The Day I Was Schooled on CME

Mikkael Sekeres, MD, MS
Director of the Leukemia Program at the Cleveland Clinic in Cleveland, Ohio

I put the final exclamation point on the “Thank you!!!” slide for a local continuing medical education (CME) talk on myelodysplastic syndromes (MDS) and sat back in my faux Aeron chair to admire the work. While the talk was not handed down to me directly from God, let’s just say God wouldn’t have been embarrassed to use my slides to give a talk on MDS, if asked.

I submitted the slides to the event organizers and, within about a nanosecond, a CME representative got back to me asking for more. Below is a slightly edited summary of our extensive email conversation.

“Can you provide 10 to 15 objectives of your talk?”

“Objectives of my talk? The objective is to teach other doctors about MDS. Or at least, teach them within the framework of my own personal biases.”

“We need something measurable. And concise. It needs to fit next to a bullet point on a slide at a minimum 22-point type.”

“Um… okay… how about: ‘To understand the treatment of MDS’?”

“Not good enough. ‘To understand’ isn’t an active enough verb.”

“Not active enough? What if I changed it to: ‘To actively understand the treatment of MDS’?”

“You need to ditch ‘To understand.’ In CME, we don’t like it when people understand concepts.”

“Oh, I get it,” I responded, not actually getting it. “Then let’s go with: ‘To learn about MDS treatments.’”

“Boring!” They chastised me. “We don’t feel elevated by that objective.”

“’Elevated’? Should this talk be a religious experience?” I asked.

“If done right.”

Wow. That really put it into perspective for me. All those years in Hebrew school might finally pay off. I could do this.

“WITH THIS TALK, I WANT TO TRANSMOGRIFY THE ABILITY TO TREAT MDS!” I added the caps to convey my enthusiasm.

The absurdity of such experiences with certain CME providers notwithstanding, I soldier on … for the pure pleasure of communicating with colleagues, so we all understand how to better care for our patients.

A few seconds passed, and then, “That’ll do. Now we need 14 other objectives, each with a unique, equally captivating verb. No double-dipping.”

“You betcha!” I rejoindered.

Another email arrived. “We’ve had a chance to briefly review your slides. You profile a patient named Miles DePlasia. You’ll need to have Mr. DePlasia sign a HIPAA release form.”

“But Miles DePlasia isn’t a real person. It’s a pun, playing on myelodysplasia. Get it?”

“We get that we need a HIPAA release form signed. Otherwise, you’ll need to eliminate Mr. DePlasia from your talk entirely. Instead of using a name, just say ‘A Lawyer’ had MDS. Medical audiences love when we saddle lawyers with unfortunate diseases – especially if you show a slide of an unsightly, nonhealing skin abnormality.”

“Um, okay.”

“Next step: You have to develop 17 multiple-choice questions to assess participants’ understanding of the material you presented.”

“But I haven’t presented it yet.”

“Irrelevant. Our course director has decided to make your talk eligible for American Board of Internal Medicine [ABIM] maintenance of certification [MOC] credits. And MOC requires demonstration of exquisite skill in answering multiple-choice questions to prove clinical competence in treating hematology patients.”

“Wait a second. When I agreed to give a talk on MDS, I didn’t also agree to generate a series of questions, too. I’m not a psychometrician – I’m not sure I can even develop questions that are clearly written and measure what they’re supposed to measure.”

“Again, irrelevant to ABIM. And we’ll need an abstract describing what’s in your slides.”

“An abstract?”

“Yes, we thought participants would appreciate an abstract book of all the presentations summarizing what they just spent eight hours listening to. But please limit it to no more than 10,000 words.”

“Does any participant ever look at this book after the meeting?”

A few seconds of silence passed again before I received the following reply: “We believe it becomes a sort of bible to conference attendees thereafter.”

Again with the religious experience. “Anything else?”

“Yes. Your talk has been specially chosen to develop into enduring material.”

“That’s good, isn’t it?” I asked, less and less sure with every passing exchange between the CME representative and me.

“Being included in enduring materials is a place of high honor. You will now need to go through every slide and make sure you haven’t repurposed a table or figure from another publication. If you have, you either need to obtain permission from the publishing journal in writing to re-use the table or figure, or redraw it entirely.”

“Is there someone in your CME offices who can help redraw the tables or figures? I’m a horrible artist.”

“Negatory. We would never deny you that privilege. And we don’t have offices, we live in 6-by-6-foot cubicles.”

“Can I ask what you mean by enduring materials?” I wrote.

“Enduring: Lasting a long time. Nearly forever. Your PowerPoint presentation will outlive mammals when global warming kicks into high gear. We intend to place it in a time capsule that won’t be opened for at least another 1,000 years. Future species from other planets will discover your MDS talk and marvel at how humans could evolve to become such advanced life forms.”

“Well, when you put it that way, I guess it’s worth redrawing all those tables and figures!”

“Uh-huh. That’s what we thought.”

“Okay, I’ll get started on all of this, and will get you that abstract and those questions next week.”

“Negatory. We need to receive your materials in enough time for them to go through internal review by an unbiased party. He drinks only milk, eats free-range vegan meals, sees only  G-rated movies, and has never welcomed an impure thought.”

“Sounds like he has quite a social life. Okay, I’ll pull an all-nighter and get everything to you by tomorrow.”

“By noon tomorrow.”

I sighed. “Okay, by noon tomorrow. Thank you for helping me understand your processes.”

“Can you phrase that differently?”

I thought about it a second. “Thank you for helping transmogrify my knowledge of your processes.”

“Now that’s an improvement in knowledge we in CME can assess.”

The absurdity of such experiences with certain CME providers notwithstanding, I soldier on through their requirements for the pure pleasure of communicating with colleagues, so we all understand how to better care for our patients.