Corralling Content for Multimodal Continuing Healthcare Education

On this episode of Write Medicine, my guest is Dr. Eve Wilson CHCP, FACEHP (she/her), a medical writer with deep expertise who helped me get started in the field.

While Eve is primarily a creator of continuing medical education resources, she also holds a PhD in microbiology, and uses her analytical background to inform her present-day work. As Medical Director at PlatformQ Health, Eve integrates new learning concepts with the more traditional didactic experiences to design a meaningful journey for the learner that leads to new insights as a result of their learning experience.   

In this episode, we talk about career origins, and the significance of “story” in a seemingly facts-only field. We talk about the creation of curricula, how to find balance variation of content and format, and  how to create and implement multimodal ways of learning. 

Other topics covered in this conversation include how Eve:

✔️ Started in medical writing and what she tells aspiring writers
✔️ Preps for continuing education projects
✔️ Gauges audience needs and adapts content accordingly

Resources

• NBME Item Writing Guide 
• Downloadable Planning Tool for Developing Multimodal CME
• Eve is running a professional workshop on Preparing CME Materials: Concepts, Strategies, and Ethical Issues,  AMWA 2022 Conference: November 4 2022

Connect with Eve
e: ewilson@platformq.com
LinkedIn

Connect with Alex
e: alex@alexhowson.com
LinkedIn
Website

Podcast Team
Host: Alexandra Howson PhD, CHCP
Shownotes: Emma Kolakowski
Sound: SuZen Marie

Support the podcast

➡️ Join WriteCME Pro for ongoing professional development
⭐ Review the podcast
🎙️ Share the podcast
📰 Biweekly Newsletter
☕ Buy me a Coffee

Transcript

Alexandra Howson  00:15

Alright. Hello and welcome. This is Write Medicine. And I'm your host Alex Howson here today with Eve Wilson. Welcome, Eve.

Eve Wilson  00:26

Thanks for having me.

Alexandra Howson  00:28

So as has become the norm for this podcast, let's talk a little bit about how you ended up in the field of continuing healthcare education. And I should say, I've really started to call this field continuing healthcare education, I know there's a lot of different names and titles out there for, for this field. So maybe you can speak to that as well.

Eve Wilson  00:55

So, I first got into the, the — continuing medical education would have been what we strictly called it when I started in the field, but that was back… early 90s was when I when I first got in, and I had come from a background of being a scientist and a researcher, because I have degrees in microbiology, two degrees in microbiology of all things and, and from sort of finding my way from, from the lab bench; which I didn't like very much, to something I thought I could be better at; which actually I think I was really pretty good at what I was doing. But I just wasn't very happy at it. So I went to medical writing… It's a complicated story, how I got there, but I knew it was something I could do well and I was well suited to do and bopped around in a couple of jobs, and then took a job as a medical editor at a medical education company. And that's how I wound up in CME. And I've been around in different work settings. I've been in freelance for a while I've been- worked for, specialty society for a while not as- not in a writing capacity, though. And I currently work for a medical education company. So I've kind of been around the block and come back home or something.

Alexandra Howson  02:29

I love that. And so you've- and I should say that you and I first met when I actually took a course that you, a workshop that you taught, at the American Medical Writers Association on writing in CME. And you've taught aspiring education writers about developing CME content for a number of years. What are the key questions that you get from writers about creating quality content?

Eve Wilson  03:03

Well, that it's interesting, because the hardest question I ever get asked is how do you write medical education? You know, teach us how you write it? And I'm like, my response to that is: you just sit down and write. Yeah, it's a, it's a hard thing to explain. And then the other question that I get, frequently is not do…not really the quality of writing is, is how do I get into CME writing. It's not an easy field to break into. But I do try to teach, you know, hadn't taught that course in a while. But when, when I did, I tried to teach the basics, you know, you know, you know, create your outline, think through your content, do your research, do those kinds of things, and, and just dig in, that's kind of how I work. And I don't know if that's how you work as a writer as well. But sometimes I just jump in feet first, honestly, and approach the topic, sort of, like by immersing myself in it and really understanding it, so that I can write about it. If I were to say that the mistake … I don't, I don't like to think of what other writers do as mistakes. I think it's more what I've observed, is it at least through the writers I've met their AMWA is they come from so many different areas of writing from regulatory to, you know, academic type of writing. And it's, it's a very different approach, I think, to do CME. So I think that that sort of transition, and that getting their heads around how to do it is what probably people who have taken that course struggle the most with and you know, ask them those questions about. Because it's a very different approach to writing to me, with some notable exceptions, because we all we've all done manuscripts, for example, probably, at some point.

Alexandra Howson  05:10

So I really want to dig into some of the things that you've talked about there. The first is actually going back to your initial response or your response to the first question, which is, you thought that you would be suited to medical writing. What do you mean by that?

Eve Wilson  05:29

Well, I've always been a good writer. So I knew that from Miss Fitzpatrick and the 10th grade, or 11th grade, who encouraged me to be a writer, I wanted to be a writer, as a young person, I wanted to write fiction. I don't think I have a capacity for writing fiction, that's a very different thing. I've written a little bit of fiction over the years of, you know, when I was younger, but facts are, I'm better suited to facts. And I also love science and medicine, and biology. And so those are all the things I'm passionate about. And I can even remember I thought about this the other day, I remember reports that I got A+’s on one of them was on the Jumping Spider, the family softest food , and then another one being the California condor. And I was that was, that was Mrs. Fitzpatrick, she thought that was an excellent piece of work. And you know, it's people like that early in your life, when you're trying to decide what direction you're headed in. It may sound corny, but I go back to that when I think about how I ended up on this road, and why I like what I do, and why I'm passionate about what I do.

Alexandra Howson  06:40

And so, you know, one of the other things that you talked about was when you're starting, when you're starting a particular project, and when you're teaching other people who are interested in medical writing, particularly in continuing education, how to get started, part of your advice is you know, dig in immerse yourself, can you talk a little bit about what, you know, in a, in as granular away as you can about what that — what that involves, because I think I think I share that. I tend to, I tend to read really widely, when I'm working on a project, probably much more than then maybe I need to, but it helps me to kind of get into the world of the particular project. And sometimes I kind of come out the other side feeling like, you know, every, every CME project is a mini PhD.

Eve Wilson  07:38

Exactly. And I think, you know, I just have to say that sometimes how much time I spend on the prep period depends on how much time I have, because obviously, this is a very fast-paced world that we live in, me personally, where we're, we're pushing content out, that's, you know, very timely, and therefore very deadline driven. So sometimes the prep work I would like to do, I don't always have time to do but I think what the benefit that we often have in the CME world is, if we're not, if we're working on the implementation side, by which I mean, if we're writing educational pieces, or slide sets for a physician to speak to, or, you know, or different aspects of an educational program; we usually have as a resource, the grant proposal, which is somebody else's mini PhD that they because they developed it as a needs assessment, where they had to really dig in. So a lot of times, that's the starting place for me just to be getting a better idea of what the topic is, you know, what the scope of the project is? What are all the pieces? What is the need behind the education, it is always important to think about what, what's driving the need for that education, what, what deficit is there on the side of the, of the clinician who's trying to treat a patient with a complicated illness. And the needs assessment and the grant proposal also have learning objectives that we’re pretty much wedded to having to go by for you know, if more and more. It used to be we could tweak them and I know very few people tweak their learning objectives anymore. As far as I can tell, it's sort of considered part of the scope of the project, if that makes sense. So those I've always thought of the learning objectives of mine sort of, you know, 1000 foot view, 100,000 foot view of what the, you know, the outline for the program is, is so that's sort of a basic outline. And then, oh, you always have to consider, you know, who are you writing for? Are you writing for experts? Are you writing for nephrologists? Are you writing for primary care, because those are very different kinds of level of content you have to hit. Or sometimes you're writing for both, depending on the program, and one might be, you know, your primary and one might be your secondary audience. But I always say, actually kind of keep it in mind that for most of our programs, we always, you know, almost all of them have primary care physicians or primary care clinicians participating, not that I necessarily accommodate that, if it's for, you know, supposed to be around for experts, but, but I do keep it in mind. And then, you know, I never want to come across that I can do this on my own. So we are always working with experts. And I have had the privilege to work with some pretty, you know, pretty brilliant experts in developing content. I'm not a medical doctor, I'm not a clinician, I don't go into the clinic. Writing things like case studies. For me personally, I can come up with a decent draft, but I really need the insight from the, the faculty that we have involved. So I'm — it varies how dependent we are on the faculty in terms of developing the content, a lot of times it's a, it's a first draft, and then they react; or sometimes they send us a bunch of slides, and we create from there. But it's always at that interaction at some level. I think, you know, that's it. I don't know if I'm getting off track from your question, but

Alexandra Howson  11:43

no, you're off — you’re on.

Eve Wilson  11:47

And then you know, you do what research you need to, to build that story, right, whatever your educational story is going to be. And for me, that's streams of consciousness searching on Google and PubMed and, and, you know, sometimes I'm doing it as I'm going along, sometimes I'm reading a review paper first, to, you know, kind of get to the, near the big picture of what that disease or condition might be. And then I'm checking references, I'm tracking down the pivotal clinical trials, I'm looking for all those things to fill in the blanks, essentially, between, you know, what we've got from our faculty and what we're trying to reach to the end. I'm trying to think what else… and from there, it kind of really depends, I think, on what it is you're trying to produce, if it's, if it's going to be a set of slides, and the faculty is going to speak to it. And then that is sort of a self-limited kind of exercise. But very often, there's more to it, for example, where I'm working, now, they integrate a lot of what they call the patient voice, which is something that adds a, you know, a great element of engagement for any, any kind of, to me any, any kind of medical education, because that's what it's really all about, right? So, um, but you have to sometimes think with a crystal ball in mind if you don't have all your pieces together, like if you haven't yet, there's not a patient interview setup yet, or the patient is still being selected. Or if the doctor is going to bring the patient to you, but he hasn't had time to contact them. So you're trying to think all the time with what, how are you going to fit all these pieces together? And how are you going to make it work? Go ahead.

Alexandra Howson  13:47

Yeah, so there's a lot to pick up on there. The first couple of things that, that I'm hearing really strongly are, you know, the need to be really clear about who the audience is. And you talked a little bit about that. How do you, or what strategies do you use, to kind of differentiate between writing for experts and writing for — primary care physicians are experts in primary care, but if they're managing patients with diabetes, they're not necessarily — that's, that's a bad example, actually, if they're managing patients with, you know, an unusual condition, they're not necessarily experts in that in that condition. So how do you kind of differentiate that you're writing for experts versus writing for a more kind of general need to know, but need to do less basis?

Eve Wilson  14:41

Yeah, I mean, you kind of hit the nail on the head and I just want to comment that yes, primary care clinicians are often experts in diabetes these days because that's where people get their get their diabetes management for the most part, but um, but so, I think it's all about complexity of the content, like what level of detail that you go to. So when you are writing for — use my example of nephrologists earlier, which is an incredibly complicated area, that expertise, and, and I think, you know, nephrologist, neurologists, dermatologist, ophthalmologist, they, they're at a level where I think, and cardiologist, I'm just thinking about the projects that I've done in the past couple of weeks; they're at a level where they want to hear about things like the mechanism of action of a particular medication or that the, you know, the, the granular details of the clinical trials, and that, you know, the, what made, you know, what primary outcome, how significant was the change, and that kind of thing. I think that for primary care, they really want to focus on what is sort of the bottom line. What, what does it mean for them? What does it mean for them when they get into the clinic, so those, but that's sort of the compare-contrast. But I, so I would get much more granular and much more into the specifics of the science, the biology and the, you know, the details of the clinical trials with the experts. Versus we might get, you know, some of that, of course, too, for the primary care I guess, but they want to they want to know how to apply it more. And so I would say that is probably fundamentally a difference that I see. Of course, the, the experts also are treating patients and want to be aware of that, but I, but so we have, you know, it's just sort of a, it's a spectrum. In other words.

Alexandra Howson  16:51

Yeah, no, it's interesting, actually, I was interviewing an oncologist yesterday for a qualitative research project. And that's exactly what he said. He was a community oncologist. And he basically, we were talking about a particular drug. And he said, I'm not really interested in the mechanism of action, I need to know how to manage the toxicities, that's where I am. So you know, that that kind of that kind of applied perspective, which leads me to a second question about how do you get into the perspective and the shoes of the clinician, so the person in the clinic who is actually, you know, managing patients in the day-to-day situation?

Eve Wilson  17:34

Well, the, the best link to that is a carefully constructed case study to me, because then you are thinking from the patient's point of view, and that, I don't know if it makes sense to say that, but that, you know, a lot of work I've done over the years has been, it's as much building content around a case as it is building a case into the content. And sometimes building the content around the case, is really a way to get into the head of not only, you know, get into the head of the clinician, but also think in terms of what the patient's experience is. And you build, like when I say build around that, I mean, you have to, you have to walk through the patient story, but you have to bring in the facts of you know, the treatments and the, you know, the facts of the diagnostic strategy and the facts of the, you know, what the symptoms are? And what is the best management and what are the mistakes in management? And what are contraindications? And, you know, are there clinical trials for, for patients who have certain rare conditions, and you know, sort of keep that all in mind as you're creating this educational piece. So it comes kind of laid, like, laid with details that sort of build on the story of the case, but also build the educational story. And you'll hear I use that, “story”, quite a lot when I talk about writing, because it kind of helps talk about writing.

Alexandra Howson  19:05

Yeah, and it's interesting, because, you know, people who come on the podcast often do talk about the power of story as the glue that is kind of holding together all the different disparate, sometimes disparate pieces of an education, activity, or a program. So I do want to kind of come back around to story. But I am struck by, you know, you said at the beginning of the conversation that you know, fiction is a different beast from writing about facts. And yet when, when we're writing, education content for Continuing Medical Education, continuing healthcare education, we're actually having to use our imaginations an incredible amount in order to kind of make that leap into the shoes of the clinician and the patient. And so, for people who come from a bench[EK2]  background, who perhaps are drawn to this field because of the science, how can they begin to build those story-making and imagination-using skills?

Eve Wilson  20:13

I don't know if I can answer that question. It's, it's a, it's a, it's a soft skill, right? Would you call that a soft skill? I think it's, it's, it's hard to explain how I go about doing that. It's, it's more of a process that I go through. But I — that's — let me think about that just a minute. Mm hmm. So, I think that one of the things, as someone who, you know, was trained as a scientist, personally, I was also trained, an, as an analytic thinker. And I think that that process of thinking analytically, like the whole idea of what is your hypothesis? And what, you know, how are you going to set out to test it? And what are the, what are the data that you're going to gather around that?, are fundamental to the way that I think about almost everything, not, you know, that consciously, but, you know, the powers of observation and, and just attention to detail, those were all I was, maybe, maybe I'm, you know, I have, I'm intuitively like that, but I was also trained to do that. And I think that goes a really long way, in pulling together, the multiple components that you need to, you know, create an effective educational piece. You know, it's, it's hard to explain that it's knowing what to include, knowing what not to include, following a certain logic, you know, bringing together the elements that work and recognizing which ones don't, you know, I’m trying to think of something that wouldn't work. But you know, it's sometimes it's just a matter of the, the specifics of the program, sometimes I don't have any control over what those elements are. But sometimes we're trying to make things work that don't necessarily work well together. And we still have to try to, try to do that. But I, I think it's, it's more about that kind of having that background of just sort of moving logically and methodically and analytically, through the process of pulling things together.

Alexandra Howson  22:53

And I think that's reassuring for people who are thinking about making a transition into, into this kind of work that there, there are, I mean, all the all the skills that you kind of mentioned in relation to analytic thinking are things that you can learn. And your comment about making that sort of imaginative leap as a soft skill, actually, I think you could probably argue that people who are trained in visual and textual arts, do we call them textural arts? Writing, you know, people who come from, you know, who maybe have done sort of, you know, English or English Lit, as their kind of undergraduate degree have that training in imaginative thinking, and, but also, but also in analytic thinking, right, if you're parsing text?

Eve Wilson  23:46

Right. Right. And it's interesting, because I don't think I ever thought quite the way about it as you do. It's an imagination as a as a imaginative process. But of course, it is, I just never really, I don't think I've really thought about it that way before. It's an interesting perspective on it. Because it is, you have to know what to what works to pull together. And that's, that means thinking, you know, thinking in a way that, you know, may be different for every single project, right?  

Alexandra Howson  24:22

Sometimes it feels like that for sure. So you talked about knowing how to kind of pull all the multiple components together and some of that you get from, from experience, right, and, and also making, I will use the word mistakes. I know that I'm better now, you know, almost 20 years into this particular kind of work in being able to identify what's necessary, what's extraneous; than I was, you know, at the very beginning or even, even a decade ago. So that experience and being able to kind of have the kind of experience across different kinds of projects and, and different kinds of goals is, is kind of important. You're working increasingly, it seems with developing multimodal content. Can you talk about what that is? And what some of the challenges are that you see in developing this kind of content? 

Eve Wilson  25:27

Yeah. Definitely, it's, it's, I think that there's more… you know, we work in a very competitive field, and particularly, so if you're working in a medical education company environment, that there's a lot of competition out there to always have the greatest new program or platform or, or, you know, innovation is the name of the game. And, and, and sometimes that really means lots of different elements organized in a way that are meant it like, I can think of some of some, there's, like, adaptive learning is one where that, that's typically a platform where you pull in different elements that all have to fit together, that take the learner through, you know, a fairly sound, you know, there's, there's science behind that; of a process of learning and showing that they've learned and demonstrating what they've learned and self-assessing; and, you know, this sort of cycle of things that, that, that we do when we learn. So that's, you know, that's one approach that it's kind of its own thing. 

I like to go back to this list that I keep of, you know, all the descriptions of education. So, there's the AMA PRA categories of medical education, right? And then ACCME has some categories as well, for medical education. And there, you know, there, we used to think in terms of live activities, and then during activities. And there's also other some more, more didactic stuff like journal based CME, and, you know, things like that, that are sort of like cut and dried. But, you know, in recent years, both of the both ACCME and the AMA have added a category of other to their, you know, right, seven or eight things; new instructional practices, blended, new, or established learning formats; new technologies, such as simulation, adaptive, e-learning, virtual reality, gamification, social media; and so, you know, I think I've worked in programs that have often combined up to, you know, you know, multiple of those, like four or five, including, you know, I remember doing an all-day program that involved like an icebreaker, but it was a learning experience in the morning, and it went to a, you know, a game, and then there was a, you know, there was a didactic session, and then there was a case exploration, and then there were, you know, and, and so, having all of these pieces come together in a way that's not just willy-nilly. But in a way that's meaningful, logical, and brings the learner through a sequence of, you know, activities, where they're building as they go along. And that's how the activity is structured to build over the course of the day. And it's, it's, that's, that's sort of increasingly, you know, they're not always all-day programs, but that's just the most- one of the more complicated ones I could think of. And then in any given, you know, activity that I'm doing in my current position, I have to think with the idea that we're going to, at minimum, pull in polling questions as an interactive element, at minimum, and then we will very likely have a case that's built through the activity with questions attached to the case, which may or may not be polling questions. And we might have an actual live patient or a patient caregiver coming in, that is completely different from the case, but still needs to be brought in in a way that makes sense and is placed properly so that you are building again, building that story from beginning to end. And making a meaningful journey for the learner so that they come out on the other end with something new, you know, so. So those are just a couple of examples of, you know, of what I mean, what I mean, when I say multimodal, I think there, there are other names for it. Micro learning is one I hear all the time, because I feel like micro learning are little, short spurts of learning, right. But a lot of what we do in multimodal learning is really combinations of micro learning activities. Right?

Alexandra Howson  30:59

So yes, yeah, no, I think it's a good way to think about it.

Eve Wilson  31:03

I’m sure that there are people out there, that would probably argue with me a little bit on that on the definition of micro learning and what that really means, but I just offer it as a, as a, as one perspective on when you're putting together these activities where you're trying to take a learner through different steps and different stages and different experiences in one in one, sometimes one hour activity. 

Alexandra Howson  31:28

I mean, I think it's interesting, so I definitely want to have an episode on microlearning on the on the on the podcast, because I'm yeah, um, it's obviously, you know, kind of flavor, flavor of the season to some extent, but, and also speaks to, you know, attention span. And so, yeah. If in your description of multimodal learning, there's a lot going on there, what are you hearing about the potential for cognitive overload in being, as a learner, being exposed to, because as a writer, you're kind of in cognitive overload all the time. But as a learner, you know, being kind of, you know, invited to interact with so many different kinds of activities in, certainly, if it's a one day thing or a half day thing, in a fairly condensed space of time, if the learner can parse that out a little bit, and, you know, do that interaction over time, then that's a different issue. But is that something that you're hearing much about? Or?

Eve Wilson  32:33

Well, I think that you have to, you know, if you, and I'm not always on the designing side of what, you know, what the program is going to be, but I, I do have strong opinions about, you know, how much you want to want folks to do, like in a one day program, I think it's a good idea to mix in, you know, if you're going to have games don't have at all be games, but have, you know, games interspersed with some, you know, more traditional approaches, or, if you're attacking a really complex topic. You know, break it up into chunks, break it into digestible bits, and have, teach some of that via case study and teach some of it just didactically you know, didactics almost has become a dirty word in medical education, I think sometimes, but I think that there's a value to it, because it's just the nuts and bolts, and sometimes if you've got people heavily involved in, you know, you know, sort of this active learning of, you know, choosing a card for the correct diagnosis, or, you know, or, you know, working through a kind of a game scenario that you might want to give them a little bit of break of something a little more traditional, before you move on to the next sort of, in, you know, innovation or whatever it is you're doing in your program. That's the thought. I don't have, I don't have I don't know the science behind that. I just know that it's like you said, it's a lot to have people to jump from one thing to the next thing to the next thing without some sort of break. And of course, people do need a little bit of downtime if you're if you're doing that. So you do have to build in those, that quiet time for people to either take a break or interact with one another in a way that may not necessarily be committed to the education itself, but just an opportunity to, to interact. 

Alexandra Howson 34:40

Rest and recovery. Absolutely.

Eve Wilson 34:44

Yes. Yes. Because I- otherwise it's just going to be a deluge.

Alexandra Howson  34:49

I love the French pronunciation there.

Eve Wilson  34:53

Wait how do you say it?

Alexandra Howson  34:55

in a very Northern European deluge kind of way. The Scottish way isn't necessarily the right way. 

Eve Wilson 35:06

I don’t know if that’s the right way either. 

Alexandra Howson 35:10

It sounds good, it sounds good. 

Eve Wilson 35:12 

We’ll go with deluge

Alexandra Howson 35:14

We’ll go with deluge, I like that. It sounds soft on the ears, gentle on the ears. So just kind of sticking very briefly with, with multimodal education and all the different components that you've been talking about, who in your experience, you know, if you're a writer working in that kind of context, where you're at, you're having to think about and manage lots of different components. Do you have strategies or tools that help you do that?

Eve Wilson  35:46

Well, so can you repeat that question? I want to make sure I, I fully understand

Alexandra Howson  35:53

Yeah! If you're the writer working on a multimodal project with lots of different pieces to it, there's a lot to keep track of. So do you use any strategies or tools to help with I guess, with that tracking and management process?

Eve Wilson  36:13

I should be, I do have tools, I do not always use them, I have to say, like I said, I can be a very feet-first kind of person. I don't know if that, if that makes sense. But I like, I have that strong tendency to just jump right in and start mushing things together and mushing them back out it’s sort of like, it almost is like, it's almost like painting a little bit like you, you make a sketch, and then you add the layers, and then you go back and you move, you move things, and then you take it away, and you get the linseed oil out and you know, you wipe the canvas dry. It's not quite that, quite that involved. But you know what I'm saying that process, but, but I also do, like I like to use when I can. And I can even share this. I shared it at an Alliance meeting in the summer. It's content mapping, which basically is just a, it's just a big chart that gives you the big picture of what are all the pieces. This is this is not original to me, it's a fairly commonly used tool from my experience. So, basically, it's a big table, and it's on, you know, on the, the column on the far left has got tactic one tactic two tactic three, and you know, three different rows, or in so forth, and then a little description of what that is. And then on the top row, it's, there's the learning objectives in one column, and there's key, key takeaway points that, you know, on the next in the next column, and then I even put in there when I can, when I can get it, number of pre/post questions, you know, that will go with each section, like if it's all one thing, you know, and what you know. And that's, so that way everything maps to the learning objective, you know, the tactics map to the learning objectives, match, map to whatever map to whatever is the key teaching points that you want to get from there. And they also map to hopefully, this isn't always an easy thing to do, a particular assessment question, either I say a pre/post, but it could be other questions on the on evaluations, which is a whole topic we haven't discussed at all so far. But I use, I have used this. I'm currently in my current position, I haven't used this, but I have used this in the past on faculty calls, because it helps me organize what I need from them in terms of getting them, you know, up to speed on what we're looking for. You know, you know, if we're asking for content from them, it helps us to assign it out. But it also keeps track of every little bit, right. So it's all in one place. And it has a purpose. Everything has a purpose.

Alexandra Howson  39:44

And it's very, it sounds very visual.

Eve Wilson  39:46

Yeah, it's actually quite very straightforward. So I can, I can send that to you if that would be helpful. It's just it's pretty basic.

Alexandra Howson  39:55

Yeah, no, I think that'd be great to include in the show notes for people who, who might be kind of relatively new to the field. So a couple a couple more questions. Before we, we wrap up. One is you talked about pre/post questions, and we haven't we haven't really kind of touched on that. Do you want to talk about that in terms of the writer’s role in developing outcomes questions?

Eve Wilson 40:41

Yeah, I mean, I think it's sort of a less appreciated aspect of what medical writers have to, have to do. Or as part of their job. And it's, and, and the reason I say that is one of the hardest things I have to do is write pre/post questions that like one of the hardest things that I do, honestly. It takes. Yeah, well, and, and I've also done some training, even faculty training, of, you know, and, you know, I'm sure a lot of people know, some of the basic fundamentals of writing how to write a good test question, and I'm going to not be able to remember the name of the Medical, Board of Medical Educators Guide is a great resource for that, with examples, I believe I got that right. Um, and it's hard. And then it's hard sometimes, because you're working, sometimes with the skeleton of the content and not the actual content. You know, if you're doing a slide set, and you have to write pre/post questions that are supposed to be linked to learning objectives from the grant, so that you can assess changes in knowledge or competence, or, you know, that kind of, you know, those kinds of outcomes that we have in evaluations. You know, again, this could be a whole topic on itself. But it can be really challenging, you know, if what you have is a set of 40 slides, and you have to write, you know, four or five, pre/post questions that are not too easy, not too hard, linked to your learning objectives that have to meet, you have to tick a bunch of boxes when you write those. And so that's probably I think that people, you know, I often get a requested “Oh, can you get us the pre/post questions?” And I'm, like, you know, today, you know, okay. I need four or five hours to write sometimes four or five questions, and then they seem I don't maybe, maybe other people are fast, faster than I am. But it probably it also depends on the content, what content I have to work with, and how, how, how well, I know the topic area. So how deeply I know the topic area.

Alexandra Howson  42:56

So I would agree that it takes it takes time to write those questions. Because, you know, you may have that that skeleton content, but also you need to, you need to think about all the nuances and the different ways in which the question could be interpreted. And if you're, if it's multiple choice, what the, the relevant distractors are, and if you're also having to write a rationale for the question; yes, for me, that's probably longer than an hour question. But I agree, I think it's I think it's probably a separate topic, because there's so much associated with that. Right, to kind of wrap up your question? 

Eve Wilson  43:40

Oh, sure. I just want to add that I think it's an increasing, increasing, increasing. It's a hugely increasing emphasis of medical education, to, to prepare you to have created those, those evaluations that measure all of the things that, you know, require by ACGME standards, but also increasingly, the people who support education, the, the people who provide us grants are increasingly concerned about the le- quality, and the levels of outcomes that they are getting from their education. And I think there's, that's because there's pressure on them, to demonstrate to, to their, you know, people to other people that support, you know, at the supporters’ side, the legitimacy of medical education, you know, sort of gets the whole, you know, what is the value of it, and there's more and more emphasis, which means to me, we have to pay more and more attention to the quality of what we're doing.

Alexandra Howson  44:42

And so in that vein, what are some of the best resources that you've seen to help writers in particular get the support they need to develop their skills to write quality content for continuing medical, medical education, continuing healthcare education?

Eve Wilson  45:01

I mean, I, I, I don't know if I can answer that. And AMWA- I think still, American medical Writers Association offers topics on continuing medical education, I am not 100% certain if they have offered a CME workshop in the last several years. 

Alexandra Howson  45:45

I know there are different courses that have popped up now in academic settings, such as a University of Chicago Graham School has professional certificate- certification on medical writing and editing. I think there's a couple of others, university of San Diego I think, or University of California, San Diego, I think has a similar type course, there might be another one over in Philadelphia, somewhere, but I'm pretty sure I'm not really familiar with the content, I'm pretty sure that none of these courses really focus on you know, skills for developing pre/post questions I think the one at San Diego is CME focused, I would have to kind of check that that out. Yeah. But the very fact that we are- that you and I are kind of struggling a little bit to identify bonafide resources to support writers kind of moving into this field is I think, is probably itself telling because we're, we're both pretty embarrassed. It's fair to say

Eve Wilson 46:55

Yeah. Yeah

Alexandra Howson 46:48

So that's interesting.

Eve Wilson 46:57

So I wanted to look it up and make sure I said it properly. It's ,it's not the Board of Medical Educators, it's the National Board of Medical Educators, I think, one second.

Alexandra Howson  47:09

And I can check that.

Eve Wilson 47:11

Is it National Board of Medical Education, or Medical…?

Alexandra Howson  47:17

I'll check it Eve, don't worry.

Eve Wilson 47:19

It is. I think it's National Board of Medical Educators. [Note: The organization’s name is National Board of Medical Examiners]. And they have a resource for test writing test questions that I have relied on multiple times, because I've had to, I've also had to not only write questions, but train faculty to write questions for like, there's self-assessment programs in there for their various medical associations. And there- that can be I mean, some of the, some of the, there's sort of two things about that, that writing, writing for self-assessment that something's going to be used to train. You know, medical students or people coming through the medical training cycle, at their various institutions, those kinds of assessments, I think are written at a higher level than is really necessary for, you know, I don't want to call it ordinary, but for day-to-day medical education, so but so those there's a very high standard that's set by the National Board of Medical Educators. But it's also really great advice, in terms of just basic steps of walking through writing test questions. I was just trying to think of so I'm, you know, I had really no formal training as a medical writer, other than I was trained as a researcher to write papers and trained in, you know, college and even as far back as high school, as I mentioned, is, you know, what the, you know, an organized approach to writing clear and concise writing. I've taken a number of courses through American Medical Writers that were very helpful in terms of, you know, just the basics, basic writing skills, and even I think, you know, putting together a set of slides as well. It's been a while since I did anything like that, because I've been doing it for a while for such a long time. But I think those resources are still there and can very much supplement what it is. You know, there's some basics to writing that applies across all types of writing in other words.

Alexandra Howson  49:28

Absolutely.

Eve Wilson  49:31

And I think some of that can't be learned.

Alexandra Howson  49:35

Yes. Yeah. I mean, I interrupted you there.

Eve Wilson  49:39

Well it was because I keep talking. I just keep going on. But I, I think that writing is a talent, but it's also a skill and it that can be trained and improved. So I think it's a combination of that.

Alexandra Howson  49:58

Agree. 100%. And also, I think it can be, can be really helpful for writers who work in this field to try other kinds of writing and hone skills in other kinds of writing because there's a cross fertilization there just in terms of developing your capacity for communication and being really clear about word choice and those kinds of things. Is there anything else we haven't touched on that is, you feel is really important to support quality writing, in continuing healthcare education.

Eve Wilson  50:40

I think I will fall back. And I may have already said this is that the work that we do, and to me it is, for me is a collaborative effort, I am not I said this, I'm not a clinician, I do not walk the halls of the hospital, unless there's an emergency in my family, God forbid. But, um, so I think it's really important to keep that idea that you're collaborating to create the content, it's, it's, it's both a little challenging, but also kind of comforting to know that you don't have to know everything. It also can be really challenging, working with some faculty who are, you know, are, you know, clearly brilliant experts, and don't have a lot of spare time. I take it as a personal challenge to impress them with what I can come up with. And, and that's sort of part of the process for me, but I think one of the things I really do find I like best about medical education, or whatever it is, we're calling healthcare professional education, is that I get to collaborate with these really bright people and learn something new every single day. So yeah, maybe I'll finish, finish off with that.

Alexandra Howson  52:00

Dr. Eve Wilson, thank you for sharing your expertise with us. I've learned from you. I learned from you right at the very beginning of my entry into this field, and continue to do so. Thank you.