Healthy Skepticism Library item: 19793

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Electronic Source

Olohan J
Medical education: Part 3
PMLive.com 2005 July 27
www.pmlive.com

Full text:

Knowing the basics is the first step but in order to create and implement effective medical education programmes you need to know some tricks of the trade.
Medical education is only effective if it truly results in the recipient learning new skill(s) or priniciple(s), which then change their habitual practise. An accurate definition of education in the context of medicine is: to improve or develop (a person, judgement, skills) and to train for some particular purpose or occupation.
Medical education and the pharmaceutical industry support has received a barrage of bad press recently, largely, fueled by a promotional communication programmes being presented, or misinterpreted, as ‘education’ for healthcare professionals.
With the continuous pace of NHS change – the new primary and secondary care service contracts, nurse prescribing, re-accreditation and personal development plans, to name but a few – there is now a greater need for disease-, treatment-, organisation- and skills-based ‘healthcare’ education than ever before. Alongside this, there is a limited amount of NHS-funded training available.
However, for industry-supported medical education to attain and sustain credibility and value with the healthcare community in the future, both industry and healthcare professionals have to understand its correct role in the communications mix.
The NHS and individual healthcare professionals across a range of disciplines will be seeking to ‘learn’ with rational investment of time and funding. The pharmaceutical industry remains an ideal partner to deliver education that is highly relevant, personalised to individuals’ needs (as far as possible) and balanced.
Crucially, education is not selling or promotion, it should result in learning – a demonstratable and measurable change in practise resulting from an experience.

Developing the plot

Working with opinion leaders

Like a gripping plot in a novel, a medical education programme – discreet or wide-reaching – needs to have a defined beginning, middle and end, and tell a story. The most common reasons for industry-supported medical education are: *the need to communicate new data or new clinical practise in an established disease area or treatment regimen *supporting the entrance into a disease area of a new development or the launch of a new therapeutic option

To be effective, educational activities must form part of an integrated communications strategy. Tactically, this might mean a satellite symposium at a major congress with follow-up activities which complement other activities as part of the marketing mix – meeting reports, web-based summaries, media activities and so on.

Alternatively, your activities may be as far-reaching as a five-year education programme on a new disease area, involving a sequence of projects planned on an annual basis. However big or small, at the heart of all high-value medical education must be a core group of opinion leaders that: *understand the need to teach something new *believes in the purpose of the initiative *is passionate and committed to spreading the word to the relevant audiences

Irrespective of the circumstances in which you are working, the critical and immediate first step must be to involve your key opinion leaders in developing and testing your concept and outline plan. This concept and rationale testing for a programme of education activities can be implemented through small consultation groups of mixed or same disciplines, one-to-one meetings or larger group consultations.

Take the advice of opinion leaders on what they feel would be the best route. Such advice from opinion leaders is absolutely critical to the process. It is imperative to discuss strategies and activities that will suit the learning environment of the recipients.

It may be that during the first consultation process some opinion leaders decide not to continue taking part, but it is important to understand their views and reasons, and to take these into consideration when developing the programme.

The term ‘key opinion leader’ is an old but commonly used one – it is too often used to mean someone who ‘advocates’ a product. However, the accurate definition of an opinion leader is somebody well-recognised and respected within their immediate or extended community for their experience and expertise in their relevant field.

He or she will be highly motivated to challenge and change current healthcare or medical practice, based on new evidence. Remember, a true opinion leader will be naturally concerned about protecting his or her reputation and your relationship with them will be irreparably damaged if they are misrepresented as product advocates.

Effective medical education, supported by opinion leaders, should mean that specific product messages are communicated in the right context and in a balanced manner.

Plots and subplots

Integrating elements of the mix

With the growth of medical education, a set of traditional, tried and tested approaches have evolved and become established, albeit with ever increasing degrees of creativity and success. The escalating use of Information Management & Technology (IM&T) by the healthcare profession plus the NHS’ own commitment to IM&T leaves the door wide open to significantly extend expertise and creativity into different spheres.

The total budget for IM&T in the NHS for 2003-4 is £2bn compared to a paltry £317m in 2002-3. Standard computerisation of general practises is now almost universal.

Department of Health statistics show that 98 per cent of GP practises are connected to NHSnet. Although computing had been treated as a management overhead in secondary care, in 2001 this all changed and figures from May 2002 show that 76 per cent of consultants had access to NHSnet for email and browsing. In short, IT should clearly be a regular route to deliver education.

Due to the time constraints imposed by the new NHS changes on busy healthcare professionals, education providers need to strive to make their programmes as appealing, attractive and, above all, valued by the recipient as possible.

Content needs to develop an even greater focus on national guidelines and standards being driven by Health Departments. Your programmes should always acknowledge, complement or indeed challenge, if necessary, national policies and directives.

With the advent of NICE guidelines across numerous disease areas and the National Service Frameworks, healthcare professionals have welcomed quick, easy to follow education, which helps them to deliver on their own local targets and which add to their career development. This should continue.

Already, healthcare professionals across all disciplines are becoming less concerned with possessing a comprehensive manual or an encyclopedia for a given disease area. However, never jeopardise quality in reducing quantity – healthcare professionals need concise, digestible resources, tailored and relevant to their individual needs, day-to-day practise and working environment.

Above all, education needs to be highly accessible. Learning, on the job will become ever more critical as the new NHS gathers momentum. However, this doesn’t mean we should disregard the slide kits (now in the essential CD-ROM format), the disease backgrounders, master class meetings and distance-learning programmes, in favour of solely IT-based packages. Far from it.

There are always going to be those who prefer to read a hard copy of a clinical paper rather than scan it on the internet after a hard day’s work in front of a computer. As education providers we must establish an integrated combination of traditional and innovative approaches that continue to build on the traditional methods, share best practise and deliver relevant content.

Educationalists are correct when they say that learning should be enjoyable and fun! These days too, it is almost a prerequisite for it to be interactive. We need to continuously understand and respond to the learning objectives of the recipient and what they will gain from the ‘learning event’.

Marrying this with your objectives will ensure the ideal mix of elements within the programme and generate that all-important change in practise.

A gripping read

Getting your message over effectively

Successful education programmes, involving committed and passionate opinion leaders and a range of planned and sustained activities, will undoubtedly gather their own momentum over time. As in all fields, success breeds success. A well-used concept has been ‘train-the-trainer’ or ‘cascade’ approach, particularly successful in the late 90’s in erectile dysfunction in advance of the Viagra launch in the UK.

With a limited number of GP specialists able to train GPs (with other specialists), it was essential that an increased number of GPs were trained to train other GPs in the clinical presentation and management of erection problems. This resulted in a UK-wide cascade approach to education, which was then implemented just as successfully in the nursing community.

However, the NHS is changing and that means medical education strategies need to change to maintain pace and relevance. In established areas of medicine, a different strategy is increasingly adopted in general practice. For example, GPs should be encourage to learn from ‘GPs with a special interest’ (GPwSI).

There are now more than 1000 ‘GPs with special interest’ treating patients in England. This surpasses the target set in the NHS Plan a year ahead of schedule. These GPs are soon to be joined by increasing numbers of nurses and other professionals who have special clinical interests.

This innovation is improving working practice between the hospital and primary care and is reducing hospital waiting times.

Guidelines for GPwSIs were developed with the Royal College of General Practitioners for the following specialities: coronary heart disease, child protection, dermatology, drug misuse, echocardiology, emergency care, ENT, epilepsy, headaches, intermediates and continuing care for older people, mental health, palliative care, respiratory disease and sexual health.

In the GP community in particular, GPsWIs will be the opinion leaders and trainers of the future and need to be supported in their new roles providing effective medical education and clinical practice. Media outlets such as the national and healthcare press can inform audiences about ongoing educational programmes and offer the opportunity for individuals to participate.

National and international medical meetings provide a forum for abstracts, developed by opinion leaders, on the progress of training programmes and encourage wider participation. These vehicles should be used as a matter of course, but alternative approaches, specific to your programme must be created.

A happy ending?

Evaluation

Evaluation can, for some, signal ‘the end’ or completion of a programme. In fact, the best initiatives must always begin with a robust evaluation of the need for education. Setting the benchmark at the start can be primarily undertaken through opinion leaders and healthcare professionals who are not overly familiar with the disease area or topic.
In addition, ideally, your programme rationale should be fully supported by extensive market research. Having established your objectives, a set of key evaluation criteria should be agreed, to be measured on an ongoing basis, commonly every six months.

This will ensure that you and those involved both in leading or participating in the programme can see that the initiative is meaning something to the recipient.

Evaluation criteria may include: *national and international market research *number of healthcare professionals signing up to the programme *number of professionals attending meetings and indicating the value of materials and actual changes in practice *sustained interest in the programme over one or more years *independent editorial coverage from healthcare professionals on the given topic.

All commercial organisations are focused on return investment (ROI), yet, there is never a straightforward translation of education into sales with educational elements of your communications mix. Nor should there be.

Medical education is a must for every communications programme and should be clearly separated from sales activities. Clearly, reps will play a role in the delivery of, and discussions surrounding, educational materials and be involved in facilitating some of the activities. However,it is vital that their primary sales role be maintained.

In the sphere of education and learning, I find it helpful to see its role rather like this. When a car manufacture is designing a new model, he does not ask those in charge of wheels and tyres to do an ROI study to justify having wheels and tyres on the new model.

It is accepted that the new model will not be complete, will not work, without wheels and tyres. Learning should be viewed as the wheels and tyres of any programme designed to create change – “no change can be successful without learning”.

Teaching medical education
We all learn most effectively from individuals or groups whose opinions and knowledge we respect and the same applies in medical education.
Doctors learn best from other doctors. Nurses learn best from other nurses, and so on. However, more often than not, a mix of specialists and disciplines should be involved to ensure the highest quality of content for the programme.
For example, a nurse education programme focusing on nurse prescribing issues may be led by specialist nurses but in order for nurse participates to take back what they have learnt to their practice and implement change, the involvement of GP and consultant ‘teachers’ would be invaluable in providing advice on how their plans may be received in their local environments.

Capturing the imagination – Developing successful relationships

It may well be that you are inheriting an existing medical education programme or rejuvenating educational activites rather than starting a new programme from scratch.

Professional opinion leaders may already be involved in the programme but whatever the scenario, it is critical to build mutually respectful relationships with opinion leaders. This can only be achieved through regular and ongoing communication.

Keep those involved updated on your thinking and progress with emails, face-to-face meetings and regular advisory board progress meetings. Your communication agency will undoubtedly be able to assist with opinion leader relationships.

Extending the support network

Being on the look-out for extending professional involvement in education programmes, even in the early stage, is always vital. Opinion leader involvement should not be exclusive to an orginial founding group, so always allow for the involvement of other individuals or professional/patient groups to further your educational cause.

You can undoubtedly benefit throughout the planning and implementation of activities from the involvement of professionals who are not necessarily experts on the field. They provide an excellent sounding board for how your messages are going to be received by those professionals you are aiming to educate.

When establishing a new programme, it is always critical to seek the views of independent organisations in the field. Today, there are very few specialties invaluable to you and also to them. Always seek partnership and/or professional accreditation from independent organisations – this involvement can substantially increase the value to individual participants.

Financial arrangements

It is generally accepted that industry-supported education programmes should offer a degree of financial reimbursement to healthcare professionals for time away from their practice to implement activities.

In line with recommendations from the Association of the British Pharmaceutical Industry (ABPI), your company will have guidelines on honoraria and other financial matters eg, accommodation of partners at meetings. It is important that you discuss these guidelines and arrangements at the outset and continually review them with the financial guidelines and arrangements with opinion leaders to avoid any unnecessary confusion.

A twist in the tale – Skills training

Demands upon healthcare professionals are increasing beyond just clinical and care work relating to patients. Within NHS changes, healthcare professionals are also becoming expected to perform management, crisis management, financial and administrative roles.

‘Added-value skills training’ has emerged as a service provided by the pharmaceutical industry over recent years and should also be considered critical under the remit of effective medical education.

‘Added-value skills training’ – such as presentation skills and dealing with the media – may traditionally have been reserved for the leaders of medical education programmes as, often, those in educating roles were keen to polish presentation skills, workshop facilitation and chairmanship skills. However, the future should see such skills training becoming an integral part of the education of a much wider catchment of healthcare professionals and disciplines.

GMS2 and re-accrediation are now a reality, demanding delivery of expanded services from all healthcare professionals and they will welcome the opportunity to develop new skills over and above those required for clinical care delivery. Education and training programmes encompassing aspects of work, such as appraisal training, time management and change management will be invaluable.

The support of the pharmaceutical industry should be valued for its corporate contribution to medicine as a whole, rather than be limited to one disease or portfolio.

Case study – Nurse Education in Erectile Dysfunction (NEED)

Nurse Education in Erectile Dysfunction (NEED) – supported by Pfizer and accredited by the Royal College of Nursing – is a nationwide training programme initiated in 2000, continuing into 2004. It offers nurses in primary and secondary care the information and confidence to manage erectile dysfunction (ED).

With an expert multi-discplinary ‘Faculty’ – including 10 nurses with specialist experience in the management of ED – NEED was designed as a motivational training course, specifically for nurses. It covers: *the aetiology, treatment and management aspects of ED *guidance and confidence on the communication and sensitivity issues surrounding ED, when speaking to either the patient and/or the partner *proactively identifying and treating patients at risk and how to work with the doctor, where appropriate, to formulate a workable screening and management protocol for patients *participating in training a wider audience of nurse colleagues.

NEED combines a distance-learning and meetings-based educational approach – area meetings also allow participants to consolidate their distance learning and to prepare them to proactively manage ED patients and run local training meetings for their colleagues.

The Programme

In January/Februrary 2000 Pfizer sales reps invited nurses, on behalf of the Faculty, to participate in NEED – distance-learning followed by attendance at one of 13 area meetings in May/June. A letter, emphasising the value of the nurse attending a NEED meeting, was issued to doctors working with the NEED invitee.

Completion of NEED (distance learning and attendance at a meeting) granted 50 RCN University accreditation points plus one PREP day – a considerable contribution to the mandatory PREP requirements of five PREP days/year.

For the one day area meeting, speakers/facilitators (nurse specialists, consultants and/or GPs) were selected to ensure a ‘multi-disciplinary team’ approach. The days were divided into a morning session – where the nurses could consolidate their distance learning – and a practical workshop afternoon session.

The morning session allowed nurses to clarify issues on theoretical management of patients and their partners in an open forum with expert speakers. Part one of the afternoon workshop sessions focused on enabling the nurse to develop the skills and confidence. This was achieved through effective facilitation and active participation of the nurses in ‘role-play’ involving the identification and management of ED patients and their partners.

Potential embarrassment to participate in ‘role-play’ sessions was anticipated during the programme planning. Embarrassment could have been compounded further by the subject of ED. However, role-play was used to instill confidence in the participants and a video was developed as an introduction to the session showing typical consultation scenarios with the nurse and ED patients and partners.

Part two of the workshop took the format of a best-practice discussion, drawing on the facilitator’s practical experience. At this point, new information from later NEED modules was presented covering the follow-up of ED patients, referral guidelines and other sexual conditions.

Results and Evaluation

NEED was very popular with 500 nurses taking part. Results from, and evaluation of, questionnaires issued at the area meetings and after six months showed that the majority of nurses who participated: *rated the educational value of the programme as excellent *had significantly increased their confidence in managing patients with ED and their partners *had modified their practice as a result *would be, or had already been, involved in assisting in training colleagues.

The programme also met the expectations initially set for RCN accreditation at the time of development and planning. The RCN accreditation form described NEED as an “excellent, well-planned, nurse-orientated programme with educationally sound teaching strategies and realistic learning outcomes”. Success is also confirmed by the programme’s endorsement from other professional and patient organisations. These include: *the British Association of Urological Surgeons *the British Association for Sexual and Relationship Therapy *the Impotence Association.