As the main ballroom fills up at the annual medical society meeting, attendees—facing the front in homage to the great screens—wait patiently, rifling through their syllabi and scrolling through e-mails on their smartphones. Anticipation builds until the room finally darkens and the experts begin sharing their latest basic science or clinical data. In an hour, the lights go back on, and the attendees file out to their next activity.
Of the thousands attending the annual meeting, how many were actually in the room for that presentation? Of those in the room, how many immediately understand the impact of the new findings? And how many of those are in a position to make the changes needed to put that new knowledge to work once they return to the clinic? And what about the hundreds of thousands of healthcare professionals who weren’t in room—how will they learn about the new data? How will they find its relevance to their practice setting? And how will they find the resources to integrate these new data into practice?
What Happens When an Annual Medical Meeting Ends?
We can no longer wait the years it may take for that data to trickle down from the annual meeting into standard practice—quality healthcare care is too important to have to rely on the vagaries of the natural flow of information. And we need to find ways to ensure that the new types of medical data and information we are introducing (comparative effectiveness, individualized genomics, patient-reported outcomes, etc.) don’t overwhelm our existing systems for sharing and disseminating new medical information.
Instead of relying on a natural flow of information from annual meetings, what if we could engineer an “aqueduct system” of medical information sharing? One that could be controlled, accelerated, and prioritized as needed? What if we could engineer the flow of medical information to ensure it was timely, widely available, and responsive to local needs?
What Is the Current State of Information Flow?
Let’s look at how new medical information is now being disseminated, where the system tends to fail, and how a newly engineered system can more effectively and efficiently meet the needs of the medical and CME communities.
Post-meeting information flow
Traditional Media Coverage— From the headlines of USA Today, to the breaking CNN (and CNBC) coverage from the floor of the Annual Meeting, the “news” of the societal (and financial) impact of new medical data often makes it to the general population much faster than it is shared throughout the medical community. Within hours, new information may be printed off the CNN Web site and carried into the office of an unsuspecting healthcare professional by a newly “empowered” patient. Unfortunately, what the traditional media chooses to cover and how they choose to cover it rarely has any relevance to a local care setting or to an individual patient. Nonetheless, for many HCPs the first word from the Annual Meeting may come, either directly or indirectly, from media outlets.
Expert Invited to Lecture Locally (Reactive)—Driving home, Dr. A hears about the new data on the radio, finds the data compelling, and wants to know more. Since she is in charge of her hospital’s grand rounds program, she invites one of the experts to give the same presentation from the meeting on the earliest date possible, which happens to be several months later. Dr. A doesn’t offer information on the local situation surrounding this condition, and the expert doesn’t ask. The topic may have no relevance to the actual needs of the institution, but having the visiting expert does allow for local clinicians to ask some of their pressing questions—if they feel comfortable doing so in the public setting.
Attendees of National Meetings Report Back Locally (Reactive)—Dr. B hears the same radio broadcast and decides he had better provide a summary to his colleagues of what he learned at the Annual Meeting. He delegates local clinicians who attended with him to give talks that highlight ”best of” lessons. He includes what was in the media even though he didn’t think it was the most important lesson learned. The speakers have a few weeks to create talks from memory or from content they find online. They are rarely experts in the new data, but they are familiar with local practices and this may provide a local context or flavor to the presentations. The local speakers may not have all the answers, but the live meeting allows for an extended discussion of local relevance.
Attendees Proactively Plan Reporting—Dr. C, as part of the CME quality committee, knows there are significant problems with patients in his practice setting and that the Annual Meeting on the topic is coming up. So, two to three months before the Annual Meeting, the education planning committee meets with the quality departments and begins planning and prioritizing local needs that may be addressed at the Annual Meeting. Attendees are then tasked with collecting, curating, and interpreting new information, or new data on which to base factual presentations. These “reporters,” who have a few weeks to create talks from their notes and on-site conversations, can hold a productive conversation about the local impact of these lessons.
Society Web Site/Repurposed Content—Session in Full.
Dr. D, who works in a rural area, is proficient at making the most of distance learning because she can’t afford the time or money involved in attending the Annual Meeting. She becomes aware of the new data from an e-mail blast and subsequently goes directly to the association’s Web site. The organizers of the Annual Meeting captured the presentations and immediately archived them as slides synced with audio. Because Dr. D can’t ask questions, she isn’t sure exactly how to apply the new data to her patients’ situation, but she knows about it now and continues to contemplate how to incorporate it into her practice. While on the site, she sees other sessions that look interesting and notes them for later reference.
Society Web Site/Repurposed Content—Integrated Into Learning Portfolio. In the days that follow the Annual Meeting, Dr. E expresses frustration about his challenging patients to a colleague in the cafeteria. His colleague, who was unable to attend, suggests he could get more insight on the topic from the association Web site. He promptly forgets the conversation until he runs into another challenging patient 30 days later. Searching the site, he finds he can watch all 35 hours of the meeting, but he only has 30 minutes before his next patient, so he gives up.
Luckily, the meeting organizers decided long before the event to ensure that the lessons from the meeting were captured and integrated in their associations’ online learning portal. Over the following weeks and months, the organizers systematically interpret the captured sessions and edit them to be more engaging and interactive. Individual learners can customize their learning experience so they can find answers more quickly—when questions are discreet—and the organizer makes an effort to make the more available to answer questions and interact individually. All lessons and interactions are archived in a portfolio manner to support life-long learning. However, it takes four to six months and thousands of dollars to get this format up online. A friend of Dr. E eventually forwards an e-mail link to these activities, and he uses them to figure out how to approach his patients more effectively.
Non-traditional Media Coverage—Bloggers. After returning to her hotel room each night at the Annual Meeting, Dr. F writes down what she found to be the most important data and why, and she posts it to her blog from her iPad. Her nontraditional media reach is far smaller than traditional media, but her readers are an engaged and interested audience. The commentary is lively and continues over time, giving time for reflection.
The impact of this nontraditional coverage is increasingly becoming similar to that of traditional media coverage and, in clinical areas with a highly empowered blogger community, may be the most credible source of new medical information and data. What the nontraditional media chooses to cover and how they choose to cover it may have little relevance to a local care setting or to an individual patient; nonetheless, for many HCPs, the first word from the Annual Meeting may come, either directly or indirectly, from the coverage of these outlets. One advantage of nontraditional coverage is that the blogger herself is more likely to be willing to engage in a discussion and HCPs may reach out directly to the source if they have questions.
“Best of” Volumes/Editorials in Print or Web—Six months after the Annual Meeting while waiting for his next flight, Dr. G runs across an editorial summarizing the information in his favorite peer-reviewed medical journal. End of story; that's all the information he ever gets on the topic. Whether crafted by the experts themselves, journal editors, or medical writers, the buzz at the Annual Meeting is rehashed in a new format. The local impact of these lessons is unknown to the authors, and it is up to the individual readers/participants to make sense of the lessons as they relate to their own situation and circumstances. These activities do not allow any interactivity, and participants have no opportunity to ask questions that may be unique to their experience or local setting.
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Web-Based Third-Party “Coverage”—Throughout the Annual Meeting, Dr. H receives the daily conference coverage e-mail from Medscape and/or MedpageToday alerting him to a 500-word review of the hot topics from the prior day’s sessions. The content is timely and often is written by a medical writer/journalist who was at the meeting and may have interviewed the presenting faculty. The writer has no understanding of Dr. H's local practice or patients. The content is readily available but there is no outlet for the questions that Dr. H has so he is forced to jot them down to ask a colleague in the coming days or to search for the answers through other available channels—but quite often the questions go unanswered.
Web-Based Third-Party Educational Programs—Dr. I receives an e-mail three months after the Annual Meeting that a new series of webinars and roundtable videos are available on a Web site that she has used before for CME. The content appears to be driven by the hot topics of the latest Annual Meeting, but a few of the topics seem relevant to her practice and several of the faculty members she recognizes as leading experts. Given that she is one of only three docs in her practice, Dr. I appreciates the ability to participate in the education at a convenient time and place, and she looks forward to learning from these national experts. But while participating in the online education, she realizes that very little of the content is actually relevant to her setting and she finds the “talking head” webinars to be less than engaging. All is not lost, and while on the site she stumbles across several case-based programs that offer some more practical lessons and she makes a note to inform her partners about them. In the end, Dr. I finds content that seems relevant, but she is still unable to engage in a conversation about how to integrate these lessons into her practice.
‘Best of’ Society Regional Meeting Series—Dr. J receives a brochure in the mail three months after the Annual Meeting inviting her to attend a two-day “Best of” meeting at a fancy hotel in a nearby major city. Dr. J is unable to take the time out to travel to the Annual Meeting, but she is willing to spend her weekend to catch up on the information she missed. While the agenda is very much scaled back from the Annual Meeting, the topics seem comprehensive and she looks forward to two days of engaging with her regional colleagues and the faculty.
The society is able to leverage the educational planning committee from the Annual Meeting to plan the regional series effectively, and the faculty will be presenting their own data and participating in roundtable and town-hall–like discussions. The topics were predetermined at the time the Annual Meeting was planned, so it will up to Dr J to figure out the local relevance of the data.
Live Third-Party Educational Series—Dr. K receives another brochure in the mail three months after the Annual Meeting, this time inviting her to attend a half-day “Best of” meeting at another fancy hotel in a nearby major city. The organization that is putting on this live meeting has worked with many of the faculty that presented the newest research and is working with countless other high-profile physicians to provide a high-quality program. However, much if not all of the content has to be re-created from scratch since the society has not endorsed this meeting. Tens of thousands of dollars and hundreds of hours are wasted creating new presentations, new brochures, and new meeting materials. But, in many ways, Dr. K has lucked out that a meeting is available so close to her hometown. By attending the regional meeting she will save time and money and she will still have an opportunity to interact with peers and faculty.
Synchronous Release of Embargoed Primary Publication—Dr. L has set up a number of reminders and RSS feeds with many of the top medical journals in his field, and on the morning of the first plenary session at the Annual Meeting he receives an e-mail that one journal is releasing a full publication of one of the most important datasets to be presented. Since Dr. L is unable to attend the Annual Meeting, this alert and publication gives him simultaneous access to the data. Throughout the Annual Meeting he receives two similar e-mails. The publications present much more information than is even being presented at the Annual Meeting, but Dr. L has no access to the authors, the publication fails to provide any context or relevance to his practice, and he quickly realizes that he has access to only three publications out of the hundreds of Annual Meeting presentations. How can he learn about all the other new medical data?
Abstract/Proceeding Books and/or Indexed Abstracts (Pubmed)—In the weeks leading up to the Annual Meeting, Dr. M receives an alert that the abstracts are now available online— Dr. M appreciates the opportunity to do some homework beforehand. The online searchable abstracts, much like the abstract booklets handed out on location, offer a snapshot of the information to be presented. But Dr. M quickly becomes frustrated by how limited the information is. There is very little context to the research, little insight into the methodology, and even less discussion about the practical relevance of the findings. Dr M makes a note to attend a few sessions (though many are concurrent) and several poster sessions, hoping to find out enough about the research to determine its relevance to his setting. He is struck that so much information that is included in the oral presentations and posters is not shared with HCPs who are unable to attend the Annual Meeting.
Word of Mouth—Dr. N drew the short stick and is unable to attend the Annual Meeting, having to cover hospital service instead. She looks forward to being able to pick her colleagues’ brains over a few cups of coffee. Dr. N recognizes that this is not the most efficient way to learn and she realizes she will have to supplement her learning with a variety of other sources (described above). Learning through word of mouth allows Dr. N to have deeper and more prolonged conversation than she would have had with the faculty at the Annual Meeting, but there is no telling how much detail her colleagues can provide, or remember. In the end, she realizes that this is certainly no way to stay up-to-date and she finds her practice changes minimally, given these conversations.
Social Media ”Coverage”—Dr. O has set up a few professional social media accounts both within restricted professional communities such as Medtrust online or Medscape’s Physicians Connect, but also on open applications such as Twitter and Google Plus. So when it comes time for the Annual Meeting, he has access to a new set of resources for learning, even though he is unable to attend. By following the hashtag for the Annual Meeting, he is able to sneak a peek into the new data from the Annual Meeting and he is able to engage in real-time virtual conversations. Dr. O recognizes that it is tough to get detailed information through these channels, but he also learns that there are many trusted voices among the attendees, and these individuals are curating information, providing critical feedback, and are able to relay questions as they arise through the social media channels to faculty. But in the end, very little information is organized and the social media community is forced to establish their own
signal/noise tolerance level.
(Download a PDF worksheet that compares all the knowledge stream channels so you can rate them for yourself.)
Creating a Better Information Flow
For some in the medical community, the frustrations and the inadequacies of the system described above are glaring, and many have begun to engineer their own personal workarounds But homegrown efforts and small peripheral technology solutions aren’t going to fix the inefficiencies and failures of the current knowledge stream.
While "need" and "education" are defined locally, an efficient flow of new medical information into practice requires a re-engineering of the very system of data collection, review, publishing, and subsequent dissemination and education. This means the central players in the medical community—the societies, associations, research institutions, and educational providers—must evolve as well, embracing the parallel movements of rapid-learning healthcare systems and social learning.
This is what is needed to make that happen:
- Data that are presented at annual meetings must be curated more effectively.
- Societies/associations must develop clearinghouse models that enable rapid and open access to new medical information. The education community must avoid wasteful redundancy and develop solutions that instead accelerate knowledge flow.
- Investigators/authors should be obligated to shepherd their new data for a period of time to ensure that questions are answered, limitations discussed, and follow-up research questions can be proposed. These discussions must be public, so learners can put the information in context and make it relevant to their local setting. This means that social learning models and the emergence of new social technologies will likely have a huge impact on how this “aqueduct” system evolves.
- Technology should be woven into the model such that community educational providers can pull the new medical information into their networks. These tools must be engineered to overcome knowledge silos—the community providers cultivate their own crops and take ownership of the local needs for information.
- Local educational providers and learners must stream their feedback into the clearinghouse system so it can assess how the new medical information was received and ensure that best practices in knowledge transfer are being shared.
Every system is designed to achieve the results that it yields. To get different results, the system must be changed.
Some may object to the re-engineering. Some may contest the change in the status quo. But this cannot be about business interests, copyright, or membership value propositions—three challenges that are valid, but can be practically and intelligently addressed though parallel innovation. This re-engineering is first and foremost about improving the flow of medical information.
Brian S. McGowan, PhD, has dedicated the past 12 years to medical education as a faculty member, mentor, accredited provider, and commercial supporter. Contact him via Twitter: @BrianSMcGowan.
Jennifer Spear Smith, PhD, is chief learning officer at the continuing medical education company MedEdRules LLC. Contact her at email@example.com.
The opinions expressed are those of the authors and do not represent the views of their past, present, or future employers.