Indian Pediatrics 2001; 38: 987-993  

The Art and Science of Conducting a Continuing Medical Education Program

Mukta M. Jain, Salim A. Khatib, Arvind Shenoi, H. Paramesh

From the Department of Pediatrics, Lakeside Institute of Child Health, 33/4, Meanee Avenue, Ulsoor, Bangalore 560 042, India.

Correspondece to: Dr. Arvind Shenoi, 3E, Crescent Court Apartments, 8, Crescent Road, High Grounds, Bangalore 560 001, India.
E-mail: [email protected]

Medical practitioners need to update themselves frequently as radical changes are occuring in the practice of medicine with the advent of new technologies, changes in health care delivery, changing demographics and patterns of diseases. Continuing medical education programs (CME) are organized for acquiring the skills and knowledge that the new trends in health care demand; and to motivate doctors to improve their perfor-mance and adopt continuous learning. CME also acts as a vehicle in plugging the gap in knowledge that has supposed to have developed over the years(1) between the medical personnel and the changing health care patterns. The aim of any type of education system is to provide maximum benefits to the respondents. Similarly a CME also has to have a method for effective communication to improve the quality of learning and provide an opportunity for improvement. The CME should be organized in such a way that it encourages questioning, reflective and creative thinking in the delegates. Organizing a CME to meet these ends requires skill and adequate planning. One of the authors has been organizing CMEs in Bangalore for the last 18 years. Despite so many CMEs being conducted each year, there are no published guidelines regarding how to conduct one. This article tries to provide an overview of the organization of CME in ten simple steps (Table I) and also attempts to throw light on the practical difficulties faced.

Organizing a CME requires preparation months ahead of schedule. The first task is to identify a core group of dedicated and reliable individuals, who will work towards organiz-ing the CME. These members have a list of tasks ahead of them like charting the scientific programs, arranging the details of local hospitality of guests, accommodation, venue, audiovisuals and catering. For better function-ing and improvisation the same groups form sub committees each of which is then delegated specific responsibilities. One or two key persons share the responsibility of coordinating between the sub-committees and this mantle usually falls on the Organizing Secretary. The second task is to define the theme of the CME. The speakers and topics need to tie up towards the central theme. In addition a fair mix of lectures, demons-trations, panel discussions and symposia are essential to make a CME appeal to the audience.

The third task is to identify the target audience of the CME. The audience could either be post-graduates, practicing pediat-ricians or sub specialists in a particular field. The scientific committee needs to formulate the program to suit the delegates. Often most CMEs have a mixed audience, hence the program also tends to be heterogeneous. The most difficult task is to estimate the approximate cost and arrange the requisite funds. The onus of raising funds collectively rests on the core-group who devise strategies to meet the same.

TABLE I–Ten Steps to Successful Organization of a CME

Before the CME

 1. Form a core committee or team

 2. Decide on theme, target audience, speakers and venue

 3. Draw up a budget, and fund raising plan

 4. Finalize details of scientific content, venue, catering, accommodation, reception and travel of delegates and speakers.

During the CME

 5. Run program on time

 6. Enhance time spent on scientific discussion

 7. Encourage interaction

 8. Elicit feedback from audience

After the CME

 9. Audit the accounts and scientific content

10. Provide guidelines and tips for further improvement for the next CME.

The prime task for the organizers is to raise funds and earmark the budget for expenses. In most CMEs the chief expenses are related to travel and accommodation of the guest speakers, rent for venue, audio-visual arrangements and on catering. For a single day, in a major metropolis like Bangalore this works out to be around Rs. 50,000-75,000. To offset the costs, options of funding have to be found as only a third of the total cost is met by the delegate’s fees. The tariff set in a city like Bangalore is usually around Rs.200/- per day for pediatric CMEs. The reception committee normally pays a little more. Post graduates, who are the major beneficiaries of these programs are usually given a concession and are charged only a proportion of the delegate fee. It is worth debating whether this should continue. A recent survey conducted by us suggests that the delegates are unwilling to pay more(2). Low delegates fees and the concession given to the post-graduates ensure that the onus of collecting funds on the orgarnizers is high. The traditional methods of collecting funds are by pharmaceutical sponsorships and advertisements in souvenirs. Both of these have their drawbacks as highlighted in a recent article(3).

The organizers usually draft appeals which state the requirements for sponsoring different aspects of the CME like the lectures, lunch, banquet or other specific programs.

Pharmaceutical sponsorships are obtained by providing marketing space for advertising their products either in the form of hoisting banners at strategic points or through allotment of stalls where the products could be displayed. It is assumed that companies gain by such advertisements. The influence of drug firms on the CME programs has been aptly described in a recent article(4). Sale of commemorative items are also one of the means of raising funds but sale of commemorative T Shirt at a recent CME failed to evoke response. Souvenirs are brought in to incorporate advertisements and collect funds from non-pharmaceutical sources. Other avenues, for collecting funds are through contributions from organization including Medical Council of India, leading corporate hospitals, local universities, Indian Council of Medical Research, National Academy of Medical Sciences and local scientific bodies. A proportion of the budget is raised by generous contributions from the philanthropists. Inspite of this, most office bearers feel that it is becoming increasingly difficult to raise funds through these avenues. Perhaps we need to develop more innovative methods of raising funds for CMEs or alternatively increase the delegate fees.

Two kinds of venues are preferred - auditorium in hospitals or hotels. Auditoriums are convenient as they are well equipped, have congenial atmosphere for learning and can accommodate larger groups. However, they require separate catering arrangement to be made. Hotels have ambience, but audio-visual aids have to hired. The hotel staff have to be trained to meet the needs of a CME. Some hotels in a metropolis like Bangalore have however become adept at handling conferences and do a fine job, but at a price. The significant advantage is that the hotel handles catering requirements.

Delegates at conferences abroad have to fend for food on their own which is in direct contrast to the precedent set in our country. Delegates here do not often tolerate inconveniences in relation to food. The organizers are faced with a task of providing variety of food both vegetarian and non-vegetarian, depending on the taste of the audience, local availability and cost involved. In any IAP-Bangalore CME, a full course meal including dessert is provided at lunch time. In addition at least two tea/coffee breaks with snacks are provided. Many organizers give as much importance to the menu as for the academic program. Most CMEs and conferences around the country do like wise. With increasing costs, a working lunch could be thought of which could consist of low cost staple diet of the region. Alternatively, the fend for yourself concept can be imported into our CME. Alcohol served during these meets also increases the cost.

Audio-visual equipment lighting system with associated paraphernalia are essential features of any CME along with a competent projectionist. Care has to be exercised in choosing acoustics, audio and video systems. We often prefer to leave this in the hands of professionals. Most CME programs require the equipment as listed in Table II. Illumination of the dias has to be done with care to assist the speaker and not interfere with the projections. For interactive sessions one needs more microphones located at strategic points. In this computer era, data projection and slide shows from a lap-top computers may need to be done. These cost a lot but provide excellent visuals. Multimedia presentations can have an excellent impact, 

but the costs of hiring the equipment are high at present.

Inspite of adequate arrangements, many situations sometimes are beyond control. The electricity may fail, microphones may give way, slides get misplaced, jammed or projected upside down, bulbs may fuse or other equipments may play truant. These difficulties must be anticipated and adequate back-up precautions need to be taken. Hotels and many large auditoriums have back-up generators but one needs to ensure that these do work.

TABLE II–Audio-Visual Requirements for a CME for One Hall.

A CME can succeed only if there are adequate delegates for interaction. Most organizations provide information about a CME well in advance to encourage early registration. An advertisement placed in Indian Pediatrics or Indian Journal of Practical Pediatrics helps the information reach a large number of colleagues. Unfortunately most CMEs end up with many spot registrations. This leads to chaos. To prevent this, spot registrations must be dis-couraged, the fee doubled or incentives/gifts be restricted to those who have registered early. A larger gathering than anticipated creates havoc on seating arrangements, while smaller gatherings, increase the cost per participant.

Members of the reception committee have to be courteous, appealing, be able to respond to queries with aplomb and take care of spot registrations. Master of ceremonies should be a person well versed in English, stickler for time, who does not hesitate to incorporate last minute changes in a suitable way, provide a preview, conduct the ceremonies with grace and maintain the interest of the delegates till the end of the day. Each branch of the IAP has one or more of this rare species and hence CME’s continue to remain popular.

The scientific session usually consists of lectures, symposia, panel discussion and workshops. Lectures are one way exchange of information and interaction is least in this form. The advantage is that a lot of information is transferred in a short span of time. Panel discussions and seminars involve many speakers and are time consuming. The chair persons of these programs have to be adept with the recent advances and must have the capacity to extract the maximum from the panelist. Workshops are more educative, interactive and impart practical experience but they can cater only to a small number of participants. We have routinely polled participants of CMEs in Bangalore and found workshops to be most popular(5). The delegates have often been ambiguous about the other three, probably because the skill of 

the participants often determines the impact of a lecture, symposium or panel discussion. The scientific committee thus has to choose appropriate speakers and topics of current interest.

Innovations are the order of the day to attract the audience and ensure maximum attendance. Newer methods of interactions could be devised. The concept of demo-talk or learning by demonstration is in vogue. This involves use of models made of silastic or other materials. The participants could actually perform the procedure on the mannequins. This has been used extensively in the NALS and PALS courses with success. The disadvantage is that this is effective only in smaller groups.

Problem solving exercises could also be encouraged. A case situation could be discussed serially as in an actual case scenario with active participation form the audience at each step.

Video conferences are in vogue in the west. This allows a participant to contact an expert of his choice and interact. Simulta-neously this can take place at different places across the globe. This is extremely useful but costs are exorbitant.

Organizations require social and political patronage for survival. Inauguration of a CME is often then used as a platform to express gratitude to prominent persons for rendering their services to the organization. To meet this end precious time allotted for educational purposes is lost and throws the whole program out of gear. In a recent CME, we tried to limit this to a mere five minutes and solemnised the function by lighting the lamp. This evoked a mixed response from the delegates. Perhaps we need to devise short functions which achieve the objective without loss of valuable time.

This includes picking up the speakers and the delegates on arrival, arranging their accommodation, pickup to and from the venue and subsequently seeing them off. Programs have to be arranged to engage the accompanying person, spouses and children to keep them occupied during the period. This task requires a team of dedicated persons who are present throughout the period and perform their duty with a warm smile. Very often, this is what makes a name for the organizers of the CME

An evaluation sheet is given to all the delegates at the beginning of the CME. The design has to be such so as to ensure maximum compliance. We have tried making evaluation sheets into lunch coupons to ensure maximum response. A simple format also ensures a good response. To make analysis easy a computerized format is desired. The success of a CME is judged by the feed back from the delegates. Many organizations have tried to incorporate the suggestions of the delegates in future CMEs.

The organizing committee calls for a post CME meeting to take stock of the situation and also to thank the persons working behind the scenes. The most important task is to collect all the promised funds from the sponsors and keep the accounts ready for the auditors. The expenses are noted, a balance sheet is made and the savings are deposited as a fund. Feed-backs from the delegates are reviewed and an effort is made towards improvement of next CME.

Updating knowledge at periodic intervals has become a necessity due to rapid expansion in medical field at various levels and explosion of information and technology. Clinicians are forced to maintain highest possible standards in professional practice. CMEs in recent years have gained recognition as a concrete means to achieve these ends. Due to the changing scenario, clinicians have to be acquainted with the latest mode of therapy. Recognition of disparity in skills and the need to maintain core standards has been the key factor in the certification of doctors, at periodic intervals(6) who were earlier awarded certificates for life. Various methods have been devised for this re-accreditation.

Countries across the globe, who have a policy of renewing specialists licenses, have now devised means to award CME credits, which could be in different categories. Clini-cians may be required to attend certain number of CMEs every year to obtain the necessary credit for re-certification. Perfor-mance could also be gauged by letters of recommendation from chiefs of hospitals, peer review, papers published and indepen-dent assessment by other health professionals or patient satisfaction. Computer based programmes are also in vogue at certain centres which evaluate doctor’s perfor- mance and also provide remedial training where there is evidence of deficiencies in practice.

The Association of Physicians of India has suggested that the members be awarded certificate of attendance, with the credits given to them based on their participation(7). Additional weightage is given for any awards won. The proposal of maintaining CME record diaries is on the anvil which will have to be submitted to the CME directors for reaccreditation at regular intervals. This may further pressurize the organizations as they will have to play an active role in appointing these directors whose selection criteria and work pattern is still undecided. Perhaps the Academy needs to give a serious thought in this regard after carefully evaluating the situation.

Organization of a CME, involves multiple disciplines. It also needs adequate finances to meet the expenses, which are difficult to raise. With the proposal of re-accreditation based on CME-credits gaining momentum CMEs are here to stay but the format is difficult to define. As already stated, the problems faced by the organizers are varied but arranging finances is the prime yet most difficult task. The explosion in technology, particularly the advent of intenet has led to the availability of knowledge at their doorstep. To sustain interest and maintain the attendance the organizers are hard pressed to devise inno-vative methods to drive home their messages. A format to benefit all and serve the objectives of the CME is the need of the hour. 

How this could be done perhaps requires a debate on the subject. The Academy could lay down rules to meet the same.

Contributors: HP was the principal author responsible for conducting CMEs for 18 long years and critically reviewing the paper. AS made extensive revisions of the draft of the paper; he will act as the guarantor. SAK helped in drafting the paper and critically evaluating the manuscript. MJM drafted the paper including the revised versions.

Funding: None.

Competing interests: None stated.

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