The Art and Science of Quality CME Presentations: Creating Impact and Driving Outcomes Donald S. Nelinson, PhD American College of Osteopathic Internists Annual Convention and Scientific Sessions October 31, 2019
The Art and Science of Quality CME Presentations:
Creating Impact and Driving Outcomes
Donald S. Nelinson, PhDAmerican College of Osteopathic Internists
Annual Convention and Scientific Sessions
October 31, 2019
Disclosure
I have no commercial interests in any product or company to disclose.
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Objectives
Apply 7 key tenets of adult learning to the design of outcomes-driven CME
01Actively engage physician learners in the educational process
02Summarize presentation characteristics associated with improved audience retention including those aligned with Mayer’s cognitive theory of multimedia learning
03Review practical tips for developing effective CME presentations
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After actively participating in this convention and follow-up learning activities, participants will be able to:
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Physician as Adult Learner: Knowles Knew!
• Physician (adult) learners have well-established sense of self
• Past experiences play pivotal role in physician learning
• Physician learning is purpose driven
• Physician learning relies on readiness to learn
• Physician learners driven by internal motivation
• Mistakes are often most valuable teacher
• Physician learners must play active role in learning activity design
Manning PR, Clintworth WA, Sinopoli LM, Taylor JP, Krochalk PC, Gilman NJ, Denson TA, Stufflebeam DL, Knowles MS.
A method of self-directed learning in continuing medical education with implications for recertification. Ann Intern Med. 1987 Dec;107(6):909-13. PubMed PMID: 3688682.
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Physician (adult) learners have well-established sense of self
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Autonomy demands a “say” in content, format, faculty
The consequences are disengagement and/or boredom
“OK Don….how do we ensure engagement?”Needs assessment
• Not just surveys!
Self-directed learning
• What have you done that engaged you and advanced your knowledge or skills?
Case-centricity
• Cases as an “also ran” don’t work!
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Past experiences play a critical pivotal role in physician learning
Clash of the experiential titans!
If new data clashes with the learner’s existing knowledge base, they’re not likely to accept it!
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Learning must relate to the learner’s experience
INVITE CHALLENGING CASES UTILIZE PEERS PRESENT CLINICAL VIGNETTES AND SOLICIT RESPONSES
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Physician learning is purpose driven
It’s a choice, not a duty
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Learning must be goal-oriented
• Measurable learning objectives
• System for learner to gauge progress
How do we do this?
• Simulations
• Real-world, case-centric models (ACOI-OCC)
• Provide opportunities to see how skills optimize patient care and/or overcome a challenge
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Physician learning relies on readiness to learn
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I’ll tell you what I need to know……if you ask!
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Multiple models fuel more effective behavior change
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Prochaska’s Transtheoretical Model/Stages of Change
While all treaters will not start at the earliest stage, sequential progression is inevitable and differentiated communication is essential.
Roger’s Theory of Diffusion of Innovation
Roger’s theory reveals how innovation occurs within a community by agents of change and resistance. Leveraging this knowledge in combination with the stages of change will further our ability to communicate in a customized fashion and accelerate adoption of innovation.
Physician Self-Efficacy
(Krupat, Frankel, Nelinson and Meldrum, et al)
Self-efficacy is referred to as the confidence (emotional) and competence (rational) to effect a change. As we move our treaters through the roles and stages referenced above, enhancing self-efficacy should be a guiding objective
Prochaska’s Transtheoretical/Stages of Change Model
Norcross JC, Krebs PM, Prochaska JO. Stages of change. J Clin Psychol. 2011 Feb;67(2):143-54. doi: 10.1002/jclp.20758. PubMed PMID: 21157930 Parker K, Parikh SV. J Eval Cl Prac, 2001.Valente TW. Network models of the diffusion of innovations, 1995.Nelisnon DS & Meldrum H. In search of a perfect storm: Provider self-efficacy, patient centered care, and medical education. Poster presented at WONCA; July 5, 2012; Vienna, AT.
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Physician learners driven by internal motivation
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Focus on problem-solving
SIMULATIONS CONTEXTUAL, CASE-BASED ROLE PLAY
TRANSLATE ONLINE LEARNING INTO REAL LIFE
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Mistakes are often most valuable teacher
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Physician learners must play active role in learning activity design
The goal is to provide resources that allow learners to immediately
apply what they’ve learned and address individual pain points
WHAT DOES THIS LOOK LIKE?
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What is in a name?
• Docere = to teach (Latin)
• Teaching is the facilitation of learning
• Physicians teach every day
• Were we adequately taught the principles of effective teaching and learning?
– Is knowledge base alone adequate?
Stull MJ, Duvivier RJ. Acad Med. 2017;92(4):432-433.
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Educator vs. presenter, faculty, etc
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Active learning: Engaged learner vs engaged faculty
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Older Doesn’t Always Mean Wiser: Clinical Experience Is Not Associated with Increased Knowledge
Emergency Contraception
(N=233)
Blood Product
Transfusion (N=122)
In a Systematic Review of 12 Studies, All Demonstrated a Negative Association Between Knowledge and Experience1
General Medical Knowledge
(N=3356; 1947; 289)
General Surgical
Knowledge (N=478)
HIV
(N=473; 1000; 1271)
Hypertension
(N=56)
MI
(N=1211)
Non-Small-Cell Lung
Cancer (N=1010)
1. Choudhry NK, et al. Ann Intern Med. 2005;142(4):260-273; 2. VanNieuwenborg L, et al. Postgrad Med J. 2016;92(1086):217-222.
Professional experience must be supplemented
with lifelong learning2
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Becoming a….
• Doctor– 4 years medical school + residency
• School teacher– 300 hours of field-based practicum experience (in MA)
• PowerPoint expert
• Medical writer
• Medical editor
• Public speaker
1. Massachusetts Department of Elementary and Secondary Education. http://www.doe.mass.edu/lawsregs/603cmr7.html;
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The Most Common CME Teaching Methods Are the Least Effective
• Learning – not merely educating – results in a change in clinical practice
• Lectures and printed material– Increase knowledge (but may not change behavior)
– Role play or practice sessions more effective
– Multiple sessions > single session
• Online courses
Case studies
Interactivity
Flexible schedule
Individualized
ProsCons
Social isolation
Cost
Technical problems
VanNieuwenborg L, et al. Postgrad Med J. 2016;92(1086):217-222.
Slide-Based Presentations
MedPage Today. The Worst Slide Show Ever. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/69422
MedPage Today. The Worst Slide Show Ever. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/69422
MedPage Today. The Worst Slide Show Ever. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/69422
MedPage Today. The Worst Slide Show Ever. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/69422
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A Word About Slide Colors and Slide Sizes
Do you still have your television from 1987?
• Early monitors/projectors
– 4:3 aspect ratio
– Limited color palettes
– Lower pixel density
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Just Because You Can…
Doesn’t mean you should
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Just Because You Can…
…doesn’t mean you should
Transitions
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Just Because You Can…
…doesn’t mean you should
Ani mat i o n
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Mayer’s Cognitive Theory of Multimedia Learning
People Learn Better from Words+Pictures Than from Words Alone
Mayer RE. Journal of Computer Assisted Learning. 2017,33:403– 423. Image from https://medium.com/learning-matters/series-influential-educators-richard-mayers-cognitive-theory-of-multimedia-learning-9c1db2f0805c
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Select Principles
1. Mayer RE. Journal of Computer Assisted Learning. 2017,33:403– 423; 2. Nagmoti JM. Indian J Med Microbiol. 2017;35(2):199-203
Reduce Extraneous Processing
BOPTIONS
Manage Essential
Processing
Foster Generative Processing
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Select Principles
1. Mayer RE. Journal of Computer Assisted Learning. 2017,33:403– 423; 2. Nagmoti JM. Indian J Med Microbiol. 2017;35(2):199-203
Reduce Extraneous Processing
BOPTIONS
Manage Essential
Processing
Foster Generative Processing
Eliminate extraneous material (coherence principle)
Highlight essential material (signaling principle)
Key on-screen text benefits narration (redundancy principle)
Place pictures and text near each other (contiguity principles)
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Select Principles
1. Mayer RE. Journal of Computer Assisted Learning. 2017,33:403– 423; 2. Nagmoti JM. Indian J Med Microbiol. 2017;35(2):199-203
Reduce Extraneous Processing
BOPTIONS
Foster Generative Processing
Break lessons to allow self-pacing (segmenting principle)
Provide pre-training on key terms (pre-training principle)
Narration preferred (vs text) (modality principle)
Manage Essential
Processing
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Select Principles
1. Mayer RE. Journal of Computer Assisted Learning. 2017,33:403– 423; 2. Nagmoti JM. Indian J Med Microbiol. 2017;35(2):199-203
Reduce Extraneous Processing
BOPTIONS
Use conversational language (personalization principle)
Draw graphics as you explain (embodiment principle)
Manage Essential
Processing
Foster Generative Processing
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Implementing Multimedia Principles
Issa N, et al. Med Educ. 2011;45(8):818-826.
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Implementing Multimedia Principles
Issa N, et al. Med Educ. 2013;47(4):388-396.
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Does it Work?
Improved1,2:
• Immediate retention
• Delayed retention
• Transfer
1. Issa N, et al. Med Educ. 2011;45(8):818-826; 2. Issa N, et al. Med Educ. 2013;47(4):388-396.
• Age <50 years with DM and 1 additional
risk factor for atherosclerosis
• Age 50–64 years with risk factors for
atherosclerosis or family history of PAD
• Age ≥65 years
• Individuals with known atherosclerotic
disease in another vascular bed
Patients at Increased Risk for PAD
Fatal, intracranial, or bleeding with
hemodynamic compromise requiring
intervention
GUSTO Severe
Bleeding requiring transfusion of whole
blood or packed red blood cells without
hemodynamic compromise
GUSTO Moderate
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Different Ways of Presenting the Same Content (1)P
ati
en
ts W
ith
an
Eve
nt
(%)
0
20
30
10
Arm 1
0 1 2 3 4 5
Arm 2
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Different Ways of Presenting the Same Content (1)P
ati
en
ts W
ith
an
Eve
nt
(%)
0
20
30
10
Arm 1
0 1 2 3 4 5
Arm 2
28.3%
23.2%
HR (95% CI)
0.75 (0.52–0.80)
P<0.001
ARR –5.1%
−25%RRR
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Different Ways of Presenting the Same Content (2)
• An Estimated 750,000 Adults Will Have an MI in 2016
• Within 5 years of an MI
– 22% of patients ≥65 years of age will have a recurrent MI or fatal CHD
– 22% of women 45–64 years of age will have a recurrent MI or fatal CHD
– 15% of men 45–64 years of age will have a recurrent MI or fatal CHD
– 8% of women ≥65 years of age will have a stroke
– 5% of men ≥65 years of age will have a stroke
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Different Ways of Presenting the Same Content (2)
An Estimated 750,000 Adults Will Have an MI in 20161
Within 5 Years Following an MI2
of patients ≥65 years of
age will have a
recurrent MI or
fatal CHD
45–64 years of age will
have a recurrent MI or
fatal CHD
≥65 years of age will
have a stroke
22%22%
(of women)15%
(of men)
8%(of women)
5%
(of men)
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Graphical Assistance Is Readily (and Affordably) Available
Subscription Services Offering Slide Assistance
Templates Royalty-free images
Customizable animations Maps
GraphsTables
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Visual Abstracts
• Visual summary of the information found within the abstract portion of an article
• Meant to convey the key findings of the article
– Not a substitute for the article and does not contain all of the details
• Associated with increased dissemination and readership1,2
• Used >50 journals, organizations, and institutions3
1. Colbert GB, et al. Kidney Int Rep. 2018;3(3):519-529; 2. Ibrahim AM, et al. Ann Surg. 2017;266(6):e46-e48; 3. Ibrahim AM. Visual Abstract Primer 4th Edition. https://static1.squarespace.com/static/5854aaa044024321a353bb0d/t/5a527aa89140b76bbfb2028a/1515354827682/VisualAbstract_Primer_v4_1.pdf.
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Visual Abstract Example 1
https://twitter.com/i/web/status/1091743052794945538
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Visual Abstract Example 2
https://resident360.nejm.org/visual-abstract/four-treatment-choices-for-actinic-keratosis
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Visual Abstract Example 3
http://www.nephjc.com/news/2017/6/20/canvas-visual-abstract
Non-Linear Presentations
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Zoomable User Interface
• Single visuospatial canvas– A blackboard of infinite dimensions
– Navigated by zooming and panning
– User (Presenter? Audience?) defined path
• Prezi (and to some extent PowerPoint)
• Allows enhanced visuospatial integration
“Whereas PowerPoint's linear slide format might reduce cognitive load, focus attention, and promote logical analysis, Prezi's map-like canvas format and heavy reliance on animation might facilitate visuospatial
processing, conceptual understanding, and narrative storytelling .”Moulton ST, et al. PLoS One. 2017;12(7):e0178774.
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Three Major Syndromes of Atherothrombosis1,2
Coronary artery disease (CAD)
1. AlMahameed A. In: Bhatt DL, ed. Atherothrombosis in Clinical Practice. New York, NY: Oxford University Press; 2013:79-94; 2. Benjamin EJ et al. Circulation. 2017;135(10):e146-e603.
Cerebrovasculardisease (CVD)
Peripheral artery disease (PAD)
~790,000 US adults ≥35 y have an MI annually2
580,000 – first MI,210,000 – recurrent MI2
Benjamin EJ et al. Circulation. 2017;135(10):e146-e603.
Three Major Syndromes of Atherothrombosis1
~531,000 US adults experience an initial
ischemic stroke annually2
Benjamin EJ et al. Circulation. 2017;135(10):e146-e603.
Three Major Syndromes of Atherothrombosis
~8.5 million US adults ≥40 y are affected by PAD2
Benjamin EJ et al. Circulation. 2017;135(10):e146-e603.
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Non-Traditional CME Modalities: TED Talks
• TED talks
– Short
– “unstructured” storytelling
– Few slides and almost no text
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Non-Traditional CME Modalities: Trends
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Presentations You Didn’t Develop
• Know your audience
– What is their background and knowledge base?
– What outcome are you looking for?
• How many slides/points do you think the audience will remember?
– Pick which information you emphasize
– Orient audiences to the slide
Embedded PowerPoint Video
One Last Tip
Finish on Time
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Questions, comments, crtitiques…