A pandemic of change to digital medical education

COVID-19 – Delivering a pandemic of change to digital medical education

As the world of medicine continues to deal with the impact of the COVID-19 pandemic, clinicians are moving to digital solutions. Adrian Duncan dives into research into the power of digital communication to see how they could be most effectively used to improve public health.

Even as some locations move forward in their reopening plans, the shift to digital events and virtual education options are expected to continue far into the future. The move to digital by clinicians looks more than temporary – 93% of physicians expect to use digital tools for clinical-decision support, and 90% of clinicians expect to use digital learning solutions to the same or a greater extent even after the COVID-19 crisis passes.¹

A major change in the medical community has been the transformation of live conferences and events into virtual events. A majority of physicians (60%) expect that they will not attend live meetings for more than one year, and 64% of physicians say they are likely to participate in an online version of a national meeting.²

While this switch presents a change to how clinicians are accustomed to learning and staying current on practice guidelines, there are new opportunities realised with the shift to virtual conferences. With virtual, many of the barriers that clinicians faced with conference attendance — cost, travel, time away from practice — are less of a factor in participation. Virtual events provide an increased level of convenience and accessibility.

The big downside for many with the switch to virtual events is the lack of one-to-one interactions with peers. However, while face-to-face peer interaction is reduced, virtual platforms can provide a chance to interact with clinicians beyond the usual geographic boundaries and core specialties. The inclusion of interactive tools and collaborative opportunities to foster that connection and network can really elevate the congress experience for global attendees.

Digital CME

In the same way that events are moving to digital, clinicians are embracing digital certified Continuing Medical Education (CME) as well. Seventy-four percent of physicians agree that online CME is more important for clinical practice during the COVID-19 pandemic than it was previously.² Digital CME is powerful in its ability to be flexible and accessible in a way that allows clinicians to learn on their own terms and incorporate education into their busy practice schedules.

“CME is the most trusted form of information for healthcare professionals due to its rigorous learning and content design,” says Christina Hoffman, group vice president of quality and strategy at Medscape Education. “Physicians also value digital education because it is flexible and accessible, allowing them to learn in their own time and in their preferred format (online, video, audio, mobile, etc.), and to fit education into their busy practice schedule.

“It has the specific ability to provide ‘just in time’ learning — a feature unique to digital platforms. Digital CME is available when and where physicians need it, providing them with the education that is most relevant to their practice.

“This is even more in the spotlight in our current environment as live education options are limited, and research shows this will continue after the COVID-19 pandemic is well in hand.”

The power of digital CME

Digital education has the potential for strong reach and accessibility, but what is the effectiveness of digital education solutions on the learner and ultimately, patient outcomes? A 2020 peer-reviewed study published in collaboration with the FDA sought to investigate the power of such digital education to positively impact public health.

The study examines the efficacy of targeted short form messaging and CME aimed at reducing overprescribing of fluoroquinolone antibiotics.

In 2014, five percent of all fluoroquinolone prescriptions in the United States were given for conditions for which no antibiotics are indicated, and 20% were given for conditions for which fluoroquinolones are not recommended in first-line therapy, including 6.3 million for sinusitis and UTIs and 1.6 million for viral respiratory tract infections and bronchitis, where the risks to the patient outweighed the benefits of the medication.

This is particularly concerning because fluoroquinolones are associated with a range of disabling and potentially irreversible adverse reactions, including tendonitis, peripheral neuropathy, suicidal thoughts, decreases in blood sugar and attendant risk for coma.

The researchers recognised this gap in physician knowledge around proper treatment and saw an opportunity for better communication and education. Traditional forms of physician feedback that include showing clinician behaviours are consistent with what their peers are doing seemed to only provide moderate effects.

The large study examined nearly 24,000 high prescribers of fluoroquinolones and divided 11,774 into 3 treatment groups to evaluate and measure the efficacy of targeted short form messaging and CME aimed at reducing their overprescribing of these antibiotics.

Group 1 received short-form targeted messaging only (n = 8,895). A second group received CME activity only (n = 1,756) and a third group received both short-form targeted messaging and CME (n = 1,123). A case-matched control group was also included (n = 11,774) and results were stated against that comparator population.

Hoffman, who was one of the study authors, says that to deliver these messages, the researchers followed the best practices of short form content delivered to a specific audience.

“The messages needed to be concise, read in as little as two minutes, and not require a time-consuming amount of critical thinking,” she says. “Short form messages are typically 400-600 words long. We tested short form messages in email, as well as in web and mobile alerts, to select the most effective messages to use in the study and compared these to the impact of CME.”

So how effective were these different digital communication strategies? In fact, all three approaches were effective, with targeted short-form messages and CME each resulting in a statistically significant reduction in new prescription volume versus control. And combining targeted short-form messages with CME yielded the greatest percentage of test HCPs with reduced prescribing (80.1%) versus controls.

“Studies have shown that multifaceted approaches are most likely to be effective in behaviour change, and our study matched this result, in that the combination of targeted short form messages and education was the most effective,” says Hoffman.

“Although not directly linked to outcomes measures for new prescription volume, we observed that targeted short form messages with subject lines addressing personal fluoroquinolone prescribing were opened at slightly higher rates than targeted short form messages with a subject line addressing general fluoroquinolone safety data only.

“This result may suggest that feedback on personal prescribing had a somewhat greater effect on physician engagement than safety data alone and, by extension, was more likely to lead HCPs to education that may influence prescribing behaviour.”

She adds that these techniques are broadly applicable for any matter that addresses public health concerns. The study authors have discussed the possibility of using such education in areas as varied as undertreatment of MDD, elevated blood pressure, dyslipidemia, low testosterone as well as inappropriate treatment seen with controlled substances.

“We also see some cases where anticoagulants aren’t being used when patients could benefit, and this could be an intervention to make sure patients get the treatment,” Hoffman says.

“One major area where we would see potential to use these interventions is in the prescribing of opioids, and how we could impact the path to addiction. It is not about getting clinicians to stop using opioids, but about how we can educate them on how to prescribe safely to the benefit of patients and their families.”

She adds “The results of the study also suggest that targeted short-form messages paired with online CME could be a viable and COVID-safe alternative to other prescribing management tactics that may be more time-consuming or costly for a health system, particularly during the current health crisis.’’

With increased physician use of digital education looking increasingly likely to be a lasting legacy of the pandemic, now is surely the time to leverage evidence based approaches that have measurable and significant outcomes, whether they be advances in knowledge, competence or confidence, or go beyond with a deliverable impact on prescribing practice.

Medscape is the leading provider of digital continuing medical education (CME) worldwide.⁵ As an alternative to in-person events, Medscape Education provides a variety of digital live education solutions, including Virtual Symposia: livestreamed virtual events where expert faculty present on multispecialty topics. Virtual Symposia events have the potential to reach a large, engaged, global audience by being accessible and interactive, and providing the content that clinician learners seek.

As a trusted learning partner for the medical community with proven ability to deliver education that makes an impact, Medscape Education is committed to providing digital CME to learners where, when, and how they want to learn.

Adrian

Adrian Duncan is group vice president & head of global education at WebMD and Medscape Global. He manages all aspects of the Medscape Medical Education business outside of the United States.

References

Kelleher K, Kumar K, Patel P, Schrader U. Pharma operations: The path to recovery and the next normal. McKinsey. May 2020. Available at: https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/pharma-operations-the-path-to-recovery-and-the-next-normal#.
Medscape internal data. Multiple studies. April, May 2020
Lowe MM, Aparicio A, Galbraith R, et al. The future of continuing medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009;135(3 suppl):69S-75S.
Whyte J, Winiecki S, Hoffman C, Patel K. FDA collaboration to improve safe use of fluoroquinolone antibiotics: an ex post facto matched control study of targeted short-form messaging and online education served to high prescribers. Pharm Pract (Granada) [Internet]. 2020Apr.24 [cited 2020May9];18(2):1773. Available at: https://pharmacypractice.org/journal/index.php/pp/article/view/1773.
DRG Digital Taking The Pulse^® EU5, 2020

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COVID-19 – Delivering a pandemic of change to digital medical education

As the world of medicine continues to deal with the impact of the COVID-19 pandemic, clinicians are moving to digital solutions. Adrian Duncan dives into research into the power of digital communication to see how they could be most effectively used to improve public health.

Digital CME

The power of digital CME

“This result may suggest that feedback on personal prescribing had a somewhat greater effect on physician engagement than safety data alone and, by extension, was more likely to lead HCPs to education that may influence prescribing behaviour.”

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