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Cramping your style?

Are recent regulatory changes stifling creativity in medical education?

Once, after I had presented a creative medical education proposal, I was told by my client that we had been too creative and that the concept would not get approved. When asked how we should change it, she answered, Sometimes being creative is wearing different coloured shoes. This led me to question if regulatory changes are indeed stifling creativity in medical education, or if creativity and innovation are simply window dressing?

The 2006 version of the ABPI Code of Practice provides guidance about the industry's working relationship with key opinion leaders (KOLs), holding meetings, sponsoring educational programmes and developing educational materials.

Although almost all areas of the Code impact in some way on medical education activities, some have a more direct influence.

Clause 19, for instance, defines what is acceptable in medical education and the definitions of what is appropriate content for a meeting. It also provides regulations on travel, accommodation, venues and refreshments. These definitions have forced the face of med ed meetings over the last few years to change.

Trends and challenges
It is not only the regulations and their interpretation that have changed in recent years — the role and status of medical education as part of the overall marketing mix has also had to adapt.

These changes have, in part, been driven by two factors. Firstly, there has been a notable shift in the promoted medicines and pipelines of the industry towards hospital-focused or hospital-led therapies — making KOL relationships more important.

Secondly, changes in the effectiveness, efficiency and reach of some aspects of marketing have increased the role and prominence of med ed. The well documented decline in efficiency and effectiveness of the sales force as a marketing tool, and the increasingly blurred line between the formerly separate activities of public relations, public affairs and medical education are examples of this change.

At the centre of these shifts is a pharma industry's marketing fundamental — advocacy. As the process by which a medicine is selected and prescribed becomes more complex, involving stakeholders beyond the GP or specialist, the role and importance of advocates has increased.

Updated Code of Practice 2008

The new version of the Code further focuses on the principle of transparency, although it contains many new clauses, most of them relate to current best practice and common sense already established in the industry. From a med ed perspective, a new clause entitled 'The use of consultants' is worth noting (Clause 20 in the new Code). This sets out how and in what circumstances HCP consultants can be utilised and how these arrangements should be made and documented.

Different approach
Added focus and reliance on med ed has caused the discipline itself to change. The traditional tiered opinion leader (OL) approach — where leading OLs were engaged, educated and mobilised to cascade their opinions and advocacy — is being replaced by an inclusive and multi-disciplinary approach.

Setting up meeting series that act as a forum for onside KOLs to didactically deliver their opinions is no longer the draw it once was. Meeting fatigue, the need for scientifically credible and independent content, and time constraints on prescribers and influencers are affecting even the simplest meeting programmes.

Medical education is now much more than simply the drive to create brand advocates, it is about being at the forefront of practice and creating a forum for opinions to be formed and changed — about the disease itself, as well as individual treatments.

The result has been significant growth in unbranded medical education (continuing medical education — CME), and a growth in non-meeting-based channels such as med ed materials, virtual meetings and online education. CME has always been a part of a number of med ed programmes, however, the emphasis of these programmes is now more on scientific independence and credibility.

Industry investment in CME has not gone unnoticed; a number of new, independent suppliers are emerging to provide multi-disease forums, each sponsored by one or more companies. Societies such as the Royal College of Nursing are now actively seeking sponsorship for a number of disease education websites. The advantages are clear — access to a wide audience, credibility through an independent third party and an opportunity for the firm to build its profile and reputation in a specific disease area.

Despite the growth of other medical channels, it is my view that all of these programmes will remain grounded or shaped around face-to-face meetings.

Although DVDs, educational materials, virtual meetings and online education are seen as valuable, most of the OLs and clinicians we speak to still value peer-to-peer interaction above all else. This is not to say that add-ons don't extend the reach and impact of meeting-led activities, it is simply that they can't replace the value of human interaction. 

Toeing the line

The challenge for medical education programmes is to delivery advocacy from a range of stakeholders for brands, companies and ideas; support and build synergies with other parts of the marketing mix; overcome meeting fatigue; capitalise on the growth of CME and non-meeting channels, while still remaining within the strictest interpretations of the regulations.

How can medical education rise to these challenges? In the same way that public relations is no longer simply about media relations, medical education programmes must look beyond the quality of the agenda and prominence of speakers, and address the following:

  • Integration: how aligned is the content of the meeting to other marketing and sales activities?
  • Content: is there a clear unmet clinical need? How does the content relate to current guidelines or clinical practice?
  • Presenters: are the leading thinkers in the area presenting? Is there multi-disciplinary representation?
  • Style and format: is there an interactive element such as workshops, case studies or debates?
  • Outputs: is there a formal or informal output of the meeting eg publication, guideline, report?
  • Extending the reach and impact: are you producing a DVD of the meeting, or putting it online?

    Measuring RoI in medical education 

    It is often the holy grail of a marketing and communications programme, yet is RoI such a hard thing to measure? The short answer is you get out what you put in — it's important to invest in measurement from the beginning of the programme.

    1. The most successful programmes are clearly those where the desired result is agreed upon by all internal and agency stakeholders — whether this is to change opinions, building advocacy behind a brand, idea or company, or influence clinical practice.
    2. It is important to set clear benchmarks — ideally though market research. For example, if the objective relates to physicians' opinions about a brand, set an adoption ladder to monitor how many and which type of physicians are at what level of adoption.
    3. Identify the other marketing/communications activities that will also have an influence on the desired result. The best programmes are clearly those that combine and integrate to push towards a uniform result. However, this makes it more difficult to measure the exact contribution of the medical education component.
    4. Set a dashboard of indicators that measure not only the desired end-result, but the steps to get there, including answers to the following questions: what med ed activities were implemented? Did we reach our target audience? Did we achieve our target outputs? What business results were achieved? What is the value of our efforts?
    5. Set regular reviews of commercial objectives, the market environment and the scope of the programme. Reviewing these things regularly will ensure the programme and measurement adapt as a result.

    Innovation is not only about ensuring you run an interesting, engaging and topical meeting; nor is it about gimmicks or celebrities. There has been a recent trend in satellite symposia to have 'celebrity' speakers or chairs. However, these are not a replacement for strong clinical presenters and can sometimes even be a turn-off to prospective audiences.

    The key is to take the innovations in format, style and content and combine them with the fundamentals of expert speakers, topical agendas, and practical and interactive sessions. Some recent trends and innovations in medical education include:

  • Balloon debates: here each speaker is given a set time to present their arguments. The audience then votes one speaker off and the remaining speakers are given 8 minutes to respond. This continues until only one speaker is left.
  • Interactive video technology: the use of video scenarios, for example a patient consultation, where the audience is asked to vote around key decision points. The video then changes depending on the vote.
  • Crossing the political/clinical boundary: given the rate of change within the health service, adding a political element into med ed programmes can drive interest.

    So, to answer the initial question of whether medical education can be creative and still stay within regulations, I believe the stricter the regulations and the more challenging the environment, the more creative and innovative medical education programmes become. For some it may seem like window dressing, but for others it is the core of their brand strategy and marketing programme.


  • Our approach to measuring RoI in medical education

    Rigorous evaluation methodologies are put in place to set SMART objectives, evaluate outputs and outcomes and ultimately measure return on investment
    What med ed activities were implemented?
    Did we reach our target audience?
    Did we achieve our target outputs?
    What business results were achieved?
    What is the value of our efforts?
    · KOL mapping
    · Advisory boards
    · CME education
    · Workshops
    · Supplements
    · Symposia
    · Skills training
    · Advocates
    · Prescribers
    · Fundholders
    · Guidelines
    · Formularies
    · Readers
    · Bloggers
    · Event attendees
    · Employees

    · Event attendance
    · Number of meetings
    · KOL relationships
    · HCP feedback
    · Market feedback
    · Awareness levels
    · Prescribing shifts
    · Patient access
    · Market share
    · RoI indicators
    · KPIs
    · Sales increase
    · Stock price

    The Author
    Sam Barnes is a director at dna medical communications, a member of the Interpublic Group Companies

    10th June 2008


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