 1 Credits. The American Nurses Credentialing Center’s Commission on Accreditation also accredits Lippincott Williams & Wilkins as a provider of continuing nursing education, so it can provide nursing credit. The company also applied for continuing-education credits from Temple University School of Podiatric Medicine for podiatrists. For physical therapists and physical therapy assistants, it applied for continuing education course approval from the Georgia, Louisiana, Nevada, and Texas Physical Therapy Examiners and the Florida and Ohio Physical Therapy Associations. Lippincott Williams & Wilkins is a continuing professional education-accredited provider with the Commission on Dietetic Registration and so can offer continuing professional education units to registered dietitians and dietetic technicians. The American Professional Wound Care Association Scientific Committee also approved the program for CME/CE hours in wound care as required to maintain credentialing under its programs.

Another sweetener to the transdisciplinary pot was getting some of the wound care organizations involved. For example, the National Pressure Ulcers Advisory Panel endorsed some of the sessions, and two organizations—APWCA and the American College of Hyperbaric Medicine—offered certification exams immediately following the conference. “The conference becomes a nice way to review for someone who’s going to take the certification exam afterwards,” says Baranoski.

Innovation and Interaction
The planning team made sure that the transdisciplinary approach was built in from the start by ensuring that its planning panel reflected the diversity they wanted in the session rooms. Calling the panel “the key to the success of the program,” Baranoski credits its members for pinpointing hot topics and upcoming leaders within their areas of expertise. “We never pre-determine what we’ll be doing,” she says. “We start with a blank sheet of paper, then we brainstorm on topics and on how we can keep a topic fresh and interesting and make it fit the collaborative model so everyone gets the knowledge they need.”

The mock trial was one of the things that came out of the planning panel, says Baranoski. Legal issues are a perennial topic of interest, but the question was how to present a legal issue in a new way, instead of just providing a basic legal lecture. “We looked at how we can make it a learning tool that will enable [practitioners] to see what the ramifications would be if they were involved in a real case. Once we settled on the mock trial as a format, it was just a matter of finding faculty who would be willing to go out on a limb and help figure out a way to make the audience a part of it.”

While the mock trial may have been the flashiest way the organizers promoted interactivity during the conference, it was by no means the only way. Before the conference officially opened, there was a daylong series of hands-on workshops based on the needs identified in the previous year’s evaluations. After presenting the basics, the faculty members got off the dais and showed how to apply a dressing correctly, or how to offload pressure on a diabetic foot, or how to apply the high-tech skin-substitute dressings. “They broke out into work groups and got to touch and feel and use the different dressing applications and devices,” says Baranoski. Sometimes they practiced on each other and sometimes on artificial limbs that were brought in so participants could learn the appropriate use of available techniques and wraps.

The conference also included simulation labs designed to enhance the psychomotor skills of attendees. This year’s sim model had “every type of wound you could possibly imagine on its body,” says Baranoski. Adds Karen Overstreet, EdD, RPh, FACME, CCMEP, executive director, Lippincott CME Institute, Wolters Kluwer Health Medical Research, Blue Bell, Pa., “I was in the session that followed that lab, and we almost had to chase people out of the room—they didn’t want to take their hands off that model.”

The interactivity wasn’t limited to the Gaylord Palms breakout rooms, either. For the first time, this year’s conference included live-streaming of some sessions to people who couldn’t attend in person; these sessions also are archived for on-demand learning. And the conference also brought in live content from its content leaders’ clinics, where the healthcare provider and patient in the clinical setting could interact with the conference attendees, who could also comment on what they saw and heard. Says Baranoski, “There may be a procedure you’ve heard about, like an endovascular procedure, that you’ve never seen done. We broadcast live endovascular procedures so people could actually see what patients go through and what doctors have to do during these procedures as they happen.”

Sometimes, instead of the latest technology, organizers used simple tools to engage the audience. Overstreet says that the mock trial and several other sessions engaged the audience with nothing more sophisticated than different colored cards staffers handed out as people entered the sessions. Throughout the sessions, people would vote by holding up a red or blue or yellow card, then look around to see how their responses fit with the rest of the room. “It’s a very cost-effective way for learners to benchmark their perspectives against those of their peers,” says Overstreet.

Diversity in Outcomes
“It’s difficult to measure the outcomes when you have such a transdisciplinary group,” Overstreet points out. “We have to set very broad goals for the conference and have individuals think for themselves how they will apply what they learned to their own practice.” In addition to an on-site evaluation, organizers planned to follow up with an outcomes survey a month after the conference. To get to the goal of measuring a change in the healthcare provider’s competency and/or performance, among the questions the survey will ask is how many of the participants’ patients have benefited from what they learned at the symposium. It also will ask them to give an example of a strategy they learned at the conference that they have put into practice. (Results were not available at press time.)

For the first time, this year the organizers also conducted on-site interviews with learners to find out what were the most important things they learned, says Overstreet. “They expressed a real diversity in their outcomes,” she says. “Some focused on the legal and regulatory aspects, others on research, and others on building their wound-care team.”

The transdisciplinary nature of the symposium will continue to grow in importance as the field of wound care continues to evolve. Salcido says that the robotic procedures now being used for abdominal and cardiovascular surgery are leaving smaller wounds in patients, for example, but the problems underlying those wounds could still be big. “There’s going to have to be more communication from the doctors in the OR to let the practitioners who take care of the patient on the ward know what procedures were done and what complications could arise,” he says. In addition, says Overstreet, physical therapists don’t always know what new implants and devices are being inserted surgically into a patient.

“The interdisciplinary communication is only going to become more important as biomedical science continues to expand,” she says, adding that the conference organizers will continue to work to find new ways to enhance that communication.

Sidebar: How Did They Do?
Participants who said the content was practical, relevant, and appropriately evidence-based: 97%

Participants who stated that attending the conference will improve their skill/judgment: 93%

Participants who said they learned interactively from faculty and other participants: 99%

Source: ASWC 2010 Evaluation Data

Sidebar: Flooded Out
The floods that hit Nashville this spring also caused a bit of a ripple in the plans of the 25th Annual Clinical Symposium on Advances in Skin and Wound Care, which was scheduled to be held in September at the Gaylord Opryland. Unfortunately, while much of the city recovered by the end of May, the Gaylord Opryland was knocked out of commission until November. “Mother Nature told us that we weren’t going to Opryland after all,” says Sharon Baranoski, MSN, RN, CWOCN, president of Wound Care Dynamics Inc. and the conference’s program director.

The conference organizers were faced with finding a facility that could accommodate hundreds of exhibitors and had a general session room that could hold 1,000. Thanks to the Gaylord national staff, the organizers were able to shift their program in its entirety to the Gaylord Palms Hotel and Convention Center in Orlando. “We didn’t have to change the dates, or the program, or the faculty—every person we had invited to speak could still come,” says Baranoski.

More Case Studies of Innovative, Effective CME Activities:

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