The concept of “one size fits all” may work for T-shirts, but when it comes to continuing medical education, the model developed back when physicians were almost exclusively white males may chafe a bit with today's changing demographic of healthcare professionals.

According to data from the Association of American Medical Colleges, almost half of the 2002 medical school applicants were female. But are CME professionals adapting CME to meet the needs of women physicians? MM partnered with the research team at the University of North Texas Health Science Center, Professional and Continuing Education, and, with partial support from the Eli Lilly and Co. Office of CME, embarked on a journey to find out.

We developed a questionnaire to discover logistical and learning preferences of male and female physicians, which we mailed to 30,000 male and female physicians across the United States. (For more on the methodology, see page 27.) Here's what today's physicians said they want in a CME program. (To view the data charts, including data that was not included in the print version of the article, click here.)

Generation gap

The survey respondents reflected the trend noted by AAMC — there were almost three times as many female physicians under 35 years of age as there were males, and almost three times as many males over the age of 55 as there were females. Seventy-two percent of the male respondents were in the general boomer range; just 4 percent were in the under-35 category. Almost 56 percent of the female respondents were under the age of 45. Correspondingly, more than 50 percent of the men had been in clinical practice for more than 20 years, with the next largest group — in practice for 11 to 20 years — coming in second at 29.2 percent. Almost 20 percent of the women had less than five years in practice; only 17.9 percent said they'd been in practice for 20 or more years.

Kid stuff

While on average the men had a slightly higher number of dependents (3.72, versus 3.25 for women), the men also spent fewer hours per week taking primary responsibility for the kids and other dependents, with 18.5 percent spending zero to five hours per week, and only 11.9 percent spending more than 15 hours per week. Not surprisingly, the women told a different story, with 44.4 percent spending more than 15 hours per week taking care of children, and only 6.5 percent spending five hours a week or less on kid duty.

So it follows that almost a quarter of the women checked “inability to arrange child care at home” as the biggest obstacle to attending out-of-town CME, as compared to just over 8 percent for the guys. More than 15 percent of women also cited the lack of available child care at conferences as a big obstacle, more than double the number of men. But while family obligations were more of a hold-back for women, both genders said time away from the office was the biggest barrier to attending out-of-town meetings: 77.7 percent of men, and 70.1 percent of women.

Still, both men and women seem to think it worth the time to attend out-of-town events, with 71.3 percent of men and 69.5 percent of women obtaining more than 12 hours of formal CME that required overnight travel in the past two years. Sixty-five percent of men and 56 percent of women also attended more than 12 hours of local CME activities in the past two years.

As one would expect, as the number of dependents increased, both male and female respondents were significantly more inclined to attend a CME event being held at a vacation destination for families, and those that included family-friendly activities. Men with no dependents said the recommendation of a friend or colleague and the opportunity to network are significant factors in deciding to attend a CME activity. As the number of dependents rose, both genders cited an increase in the importance of scheduled free time to spend with family, and that of having reduced rates for spa services, tennis, and golf lessons.

His and her conference priorities

While men and women both checked relevance of the clinical topics to their practices as their No. 1 reason to attend out-of-town meetings in the past two years — and the appeal of the meeting's location ranked second for both — women voted the importance of an interesting keynote speaker to be in their top five reasons to attend, while men ranked it seventh.

Men and women both showed a balance of family and professional responsibilities in ranking what would be important factors in their decisions to attend future out-of-town CME activities, with “large number of credits offered” coming in first for both, and scheduled free time to spend with family taking second place. But then the genders diverged, with females placing patient demand for the information in third place (it came in sixth for men). While both men and women placed “recommendation of friend or colleague fourth, the fifth most important factor for women was meals and events that include families, whereas men placed reduced rates for activities such as spa services, tennis, and golf lessons fifth (women knocked that factor back to 11th place).

For local meetings that do not require an overnight stay, men put more importance on family-friendly activities. Women, however, ranked close proximity to friends and family, interest in the keynote speaker, the ethnic diversity of presenters, the relevance of the topic to their practice, and networking opportunities during breaks as more important.

Find the right format

A quick skip through the literature — and everyday observation — makes it clear that there are some differences in how men and women learn. For example, research tends to indicate that lecture formats are not very productive for women because the male-based learning structure doesn't suit the more intuitive, interpersonal way women are socialized to acquire knowledge. (See companion article, beginning on page 28.)

But docs must be different. Maybe it's all those years of med school that have acclimated them to the traditional teaching style, but the women participating in this survey didn't seem to have a problem with traditional teaching methods. When asked how they prefer to receive clinical information, men and women both placed the lecture format second (37.7 percent and 37.5 percent, respectively). Pictures, diagrams, graphs, and charts were at the top of both genders' lists as a preferred learning method, but an overwhelming 21.6 percent of men preferred a text format, compared to just 0.6 percent for women. Both genders said that having a case-based format and interactive presentations was high on their lists of important factors when choosing to attend a local meeting. Women also showed a slight preference over men for case-based, hands-on, problem-solving formats, but both genders overwhelmingly prefer an activity that provides a combination of formats to convey clinical information: 63.7 percent of the men and 62.9 percent of the women said this was the preferred method.

And while the women showed a slightly higher inclination to make practice changes based on informal discussion with peers at a formal CME activity than their male counterparts, they didn't differ from their male colleagues in ranking new data presented at the activity as the top motivator to alter behavior. Both men and women said a combination of the two was most likely to inspire them to make changes in their practice.

The literature also would lead one to believe that women place a higher emphasis on the gender of the speakers than do men — and they do, but not by much. On a scale of 1 to 5, women placed the importance of the gender of the speaker at local programs at 2.72, as opposed to 2.57 for men; for out-of-town meetings, the importance for both falls to 1.11 for men, 1.14 for women.

Ranking commercial supporters

Interestingly, women place twice as much value as men do on a commercial supporter's history of supporting women's health topics, while neither seemed much interested in the company's history of supporting men's health topics. The most important factor for both was the quality of that supporter's past activities, and the company's reputation for supporting objective, high-quality education. Men ranked a positive relationship with the sales force higher in importance than did women, where women ranked a company's community-based philanthropy higher.

Closing the gender gap

It appears from the results of this survey that the more things change, the more they stay the same, particularly regarding women continuing to balance their roles as the main caretakers for dependents and their professional education requirements.

But this could be changing. While women with more than one dependent still ranked child care, family-inclusive meals, and the availability of kiddie programs higher than did their male counterparts across the board as important factors in deciding to attend future CME activities, men with just one dependent actually ranked these factors higher than did women with just one dependent. And the availability of child care at out-of-town meetings, which stayed virtually the same in importance for women regardless of their age, increased steadily as the age range fell for men, with the under-35 males actually placing more importance on the availability of child care than did the under-35 women. The youngest categories of male physicians also ranked meals that include family members and scheduled free time to spend with family higher than did their female counterparts. And the younger the male respondents, the closer their preferences were for the small-group, case-based, more interactive activities that women of all ages say they prefer.

So if you want to attract the next generation of male physicians as well as female docs of all ages, the time to start making some changes in those traditionally formatted, family-unfriendly meetings is now.

Methodology

The survey was distributed to 30,000 practicing physicians across the United States in geographically diverse areas. The mailing list was split by gender into two equal groups. Respondents returned the survey by postage-paid envelope. The number of completed surveys was 1, 792, representing a 6 percent rate of return.

The cover letter that accompanied the survey emphasized that subject's participation and responses were completely voluntary and anonymous. No subject identifiers appeared on the survey instrument or postage-paid return envelope.

Meeting on Venus and Mars

Many CME providers MM informally surveyed when we first started examining this issue two years ago were adamant that it really doesn't matter what gender participants are. They're all docs, and they're all coming to learn the same thing. And, they added, isn't it, well, a little insulting to insinuate that women might have “special needs” when it comes to CME?

While we all live and work in the same world, men and women often experience that world differently. Gender preferences and subtle and overt discrimination impacts everything from the choice of specialty or healthcare segment — more than 90 percent of nurses are female, while males still dominate specialties such as neurosurgery — to the amount of time available for a practice due to family responsibilities.

And while gender is just one of many factors that influence how adults learn, “you can't ignore the fact that gender still plays a huge role in all of our lives, and so of course it has implications for continuing education,” says Elisabeth Hayes, EdD, professor, Department of Curriculum and Instruction, University of Wisconsin-Madison, and co-author of Women as Learners: The Significance of Gender in Adult Learning. “Providing information to keep physicians up-to-date in their field is important, and if you just focus on that, it's easy to dismiss the differences between genders. But what we need to do for medical professionals — and all adult learners — is to think about how their professional and educational choices are shaped by either conforming to or resisting gender stereotypes that exist in this culture. Those choices are going to present different challenges for them, both in their learning and in their actual practices.”

The Meetings Gap

Men and women approach meetings differently, says Pat Heim, CEO of The Heim Group, Pacific Palisades, Calif., and author of four books on gender in the workplace. “I'm looking at the schedules of a hospital administrators conference (attended mostly by males) and a nursing administrators conference (attended mostly by females). The nursing conference has pre-registration at 7:30 a.m., starts the meeting at 8 and runs straight until lunch, breaks for an hour, then goes straight until 5 p.m. The hospital administrators conference starts at 9:30 a.m., breaks for a two-hour lunch, then breaks again in the afternoon for golf, followed by an evening cocktail party.”

The scheduling difference is because men tend to hold their “real” meetings before the meeting, during breaks, and after the meeting, she says. “Women tend to hold their meetings during the meetings and find that other stuff a waste of time. Women tend to think that doing a good job and working hard is going to get them ahead. Au contraire!” Heim jokes. “If they're working with men, they better learn to play golf.” Or at least recognize that that's where the real meeting is happening. She tells of one woman, the only female member of a medical association's board of directors, who followed her male colleagues into the men's room during a break, saying, “You're not going to continue the meeting without me!” “It scared them,” says Heim. “They still talked years later about how they'd better not talk in the men's room because she might come in.”

The activities planned around meetings also benefit the male form of relationship-building, which tends to be “side-by-side,” says Heim. “Women don't need activities to build relationships — all they need is two chairs. Women do need to talk with their peers and compare work practices, but not in formal activities like golf.”

Separate but Equal Education?

One possible solution to the educational gender gap is to hold meetings with all-male and all-female participants, something that's proven to work well at the undergraduate level. “Even if you try to get men and women together to talk about gender issues or disadvantages women face, if there's a sympathetic man in the room, he winds up doing most of the talking, and the women walk on glass to avoid offending him. It's the strangest thing,” says Hayes, who adds that the idea of women-only and men-only sessions could be positive, depending on how it's handled.

Heim also thinks providing one-gender-only programming is a good idea, but one that may not fly with participants. “They might say, ‘Whoa, what's going on here?’” she says. “People become suspicious, even if you're trying to do something that ultimately will help them learn more effectively.”

Even if you don't want to be that radical, one thing CME providers can do is include females speakers. “Identity issues, while seldom spoken about explicitly, are important in professional education,” says Hayes. “Part of what we're doing is helping people develop a certain sense of themselves as people within their professions. If you have an old white male lecturing to young females, they're certainly not getting a model of someone who's like them and who's knowledgeable and has expertise. It makes it less likely that participants will be able to think of themselves in that type of position without some dissonance,” she adds. “There need to be opportunities for women to explore the type of identity they want to develop for themselves in their chosen field.”

But, providers say, female attendees don't complain about an all-male lineup. In fact, no one even seems to notice the gender of speakers. “People don't notice it because it's always been that way,” says Heim, just as they don't complain about the lecture format because they haven't experienced other types of learning. And including female speakers can be tricky. Hayes says, “One thing we know is that female professors get different responses from students than men do. As women, we're supposed to be caring and nurturing, and if you don't act that way, students respond negatively. When men act arrogantly, students often just think they're smart.”

Marketing to a Mixed Crowd

According to the survey results, here are some suggestions on how to market more effectively to female — and male — physicians.

  • Since the No. 1 barrier for female physicians to attending out-of-town CME is the inability to arrange child care at home, find ways to make it easier for attendees to bring their children to the conference.

    Make it more affordable by choosing a central site that more attendees can drive to so they don't have to purchase airfare for their families.

    While your organization may not want to provide child care due to liability and insurance concerns, you can negotiate special rates and inform potential participants about options that are available at the meeting location.

    If possible, develop special children's programs in addition to other guest activities.

    Encourage families to attend by offering extended conference hotel/resort rates pre- and post-conference.

    Choose sites that are appealing to other family members, and/or are good family vacation destinations. Be sure to play up the family-friendly attractions of the area in your marketing materials.

    Include — and point out in your brochures — scheduled free time participants can spend with family (or on their own).

    While the PhRMA Code precludes commercial supporters from paying for family meals, try to negotiate a reduced rate for family member meals — and let attendees know if you can offer cheap eats for the kids.

  • If you are able to secure reduced rates for the spa or local sporting activities, inform attendees ahead of time.

  • Tell attendees about any planned case-based, interactive, and participatory sessions.

  • Include testimonials from well-known men and women who have attended your past activities.

  • Ensure that at least some of your speakers are top females in their fields.

  • If your commercial supporter has a history of supporting women's health topics, find a way to highlight that information.

  • Consider adding a demographic question (gender) on all needs assessments and/or evaluations to track trends in responses according to gender — much as you do according to speciality or professional designation.

  • Last, but by no means least: Make sure your content is so compelling that it's worth the time they'll have to spend away from their practices.