The Changing World of Med Ed

For years, medical education activities have been a sure way for pharma marketers to deliver key messages to the medical community about scientific discoveries, new treatments, and products fostering medical advancement. The most effective activities advance physicians' knowledge and motivate them to act.

A few months ago, however, the voluntary Code on Interactions with Healthcare Professionals, adopted by the Pharmaceutical Research and Manufacturers of America (PhRMA), reined in some of the more popular physician-directed marketing and sales tactics-golf outings, tickets to sports events, dinners at luxurious restaurants, and "dine-and-dash" programs. (See "A Code to Teach By.") Effective July 1, 2002, the code states, "Interactions should be focused on informing healthcare professionals about products, providing scientific and educational information, and supporting medical research and education." To compete for physicians' attention, now, more than ever, marketers need ingenuity to develop tactics that will support their brand's strategy, educate the target audience, and conform to the code.

A Code to Teach By

The PhRMA guidelines, combined with new and emerging electronic technology, are turning traditional medical education activities upside down. At the same time, the code is a wake-up call to pharma marketers that it's time to look for new opportunities. Does it take the sizzle out of medical education? Not necessarily. It simply forces pharma marketers to rethink their approach to educating physicians.

"With more limited ways of interacting with medical professionals, pharmaceutical companies are directing a greater amount of spending to CME," says Michael Lemon, vice-president of educational services for the Postgraduate Institute for Medicine in Englewood, Colorado, which is accredited by ACCME (Accreditation Council for Continuing Medical Education). "The PhRMA guidelines will create a significant increase in the offerings available to physicians. Sponsoring companies need to differentiate themselves so they don't get lost in the noise. Physicians will choose the activities that are innovative, interactive, and case-driven, which can be accomplished using more high-tech methods."

How, then, can marketers maintain meaningful med ed programs and interactions with physicians without the glamour? What new tactics will gain physician attention using activities that are not only dynamic and interactive but relevant to marketers' goals? This article answers those questions and suggests both traditional and innovative approaches. It offers ways to make CME both more efficient and interesting for participating physicians and more effective for the pharma marketers who must compete for physician attention.

Computers Everywhere

Innovation and technology go hand in hand, and marketers can no longer consider technology-based programs risky investments. Although live activities, conferences, and written materials remain industry educational mainstays, more and more programs are incorporating electronic media. That trend parallels advances in web-based, software-based, and hand-held technologies-all of which are now an integral part of a physician's daily life. The statistics speak for themselves.

In a recent survey of US physicians, 97 percent said online CME is the medical profession's learning tool for the future, 38 percent selected the internet as the preferred forum for CME, and 28 percent preferred professional conferences. According to a November 2001 Harris poll, 93 percent of physicians said online content affected their knowledge of new treatments, including drugs, and 73 percent said information on the internet affected their prescribing habits. An August 2002 Harris poll showed that 94 percent of physicians use a computer in their practice.

Tips on Tactics

The growing use of personal digital assistants (PDAs) expands the tactical options for meetings and online programs, enhancing convenience and efficiency while facilitating data tracking. A Harris Interactive survey released in August 2001 reported that physician use of hand-held devices increased from 15 to 26 percent from 1999 to 2001. A recent article, "For the Doctor's Touch, Help in the Hand" (the New York Times, August 22, 2002), predicted that for medical professionals, "The hand-held computer may someday be as ubiquitous as the stethoscope."

Re-evaluate the Status Quo

Great ideas are not born in a vacuum. Seeking creative solutions for a medical education plan is an undertaking that marketers should not pursue alone. Partnering with a company that specializes in healthcare education tactics can increase the number of options available for educational activities, facilitate program timelines, and still be cost-effective. Before taking that step, however, they must draw the important distinction between strategy and tactics.

Strategy and messages are the spine of any brand, but no brand's strategic plan can be successful without proper tactics. Creating synergy between the message and the medium is the core challenge. Following are eight challenges a pharma company is likely to face when planning medical education activities and some creative tactics for optimizing CME goals:

#1 Add "Legs" to Live Meetings

Challenge:

The most common educational marketing tactics that pharma companies use are sponsored live meetings or stand-alone CME, often at considerable expense. Unfortunately, many companies stop when the program is over, thereby missing opportunities to expand audience reach and program shelf life. But there are creative options to ensure that a live meeting has a lasting impact.

Solution: A popular post-event tactic is to supply lasting written materials, such as proceedings in a peer-reviewed journal or monograph. Although that provides some follow-up with program attendees, such materials are usually targeted to physicians who were unable to attend the program. Alternately, some sponsors have used audiotapes.

Today's electronic media greatly expands those options. Capturing an educational conference on an interactive CD-ROM or website gives healthcare providers a virtual front-row seat. The materials can include video clips of the meeting's speaker presentations and discussion sessions, plus appropriate background materials such as abstracts, speaker bios, and links to medical organizations. If desired, an accompanying exam-paper or online-from an accredited organization allows participating physicians to receive CME credits. The extent of the information and variety of formats that companies can include greatly expand their interest to recipients. For online programs, there is also potential for interaction with speakers at specified times and at chat sites. Such materials are best distributed after the meeting to attendees to expand their educational experience as well as to physicians who did not attend to increase the target audience.

Choosing A Med Ed Partner

Why It Works: Online or software-based CD-ROM educational programs are convenient, visually stimulating, and provide a lasting record of information disseminated at a meeting. When critical data are included, healthcare providers can choose the material they view rather than sitting through an entire presentation. Also, many healthcare providers are increasingly concerned with travel costs and time spent out of the office. "Conference capturing" media allow them to attend a meeting at their convenience and comfort. The following feedback on such programs speaks for itself.

In a Postgraduate Institute of Medicine survey of 864 healthcare providers, based on ten of the institute's accredited CD-ROM conference-capturing activities, 76 percent responded "yes" to the question, "Will the information presented cause you to make changes in your practice?" When asked to rate the subsequent statement, "The programs will help me improve patient care," respondents boosted the average rating to 8.4 out of 10 (highest).

#2 Expand Brand Presence

Challenge:

Most physicians are bombarded with invitations to many more meetings in their clinical area than they can attend each year. The challenge to marketers is to find a way to maximize their brand message while working within limitations imposed by doctors' time, budgets, and staffing needs, as well as CME guidelines. How can pharma marketers make sure that their programs are the ones that physicians choose to attend?

Solution: When the budget is small or sponsoring a satellite symposium is not feasible or desired, a closed roundtable discussion with key thought leaders, captured on CD-ROM and disseminated to the target audience, can be an effective alternative for a fraction of the cost. The CD can include downloadable slides, speaker bios, transcripts, abstracts, and thought-leader interviews. Sponsors can hold it at a major medical meeting after official conference hours or off-site, without an audience present. The keys to success are:

• give the discussion a specific focus

• allow ample time for thought leaders to present their opinions and data

• allow time for a lively, roundtable-style discussion

• provide attendees with appropriate and enduring materials, such as a broadcast fax newsletter, clinical monograph, or interactive CD-ROM that captures the activity.

Why It Works: Such a simple live event can have an impact equal to that of a larger, more costly symposium-and it reaches a far greater target audience. The closed roundtable, properly enhanced with enduring creative materials, creates a stronger association between sponsor and educational activity, connecting the brand to the educational message in a way that is often incompatible with larger satellite meetings.

#3 Make Case Studies Come Alive

Challenge:

Traditionally, patient case studies have been straightforward, didactic, and linear in both presentation and format-in other words, boring. But there are creative ways to optimize this important educational vehicle and to maximize physician attention.

Solution: Patient case studies should mirror real-life experiences. Gather examples from key thought leaders and redesign them to make them appropriate for the target audience. It is important to use a problem-based learning approach and an interactive format that draws people in. Those tactics adapt well to small workshops, larger meetings, and electronic media.

Although small groups are always best for active learning, interactive case presentations are not limited to workshop venues or to meetings. Several years ago, more than 600 clinicians who attended a dinner satellite symposium at a primary care meeting rated the program one of the best ever held at the organization's annual meeting. The program used a novel format, audience evaluations for appropriate therapy, and a panel "discussion" in an audience-interactive game format. The latter focused on issues collected from those who had pre-registered for the session. The feedback tells the story:

• "It was a fantastic learning tool-an interesting way of presenting information and keeping the audience's attention that was lots of fun and very informative."

• "The program's novel format reinforced the information presented in the case studies and was a great way to help retain the information.

• "I had only one hour of sleep in the 36 hours preceding the program. You may take it as a testament to the excellence of the program and presentation that not only did I not fall asleep, but I found it both interesting and pertinent to my practice. Even the written information is excellent, and I will share it with the physicians that I work with."

Recently, a pharma company that wanted to maintain physician awareness of an allergy product developed a website that featured a series of cases that physicians could work through using a problem-based learning approach. Physicians dealt with each one as they would work with an actual patient in their office. Responses from the experts who developed the examples were not viewable until the physicians had entered their own observations based on the patient's medical history and physical examination. The cases were approved for CME credit and the site offered new cases every two months. The website also contained information about guidelines for treating allergy, abstracts of recently published papers and relevant presentations at allergy meetings, and an "ask the expert" section.

Here, too, the feedback offers insight into the program's success. Physicians were surveyed about their reasons for continuing or not continuing to use the website. Only about 6 percent decided to discontinue their use; expressing, a preference for getting CME through medical conferences. Those who continued with the website offered two reasons for doing so:

• "It is an interesting format that allows me to stay up-to-date and get CME. I like the convenience and interactivity."

• "I am a family physician in a rural area where it is difficult to access lectures and get CME credit. This is a good way for me to stay on top of new information-plus, I do not need a babysitter."

Why It Works. An interactive, case-based approach works because it engages the audience in a process of active learning. Such involvement throughout the presentation is critical to the programs' success. Immersion in the case(s) forces attendees to think critically, and, based on the decisions they make, they receive immediate feedback from their colleagues. Such presentations are an excellent way to address common misperceptions about treatments and to reinforce clinical protocols.

#4 Add Punch to Presentations

Challenge.

CME guidelines have always limited the role of sales reps in educating physicians. The new PhRMA code restricts selling venues and tools even further. Still, creative tactics are available that can improve the quality and impact of a sales rep's educational presentation.

Solution. One thing that has not changed is the importance of one-on-one relationships. For sales reps, a good relationship with a local or regional thought leader remains the number-one tactic for the success of local educational programs. Nothing more effectively motivates physicians than peer recommendations, and data indicates that peer-to-peer programs-such as local dinner or lunch programs and "grand rounds" (talks in hospitals)-can affect a company's sales.

Today's electronic media provide other venues for interaction with local thought leaders. Using an interactive CD-ROM program, a sales rep can bring a key thought leader to the doctor's office for a highly credible, topic-driven presentation to physicians and staff. Thus, the expert delivers the key brand messages, addresses common objections, presents case histories, answers questions, and handles patient management tips. When the expert is finished, the sales rep can offer value-added materials and programs such as patient handouts, software, and information about relevant PDA programs.

Sales training is critical in today's restrictive medical education environment. Training programs that are informative, dynamic, and interactive can make a brand's sales force highly knowledgeable in a clinical area, thereby increasing the value of their interactions with healthcare providers. A variety of options are available according to time and budget needs. From live presentations at national and regional sales meetings to audio programs, print materials, full video CD-ROM, or online approaches, training is an important step to improving sales efficiency and value.

Why It Works. The most effective sales tools are those that allow sales reps to focus on important scientific information-information that adds value to physicians' practices by optimizing patient outcomes. Traditional dinner programs and grand rounds continue to be effective, but they are time-consuming and increasingly competitive. Programming targeted to specific practices is a solution that complies with the new PhRMA code, is convenient for physicians, and meets their specific needs.

#5 Breathe Life Into Live Meetings

Challenge.

Live meetings often feel less "alive" than they should. Although they remain the oldest and most common vehicle for medical education, there are many ways to improve the experience for attendees, faculty, and pharmaceutical sponsors.

Solution. Most physicians walk into a live meeting knowing what to expect: two or three 20–30 minute lectures followed by 15–20 minutes of questions and answers. That's the formula prescribed by CME guidelines. However, that is not set in stone. It is possible to shake the audience up by giving them a program format that they don't expect. One way is to start with a panel discussion that includes faculty with divergent views. Another is to start by asking the audience for their input on the important questions, or to stop in the middle of the program and obtain audience feedback on key issues. These are very simple suggestions for keeping attendees' attention.

A pharma company targeting nurses at the American Academy of Nurse Practitioners used that approach to teach new asthma guidelines. During the opening session, the moderator took 15 minutes to gather questions from the audience, including patient cases that they wanted addressed. The faculty then worked those into their subsequent presentations and fielded any unanswered questions at the session's close. Attendees' evaluations indicated that the program addressed questions about asthma diagnosis and management "clearly, comprehensibly, and based on the audience's needs." Most attendees commented that the program was not what they had expected and that they found the format very helpful.

If sponsors desire interactive follow-up after the meeting, they can put it onto a CD-ROM or make it possible for people to download the session from a conference website. However, not all clinicians prefer electronic media; conference sponsors should always offer written materials as well.

Why It Works. Changing a program's format takes a bit more up front time and requires active faculty involvement in the planning. Yet, it is a good compromise to use at traditional educational forums. It keeps the audience alert and involved throughout the session, so they hear key messages. If the budget permits, providing follow-up that includes online interactive applications can expand both the program's impact and the target audience.

# 6 Announce New Data Without a Meeting

Challenge.

Sometimes marketers must present emerging data on short notice, or recently analyzed data may not fit a meeting's agenda. How can they deliver timely new information outside the meeting forum?

Solution. A live, web-based event is an effective way to announce new clinical data, particularly when the information is time-sensitive or when a live meeting is unfeasible. A live web event can have a nearly unlimited audience, with invitations extended by fax, e-mail, and business reply cards. The live webcast also serves as its own enduring material, saved as an archived presentation. That extended shelf life provides a big bang for the marketing dollar. Polling and questioning during the event can provide critical feedback to measure the program's effectiveness and allow viewers to interact live with presenters.

A leading pharma company needed to present breakthrough clinical data on an osteoporosis treatment, but the timing did not jibe with any upcoming meetings, and, of itself, the news was not important enough to build an investigator's meeting or symposium around. The company's cost-effective solution was to support an interactive webcast, maximizing the information's use, reach, and shelf life:

• Healthcare providers received invitations to the webcast, generating buzz in anticipation of the event.

• The event featured an esteemed speaker to present the news.

• At various points during the webcast, participants answered questions posed on the screen. The speaker incorporated the tabulated responses into the presentation, making it more dynamic.

• The company received feedback on physician use of the webcast viewership: the number of participants and who they were.

• The company archived the presentation on the website so future viewers could receive CME credit for watching it.

• In the future, the company may develop a CD-ROM or print piece complementing the program, further expanding the audience reach.

Why It Works. The webcast delivers new data along with the brand's key messages in a timely manner, to a far broader audience, and at a significantly lower cost than a live meeting.

#7 Go Virtual

Extending the concepts presented above, the "virtual meeting" is an excellent way to present new therapeutic information to a broad audience. By showing thought leaders giving slide lectures in a studio and answering frequently asked questions (FAQs), marketers can create an educational experience limited only by their imaginations. Options include an interactive environment such as the "virtual medical meeting" or "virtual clinic," interactive problem-based learning cases, downloadable information, links to other sites, and online chats with experts.

A leading pharma company chose that technique to demonstrate the effectiveness, safety, and positioning of a new treatment for asthma by showing allergists and pulmonologists how the drug blocks the production of leukotrienes. The marketers sought an innovative way to present the data with the greatest impact while allowing physicians to view it from locations convenient to them. To that end, they produced and disseminated a CD-ROM that featured four faculty presentations in a clinic setting, a slide presentation, an animated video demonstrating the mechanism of action, and an FAQ section. Physicians also could elect to take a test following the presentation for CME credit. The company received much praise from physicians for the program.

Why It Works. It is easy to disseminate scientific information through today's electronic media, particularly CD-ROMs, because they are convenient and easy to use. Even with the restrictions imposed by the new PhRMA code, marketers can use this cutting-edge tool to optimize educational programs for physicians.

#8 Adapt Traditional Materials to Current Needs

Challenge.

There is only so much that companies can do to enhance the value of traditional written materials such as newsletters, monographs, and journal supplements. Still, they are a mainstay of pharma medical education. Creative marketers can supplement those tactics to enhance their interest value and reach a broader audience.

Solution. Give traditional tactics a modern impact. Not all physicians prefer to receive the same kinds of information, so it is important to give them options, even with printed material, to maximize usage.

To ensure optimal impact with traditional print materials, marketers can make them more flexible, convenient, and useful to better meet the needs of today's physicians. Pharma marketers should consider providing an online companion, CD-ROM, or even a diskette with slides and lecture notes. Audiotapes or CDs that can be played in the car also extend the range of print pieces.

Why It Works. Companies can achieve significant economies of scale by adding features to a print piece rather than developing two presentations separately. For a relatively low cost, adding bonuses such as web companions or audio CDs to print pieces can increase readership and provide a better value for the target audience.