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Background

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Communication is key in any pandemic, perhaps especially in a communication-oriented enterprise like CME. In this case, communication requires application to (at least) two different groups:

First, frequent, direct communication between educational planners and public health authorities (sometimes mediated through one medical school contact) is critical. Second, and equally important, is the concept that the CME office communicate regularly with registrants/learners, faculty members, course planners, and others.

There are a variety of modalities which can work in this regard: fax networks, broadcast e-mails, listserves, cell phone communication devices, etc.

In addition, consideration needs to be given to the consistency of messaging aligned with public health and academic medical center messages. This requires coordination, and a fine balance between over-alarming and underplaying real risks. This may be easier with H1N1 as it appears at this stage; communication is more problematic with SARS, and/or if H1N1 mutates to a more lethal form. Any information via print or online materials produced by health authorities should be adapted or distributed widely.

1. Does your office have a contact person in the Public Health department or office? Who in the academic medical center does have connections with the PH authority?

2. Do you routinely develop an e-mail list of all course registrants?

3. Do you or can you develop group e-mail lists based on courses or other activities?

4. If not, do you have fallback procedures like broadcast-fax or other capabilities?

5. Do you have a Web site to which you can post updates? Are these updates clinically useful (perhaps linking to public health authorities)? Are they educationally helpful?

Proactive planning for H1N1 or similar epidemics from a CME perspective requires a holistic and systematic review of learning objectives for all planned educational activities.

If the objectives of a program are purely knowledge-based, consideration can be given to alternative modalities, generally mediated by information and communication technologies.

Online learning activities, for example, with slides and text, and/or pre/post tests to ensure participation are acceptable alternatives. Also possible are synchronous or asynchronous Webcast modifications.

Where learning objectives are more attitude- or application-based, small group case discussion can occur over a phone line. Educational activities using chat rooms also provide a forum for peer-peer dialogue, knowledge uptake, and attitude-testing. Those courses offering simulations and other real-time hands-on training may require different, protective logistics -frequent equipment sanitization in mannequins for example.

Finally, in an instance in which a keynote or other speaker cannot attend a conference because of panflu concerns, consider using audio or videoconferencing.

1. Can your office begin a process that reviews upcoming courses and other CME activities by location and by content, objectives, and formats?

2. Can any of the content of these activities migrate to an electronic format, e.g., Webcasting, online teaching and other handout materials?

3. Is there a business case for such migration? Is there a participant-risk argument here?

4. If visiting speakers are hampered by flu or other restrictions, can you bring them in by audio or videoconference? Does the meeting facility have such a capacity?

5. Are simulations used in our CME activity? Consider frequent, between-use sanitization procedures as advised by public health authorities.

Here, the advice of the PH authorities should be followed.

For courses, pre-registration information to registrants suggesting they stay home if they are unwell is useful. At the event itself, consideration may need to be given to: hand-washing facilities being widely available; and/or having staff and others wear protective approved face masks.

Consider the setting of the activity. On the one hand, hospital venues may be considered more easily sanitized; hotel or other conference facilities may not be accustomed to such activity. On the other hand, hospitals and health care sites may restrict access to outsiders and may themselves be sites in which infections are more likely.

1. Has the PH authority issued standard practices for group meeting?

2. Are your meeting planners and others aware of the practices?

3. Has the activity site been prepared for panflu risk reduction (eg., provision of face masks, hand-washing techniques, video- or audio-conferencing facilities, etc.)?

4. Have alternative site arrangements been considered?

Given that most CME offices depend on a cost-recovery business plan, any reconfiguration of services requires a thoughtful review of budget practices, alternative funding sources, staff re-allocation, partnerships with others (for example, the local IT or Web developer).

While potentially reducing usual registration fee income, careful preparedness and alteration of educational methods (bringing in a speaker in by videoconference for example), may in fact reduce expenses.

Consideration can also be given to not charging late-cancellation fees; though this may reduce income, the goodwill in an emergency situation may have long-term benefits.

Finally, office staff and others need to abide by all usual precautions and advice; policies may need to be developed, in concert with others in the AMC, regarding absence from work and other issues.

1. Have you prepared a budget plan outlining a variety of scenarios (recued registration, cancelled registration, alternative educational methods)

2. Has your state or other authority offered financial help in the even of business loss? Can you contact them to determine the characteristics of support and manner of securing it?

3. Can you waive or create financial policies given the contingent nature of panflu?

4. Do you have polices regarding staff illness and flu protection? Have you ensured that they are aware of flu symptoms, treatment, prevention, and policies?