Write Medicine

Entertainment and Edge in Education for Health Professionals

May 07, 2021 Alexandra Howson PhD
Write Medicine
Entertainment and Edge in Education for Health Professionals
Show Notes Transcript Chapter Markers

Introduction
Monique Johnson MD is the Medical Director at Physicians' Education Resource and has more than 20 years in the CME field. Monique shares some of the challenges clinicians face when they're in the healthcare industry, why she's passionate about having better education within this field, and how to overcome common structural barriers in healthcare that block health professionals from learning.

Chapters

[02:03] A little bit about Monique and how she got started in the medical education field. 

[06:37] Monique shares some of the challenges she had on the administration side of things when she was in the medical field. 

[11:20] Monique gives an example of how education can address structural healthcare barriers. 

[14:54] Some 'common facts' that medical professionals use and reference all the time can actually be outdated or flat out not true.

[18:00] The value of education on social determinants of health.

[21:40] What has changed in 2020 and 2021 on how to best approach training clinicians? 

[27:22] How should the CME industry best help their clinicians?

Resources
Williams DR, Cooper LA. Reducing racial inequities in health: Using what we already know to take action. Int J Environ Res Public Health. 2019;16(4):606.

Brewer LC et al. Association of race consciousness with the patient-physician relationship, medication adherence, and blood pressure in urban primary care patients.  Am J Hypertens. 2013;26(11):14-152.

Connect with Monique: Gotoper.com & LinkedIn
Connect with Alex: Thistleeditorial.com

Podcast Team
Host: Alexandra Howson PhD
Sound Engineer: Suzen Marie
Shownotes: Anna Codina

SUMMARY KEYWORDS 

cme, clinicians, people, education, patients, pediatrics, cma, outcomes, social determinants, healthcare, facts, company, question, learners, related, talking, changed, physicians, health, medical education 

Alexandra Howson 05:51 

Hello, and welcome to Write Medicine. Today, I'm talking with Monique Johnson, medical director at Physicians’ Education Resource. Welcome, Monique. 

Monique Johnson 06:01 

Thank you glad to be here. 

Alexandra Howson 06:03 

It's good to see you. I like to start these conversations with learning a little bit about how you found your way into continuing medical education and continuing professional development. I know you have a long kind of expertise in--as a clinician, so it would be great if you could share a little bit about how you find yourself into this rather subterranean world. 

Monique Johnson 06:31 

Absolutely a question that's common in the CME world, because almost none of us at least when I started about 20 years ago, you know, came into it like as a career path out of college. Most of the people in it now my colleagues, my contemporaries that are working alongside me, and various aspects of CME were either--a lot of them were physicians, nurses, pharmacists, and I'm speaking specifically about the content development side of CME versus the administrative and accreditation parts. But I got started, of course, you know, we all and see me really love science. So I have an undergraduate degree at North Carolina State University in biochemistry. And that was, you know, very instrumental in just kind of getting me turned on about science and not just the end product of maybe a product therapeutic agent, but just like the molecules down to the molecular level. So I have that interest. After that, went to medical school, did pediatrics and then decided I really wanted to be in education. But practicing day to day pediatrics was not what I--it didn't live up to what I was expecting in a lot of ways. 

Monique Johnson 08:41 

So after medical school, I did pediatrics residency. And in the day to day practice of Pediatrics, I found that it was a little disillusioned. I felt like I wanted to do more patient care, or be an administrator, but not both. And I, it was a time when I was practicing and which was Ohio, was going through the whole managed care transition. And of course, transitions and changes are hard. So it's a little just it was the timing was very important too. But at any rate, I decided I wanted to do something else with my education and I had no idea CME existed, or even medical education beyond CME and that for that matter. But I landed back from Ohio into North Carolina and discovered through friends, actually a publishing company that published medical education and the target audience for that was pharmaceuticals sales reps, and they produce curricula that taught those folks how to think about the therapeutic area they were in and the disease state. And of course then the pharmaceutical product they were interested in. So I did that for a couple of years. And then of course, that group really trained up people and another local group actually obtained a lot of people that work there as kind of a career advancement step--was mutual. It was beneficial for both. And so I landed at a CME and an ACCME accredited for profit CME company, called Cienta Healthcare Education and really grew they--It was a small group. It was before right before the firewall, the--the kind of early stages of commercial support standards for commercial support. Let me start that over. If you can note that. So let me reset. So after I decided I didn't want to do the daily practice of Pediatrics, I landed back in North Carolina from Ohio, and decided I wanted to do something with my education. I didn't know education existed in this realm, and certainly not anything about CME. But I landed at a publishing company that produce materials for pharmaceutical sales representatives, which basically taught them about the disease state--the therapeutic area, the therapeutic agent they were responsible for. It was pretty fun. It was a small group, I learned a lot about educational design, and curriculum development. And then from there transitioned to another company, which was the first CME company I worked with, it was a for profit accredited by ACCME medical education company called Cienta Healthcare Education, small group, we went through self studies and all the things that get accredited. And I really got my, my entree into see me in that company because we were small. I had, we all did everything. I mean, there was not an accreditation person only or an outcomes person only. I still did content development. They are primarily but we had a group of five that worked on being a CME company. So everything from writing the self study together to get to stay accredited and to get exemplary accreditation, I'm happy to say, to deciding how we're going to report outcomes and a lot of other aspects of doing education for CME purposes, for accredited CME purposes. We did it all. So I got a little taste of all the roles in a CME company, not just content development are not just accreditation or not just outcomes. So that was pretty exciting. And a pause again, because my phone's going off again, do you? 

Alexandra Howson 13:49 

No, that's okay. That's good. I did want to jump in because she said some things that I thought were really interesting. One was, you obviously moved around a few kind of little companies early on, and I feel like somebody needs to do some kind of sociogram to map the interrelationships between some of those early CME companies and the people working with them and track where everybody kind of ended up because it's, you know, it's, it's, it's, it's a common thread in a lot of people's stories about how they got into CME. I'm also curious. You mentioned Ohio, whereabouts in Ohio because-- so I actually grew up in Chillicothe, he, you can tell from my accent. But interesting. We left when I was eight and I've spent most of my life in in Scotland. So I I kind of know that area. I you know, I have family in the Cincinnati area. So it's, it's interesting. 

14:50 

Yes, yes. 

Alexandra Howson 14:52 

So you trained as a physician, you ended up in pediatrics. That didn't quite fulfill your notion of, of what clinical practice ought to feel like or look like. Can you talk a little bit about what some of that disillusionment was? What were the parts of clinical practice that were, that didn't meet that expectation? 

Monique Johnson 15:22 

Certainly, at that time, I think it's a little smoother now. But at that time, the day to day of taking care of patients in the clinic setting style patient clinic setting, involved a lot of deciding if you could prescribe an agent based on a insurance the patient had, rather than what they really needed the most, or what was really bad, the best therapy for them. And also, you know, spending time really negotiating with insurance gatekeepers. Now, you know, I certainly am about cost containment and management. But it became time consuming to deal with a lot of the administrative things related to managed care and insurance reforms that were just very new to everybody, including patients and offices. And that I was so early out of residency that I just thought, maybe there's something else. The other thing, which is all the things that I knew were, I think they call them social determinants of health. So you know, I would get kids that had asthma, and they would basically have a therapeutic ride in the car, meaning the house was smoky, they had an asthma attack, but by the time they got in touch with some fresh air, and took that ride in the fresh air into the emergency room where I saw them, they were much better, yet I knew I would treat them and send them back to that same environment. And that just didn't feel good. I know, it's a reality of life. But certainly your career has to kind of match with your personality. And sure what, what makes you feel fulfilled, and I was very unhappy, that I had to kind of send kids back to situations that they came from, that were not helping their health or even detrimental to it. So that was a big part of it. The third thing I would say that I see a lot is social related, meaning I love and thank goodness, we have medical social workers. But as a clinician, and maybe, maybe this is a chance to address it. But as a clinician, I didn't get training our tools on how to do that. You learn the ones that you need to to get patients where they need to go for the most chronic illnesses. But I, I just didn't feel equipped, or know how to get equipped to deal with kind of the social dynamics of, of patient care. 

Alexandra Howson 18:22 

Oh, that makes so much sense. When you think about the history of not just medical training, but nursing training, I trained as a nurse, many decades ago, social work, all the kind of related professions. You know, although some schools have moved toward a more interdisciplinary model, we still have this kind of siloed experience of training at an undergraduate level for doctors and nurses and, and I guess pharmacists, too. So I'm, I'm interested how much that is from your perspective, how much you think that has changed in the clinicians you deal with in your everyday work, the learners that you see? 

Monique Johnson 19:16 

Right, I definitely talk to learners a lot, we get a lot of feedback in other ways, and it definitely has improved a lot, you know, down to the fact of, even as I'm writing grants, which is part of my role now, for CME to be funded and proposed. We have learning of--Texas say, you know, incorporated a multidisciplinary approach to name the disease. So when it gets to that level, you know, that it's really important to really all the stakeholders, and you know, that it's pervasive. So I think since the time that I practiced It's definitely gotten better, within really even the smallest to the largest hospital system. I also serve on the Board of Trustees for my local healthcare system. And so we talk about these things as well. And it's definitely a high priority to reach out to your colleagues in other disciplines and help get these patients where they need to go. And it's not all, you know, therapeutics, it's a lot of support. 

Alexandra Howson 20:34 

Right, and the thing that that hasn't changed are the social determinants of health. And in fact, in 2020, in particular, we've seen just how, excuse me, how unevenly spread those social determinants are in terms of race and ethnicity and socioeconomic status, and so on. I guess that that kind of raises a question. You know, I think one of the things that comes up, and you kind of alluded to it in CME CPD a lot is is there a role for education to address these structural issues that individual clinicians can do very little about? Of course, they can, you know, we all as individuals can address what is in front of us at an interaction or on a personal level. But, but how can education really dig into some of those very durable structural issues? 

Monique Johnson 21:49 

Absolutely. And you know, I battled with this question. I was a little more...more--had a different opinion about this, answering this question for myself earlier in my career, because we know we'd get ideas for doing a program on something and or a gap, a gap in care, a gap in healthcare in some way that I was, I was very easily or very prone to in a good way, I guess. Let me start that over. I really appreciate this 

question, because it's one I grappled with earlier in my career. And I must say, at that time, I was new to this concept of CME and really could quickly look at a gap in healthcare and say, yep, I believe that's addressable through education, or that's a health system barrier that is best addressed maybe another way. I still somewhat feel that way. That indeed, healthcare is a system, it has lots of moving parts, everything is not adjustable with education. And even if there's a component of that, some things are just better addressed. If you want more bang for your buck, and you want speed and rapidity, speed and it being quick to implement education, education’s not the first thing you might do. So um, but I do think education has a role in the structural issues, because a lot of them exist a lot because of lack of knowledge and lack of education. And I do consciously say, knowledge versus perception or feeling or stereotypes--there are actual knowledge gaps related to how to think about social determinants of health and racial disparities in healthcare. So, you know, you first have to dispel the myths by giving solid knowledge, but then from address after, after dispelling myths and getting the right facts in front of people. They of course, next have to believe the facts. And believing and embracing those facts is more likely a role for something beyond education or different than education, more awareness and championing and other kinds of strategies that get people to take the facts that are now laid out through a knowledge based approach presentation to them, perhaps to doing something with it. And so I think that's, that's my answer. 

Alexandra Howson 24:43 

That's such an interesting answer. And there's so much there. One is that some kind of implicit connection I think you're making between. Like that relationship between knowing and acting, there are intervening variables. And some of those variables are about belief, and attitude and emotion. And the way that you know, emotion can derail your implementation of something, you know, to be true or factual. And that, that that happens as much for clinicians as anybody else, even though clinicians may be rationalists. In the work in the work that they do, 

Monique Johnson 25:31 

I totally agree with what Yeah, everything you're saying. 

Alexandra Howson 25:36 

It's interesting. But I wonder if-- so I wonder if you could, could you give any examples of situations where you're faced with a structural barrier, or health system barrier, and education and myth, displacement, or dispelling is definitely needed as part of moving forward with education. 

Monique Johnson 26:06 

Certainly. It recently came up in a CME activity I developed with a clinician, a cardiologist, who is actually the past president of the National Association of Cardiologists. So he's really into, you know, the clinical science, of course, but also, patient awareness, clinician awareness, the whole--everything it takes to make people; African Americans have healthier hearts. So he's in a club and all of that. So with the program that was on vascular disease, and he talked a lot about just the sheer facts, that even though we hear things like African Americans have higher risk of cardiovascular poor outcomes, and even here that women have been underappreciated in the past for heart disease, as you know, men have heart attacks and not women. And so even among clinicians, you know, they're just these thoughts are beliefs that are based on information that we feel to be true, because we're rationalist, as you said, but you know, either those data have changed, the trend is switched, which happens in healthcare over time, or we just feel like we know that we have the facts, and we just don't have the right facts. So we went did a lot about just saying, the things that people thought about putting data behind the things that people knew that there is a higher risk, and African Americans are having poor outcomes, of having having the disease of at all--having amputations due to it if they if, if it gets worse. Higher risk of when it's a comorbid condition with diabetes, and other other things and hypertension. So I think, you know, refreshing and, and this is the thing about medicine is you learn it, but you have to keep it fresh, you have to relearn it later, see what's changed since the last time you learned it. And so, while some knowledge based activities are not so 100% new information, you need reinforcement, which is of course, one of the concepts in CMA, you teach it but you have to reinforce it. So we reinforce some things people, you know, knew or--maybe they felt about disparities among African Americans related to vascular disease. But we also, you know, touched on other areas that are becoming more that are linked to race, but are not primarily race, which is like, rurality. People in rural areas versus urban areas, and, you know, I guess we, we need education, because we don't always think of all the, all the characteristics people have, they have, you know, their ethnicity, their their genetic makeup, their phenotype, but then they have the genes that relate to an ancestor. But then they may have grown up in a different kind of community than their estrus ancestor dictates. And they may be a different, you know, gender or, you know, not ascribed to selecting a specific gender. There's all these kind of buckets and I hate kind of that word--it’s not my favorite word--but you know, every single individual has all these categories associated with them. That’s not to say label, but because we do data, we collect data based on these labels. We need to say, you know, what group has science said might benefit most from this versus that. And I that's, that's the value In the education about social determinants of health, is that when you see a person, you're trying to predict their risk of having a bad outcome, you're trying to increase their probability of having a good outcome. And if we have data based on some markers about a person, some characteristics of that person that helps you predict who's gonna, which patient in front of you is going to get should get this versus that, then I think that's the value of thinking about social determinants. 

 

Alexandra Howson 30:42 

That is such a layered description, and I use the word layer deliberately, because you very beautifully layered all the pieces that we experience as individuals, as, as we live, all those layers, but as a clinician, you have to pull out what you're saying is the most relevant layer in order to manage the part of the person that's in front of you. 

Monique Johnson 31:14 

I totally agree. And you know, I will caveat this a little bit because, you know, if it's, if we truly don't have data, or at least strong anecdotal evidence, or even some degree have a strong feeling about you know, when I say these kinds of patients, I, this tends to be what happens to them. But no one's ever really, which is, I guess it true, truly anecdotal, but no one's published it or written it, it's just kind of shared oral history in a way. I think when we have those data, it is important to have these categories of kind--of the kind of patient you're looking at. I will say, though, you know, to balance that when we don't have those data, we have to be careful about labeling people, if there's no point yet, so I just wanted to throw that in there. I don't know if that helps describe what I'm saying. 

Alexandra Howson 32:20 

Well, it's a double edged sword, isn't it? I mean, you know, when we're talking about health and healthcare disparities, a lot of the early work--I'm thinking of people like Ronald Epstein and Lisa Johnson, I think her name is...I have to--Lisa Cooper at Harvard. A lot of the early work was really on patient provider communication. And the way that between largely African American patients and Caucasian clinicians and the ways in which those labels worked against patients, because they would not be heard by clinicians, because of the label, the label just gets in the way. But I don't want to impose Is that what you were talking about? Or kind of related to what you're talking about? 

Monique Johnson 33:13 

Yeah, yes, yes. Yes. Use labels when they're beneficial. Don't use them when they get in the way and are not helpful. 

Alexandra Howson 33:21 

That’s a quote Monique. I love that. So I'm conscious of your time. What has changed in 2020, about how you approach educating clinicians? Because the whole industry as a whole, the whole world has been disrupted, and industry in particular. 

Monique Johnson 35:12 

Yes. Okay, here we go. I think in 2020, compared to maybe 2010 and earlier even, we have seen changes in some fundamental ways that are mostly good. One is we have come further and recognize that healthcare is a system that involves more than just physicians. So there's been more of a focus on involving all the disciplines: nursing, pharmacist, therapy, whether it be physical, occupational, all kinds of disciplines. And that is even reflected in the fact that the alliance to which a lot of CMA professionals belong to, which has changed this name to ACEHP which, you know, HP got into play, because that's healthcare professionals. It's not just doctors. So, it's definitely been embraced that, you know, doctors are not just the only players in this field that can help patients have better outcomes, in fact, may be not, may not other disciplines may be more influential on actual patient outcomes than physicians in many, in many ways--in many cases. So that's one thing. The second thing I would say, in general, is that we have become more socially aware. And certainly, and this is kind of reflecting on some of my answers previously, become more aware of the social determinants of health, which is, as you probably can tell, one of my passions for learning about and teaching others about. And so we've definitely incorporated more of that into CME and medical education in general, in medical school curriculum, I work with people on the ACGME which is graduate medical education. And so I know that that's happened in that space as well. And then the third thing is really related to just 2020 in general, but also specifically the COVID pandemic is that we have had to pivot and luckily, a lot of CME companies at least once I've worked for, in the MEC which is medical education, communication companies group understand me, I'm not sure about though, you know, academic CME, or societies. But certainly we have pivoted, and certainly embraced technology very well. Luckily, a lot of CME companies had done that before offering, many are high, the high percentage of their overall activities were online, already before, before the COVID pandemic started. But we've definitely embraced newer platforms, thinking outside the box about how to use zoom differently, because now there's zoom fatigue. And so again, you know, we've got to make it more exciting or, or just, you know, find a way to make it more engaging. So pivoting at to really embrace technology rapidly has been really important for a really important change and innovation that we've had to do in a year, basically, but it's definitely been a fundamental change since, you know, years just before 2010. 

Alexandra Howson 38:52 

And what resources and support did you and your company have in place to, you know, allow that pivoting in 2020? 

Monique Johnson 39:03 

Well, you know, that I'm lucky to be with a company I am with, because they are really a very technology forward company. And you know, for example, very technology forward for having our own on site studio, so that collisions come to that studio and do recordings, like they're on NBC, or per se, on nightline. So, you know, they were--I think that the tools and resources that we had in place even before COVID were really extraordinary. But we certainly had to think about outside vendors to help because now we need to do more things online and growing takes time. So we've had to seek out and recruit other technology vendors, we've had to build even more solid relationships with our current technology vendors. And these are mostly the vendors that help us get the content out to the audience. 

Not necessarily develop it, but to get it completed to get it broadcast somewhere out there, to the learners. And so that's been very interesting and fun. We've also worked with, you know, gamification kind of ideas to make it be a leader whenever--we have a leaderboard, so an activity where they ask questions, and you put your initials, and they'll just like on a video game, there's a leaderboard, that you get scores and points for things. And that was quite exciting. And the faculty loved it. The audience loved it. It was pretty simple technology wise to do. Um, you know, just it's basically take your ARS and just making sure it makes--it calculate some points and showing it, you know, updating every time they answer a new question. I may pause, I forgot the question. 

Alexandra Howson 41:10 

We were talking about how, when we're talking about how 2020 has changed, what pivot has allowed that to happen in your work? 

Monique Johnson 41:24 

Yeah, so use that but what I had in place. So what I think in order for the company I'm with now to pivot quickly, and be nimble in getting what needs to be done in a different way, given COVID; one of the things is having an onsite studio is very valuable, having very trained technicians for that studio, having graphic designers. And of course, the theme here is what I'm listing is that these people help get the CME education looking and feeling inviting and enticing to the learner, and then also getting that out to the learner. Because...because you can create it-- 

Alexandra Howson 42:14 

Yeah, you gotta have distribution channels. 

Monique Johnson 42:16 

Yeah. So the distribution channel partners that we trusted were very helpful. I think those are the tools that really helped the distribution process. 

Alexandra Howson 42:30 

Thanks for sharing that Monique. Two short questions. What are some of the things that should change in how the CME CPD field educates clinicians as we kind of move forward into--I'm not going to say post COVID, I'm going to say COVID challenged world? 

Monique Johnson 42:55 

Do you want me to include things that don't relate to COVID? 

Alexandra Howson 42:59 

Yes, whatever you're seeing from your perspective. 

Monique Johnson 43:07 

I think CMA has certainly come a long way and continues to be a very revolutionary state, which is a good thing, evolving constantly. And that's what makes it exciting for me, I guess I would say the things that you know, should change or my wish list for CME would be that it strives to be a little more 

engaging in the online format. Really thinking outside the box, really using examples from other media types, media outlets, and you know, I certainly this is, you know, these are patients, this is patient care, it's very serious. I don't want to minimize that. At the same time, we are a culture of needing some degree of being engaged and entertained. And so I think CMA could learn a lot from using kind of the entertainment industry, and some some tips and tricks to just add a little bit of, you know, edge or intrigue to things to make it be more engaging to learners and want them to tune in to on to this particularly to online, live things. The other thing I think that CMA should have on my wish list for CMA going forward is-- I think that's what I want to say about that, that the biggest thing I wanted my big one the number one thing on my wish list is that you do that over. Yeah, number one thing on my wish list--so what I want to communicate is what the number one thing is that it used technology to become more engaging to learners. 

Alexandra Howson 45:59 

So entertainment and edge. 

Monique Johnson 46:02 

Entertainment and edge. Being provocative and intriguing. So the mystery around it. 

Alexandra Howson 46:10 

Okay. I think we need to have a follow up conversation about that. How can listeners find you? Yeah, just if people want to get in touch with you, I should say. And you don't have to spell out your email address right now. All that stuff. Just say they can find you an email or social media, whatever. 

Monique Johnson 46:44 

I can be found on LinkedIn, which is probably the most convenient place for me to be reached out to No, stop stewing over. I can be found on LinkedIn. I'm also certainly available by email. And social media wise, I am on Twitter with a dedicated CME account there. 

Alexandra Howson 47:25 

Wonderful. Dr. Money Johnson, thank you so much for spending time with us today. I appreciate it. 

Monique Johnson 47:33 

Thank you. 

 

Monique's journey into CME/CPD
Disillusionment with clinical practice
How can education address durable structural issues?
You have to keep refreshing what you learn in medicine
The value of education on social determinants of health
What's changed in Monique's approach to clinician education in 2020
Some of the things that should change in CME/CPD
Key Take Aways