Would you allow an acupuncturist to stick needles in your arm to demonstrate to attendees the technique's effectiveness? That's what one provider did to convince skeptical physicians to pay attention to alternative medicine. You don't have to go that far, but to design successful CME in the 21st century, providers need to take risks with unorthodox topic areas and pay close attention to patients' concerns. Here's more advice from the medical education experts we spoke with about trends in CME.

It's All in the Genes "It's the 'red thread of life' that runs through all of medicine, all of us," says Judith Ribble, RN, PhD, and president of the Institute of Genetics Education of Santa Fe, a content provider for continuing education symposia and Web sites.

Advances in genetics will dramatically alter medical practice, says Ribble, and CME providers in all disciplines must now consider incorporating these developments into programs. But despite the wide applicability of genetics, the subject will be a tough sell to physicians. "I just read a report in the British Medical Journal that basically said doctors are not interested in learning about genetics," Ribble says. "It is a very arcane area, so they think they have to learn all the basic science again."

Ribble suggests providers offer programs specific to their attendees' discipline, such as how genetics applies to neurology or oncology. "Leave the basic science of genetics to CD-ROM content and create programs based on the patients doctors will see in their own offices."

Even if physicians resist tackling genetics, patients will push the issue--by asking questions that doctors can't answer, Ribble says. "For example, some women on birth control pills throw emboli and some don't. Someday, we'll be able to find out who can take birth control pills safely." Doctors will have to keep current on the research.

Commercial supporters will be particularly interested in genetics programs, says Ribble, especially given developments in pharmacogenomics, the pharmacology of the human genome. It involves tailoring drug treatments to specific populations, individuals, or cells. Ten pharmaceutical companies have formed a consortium, and with $45 million in funding from the U.K. Wellcome Trust, they aim to create a public database of human genome markers by 2001.

"These 10 pharmaceutical companies have thrown down the gauntlet to work together," Ribble says, "and they have huge investments in genetic research. These are the companies CME providers should identify."

For more information, visit webserver1.wellcome.ac.uk/en/1/hme.html.

ALTERNATIVE to the Mainstream Physician skepticism about integrative medicine was foremost in his mind when Robert Pyatt Jr., M.D., medical director, radiology department, Chambersburg (Pa.) Hospital, organized the Annual Doctor's Day at Cumberland Valley Health Network several years ago. To gain attendee buy-in, he brought in a well-respected professor as the opening speaker, then broke the program into interactive classrooms.

How interactive? Pyatt volunteered to be the subject--the acupuncturist stuck needles in his arm to illustrate his points; and in the biofeedback session Pyatt played patient again, witnessing how the technique affected his heart rate.

The program was a big success, says Pyatt, and so far, alternative medicine tops the list of requested topics for this October's Annual Doctor's Day. Key to the program's effectiveness was its format, says Pyatt. "The demonstrations with physicians as patients--it's really cool," he says.

In fact, as in other topic areas, it is the real patients who are fueling the demand for CME about alternative medicine. Increasingly, providers are responding, even though accredited integrative medicine programs must be limited to informational, rather than how-to sessions, according to American Medical Association guidelines.

"Most family physicians are inundated with questions from their patients," says Pam Williams, acting assistant director of CME and manager of the CME productions department, American Academy of Family Physicians, Leawood, Kan. "As long as patients are using complementary therapies, the physician has a responsibility to seek education about these therapies."

AAFP will present its first program in alternative medicine in March, so the draw for attendees remains to be seen. But in a needs assessment survey, one-third of respondents selected alternative therapies as a high priority.

Alternative medicine programs may attract alternative exhibitors. Complementary therapies manufacturers expressed great interest in exhibiting at the AAFP program, says Williams, "but since we have little knowledge of these companies, we thought it prudent to exclude product exhibits this year."

Williams adds that pharmaceutical companies did not support the course. Pyatt's experience was different. "If you can guarantee a whole bunch of doctors, (companies) don't care what topic is given to them," he says.

BIOTERRORISM Build Your Defense It sounds like science fiction, but the threat of bioterrorism is very much a reality--no less an institution than Johns Hopkins University has created a Center for Civilian Biodefense Studies. "Quickly, one can see how defensive measures against biological attack are the stuff of routine epidemic management and health protection," says Monica Schoch-Spana, PhD, the center's research associate.

"There is an incredible demand for information on biological weapons," Schoch-Spana says. She helped plan the first National Symposium on Medical and Public Health Response to Bioterrorism held last February in Arlington, Va. The demand exceeded the 950-person capacity at the event, Schoch-Spana says. The second national symposium, scheduled for late this year, will accommodate twice as many participants.

Commercial supporters don't need convincing either, Schoch-Spana says. Industries that have already staked a claim range from pharmaceutical companies involved in antibiotics and vaccines to producers of personnel protective equipment to makers of biodetection devices. For more information, visit the Johns Hopkins Center for Civilian Biodefense Studies on the Web at www.hopkinsbiodefense.org/index.html.

Concerned that physicians may snicker--or worse--if you offer programs about integrative medicine? Robert Pyatt Jr., MD, medical director, radiology department, Chambersburg Hospital, Chambersburg, Pa., shares his strategies for creating a successful CME event about alternative practices:

* Converts, First: Organize a planning committee made up of physicians who are interested in alternative medicine, have referred patients, and have practical examples of how they interact with the alternative medicine community.

* Not on the Fringe: Choose the types of alternative practices that are most accepted by the medical community such as acupuncture, chiropractic therapy, and biofeedback.

* Opinion Leaders: Select presenters who are well known and highly respected; and, preferably, who are physicians as well as practitioners of alternative medicine.

* Put Physicians in the Patient's Seat: Encourage faculty to make the sessions interactive and to demonstrate techniques on attendees.