Participant-Driven Educational Program: A novel approach to bring awareness to Fever Burden Reduction

A Medical Science Liaison Approach in connecting with Key Opinion Leaders

Abstract

Successful, long-term thought leader relationships are forged through a pharmaceutical or medical device company’s ability to create mutually beneficial relationships with top opinion leader candidates. Primarily, the most lucrative thought leader relationships are steeped in cutting edge scientific research which helps the company advocate its treatments, while at the same time aiding the physician in gaining more recognition and influence in the therapeutic area.

Medical Science Liaisons (MSLs) provide the crucial link between the company and the thought leaders. Specifically, the participant-driven educational program, which is a novel approach to connect a company with influencing Key Opinion Leaders (KOL) and participants at major conferences. In many organizations, MSLs educate clinical peers about the latest scientific developments and treatment guidelines affecting a specific therapeutic area. In addition, MSLs are sometimes called on to provide summaries of recent scientific congresses, make formulary presentations, or address unsolicited efficacy or safety questions. MSLs may also facilitate educational or research grants submissions or be asked to organize regional advisory boards. The services provided by MSLs are quite varied and are continually evolving (Williams).

MSLs are organizational leaders, organizational representatives, and scientific professionals. As such, they are required to align and establish relationships with selected KOLs. The process of relationships building should be conducted and documented in a manner that is both beneficial and transparent with a focused aim. The value of a participant-driven education program is to gain insight into the clinical care gap, knowledge gap, and scientific gap to assist in direct support of an organization and its goals (1).

Goal

The goal is to establish a collaborative community that has the potential to create an essential level of awareness and to set new expectations regarding a standardized methodology of care for patients. The Guidelines from the American Heart Association (AHA) serve as the markers or triggers to identify best practices. The identification of the problem of not controlling fever has increased mortality rate and has contributed to long term disability. A consideration of these guidelines elucidates both the importance of timely management and the necessity of formulating practice changes that will result in better outcomes (1).

Scientific Area

The result of temperature management in critically ill patients is the reduction of fever development in various types of neurological injury, injuries which are associated with increased risks of adverse outcomes (2). Due to the negative effects of fever, lowering an acutely elevated body temperature might improve the prognosis of patients with stroke. These measures include giving antipyretic medications and actively controlling the patient’s temperature (American Stroke Association Stroke Council, Guidelines for Early Management of Adults with Ischemic Stroke) (3). The development of a collaborative community is necessary to create change, with special emphasis on transforming care and reducing the long-term consequences of neurological damage and long-term disability (1).

Fever was found to be strongly associated with an increased length of Intensive Care Unit (ICU) stay and higher mortality rates with worsened overall outcomes (4). Collectively, a meta-analysis presented the same results. In each of the outcome measures evaluated, the meta-analysis indicated that fever/higher body temperature was significantly associated with deleterious outcomes, higher mortality rates, greater disabilities, worsened functional outcomes, greater severities, and longer stays in the hospital and ICU. These results indicate that the association of fever with poorer clinical outcomes is present in all types of neurological injury (ischemic, hemorrhagic, and traumatic). It was observed that fever was consistently associated with damaging effects (5).

The identification of the problem of not controlling fever has shown an increased mortality rate and has contributed to long term disability. Fever, a temperature in excess of 38.3°C, occurs with an incidence of up to 70% in neurologically injured patients and it is usually not an isolated event, but rather a sustained response that can linger for as long as two weeks after injury (4). This is a problem that needs to generate more awareness and aggressive treatment in the hospital system. Best practices for fever burden management are not consistent, and, to a degree, are basically disregarded in clinical and research literature. Presented are a few references in literature that show that established fever is indeed associated with neurological deficits or secondary injuries.

The inconsistency in practice can complicate the achievement of best practices and other solutions regarding fever control. Healthcare providers should be the first to recognize this need and to embrace the continuous search for providing quality healthcare services. Fever exacerbates brain damage and is associated with worsened outcome in patients with aneurysmal subarachnoid hemorrhage (SAH) (6). Preliminary data suggests that active fever control is a reasonable therapeutic strategy after SAH. (7) Fever itself may increase Intracranial Pressure (ICP) (8).

Group Dynamics and Change in Medicine

Groups are both a pervasive part of modern life and cultivators of buy-in. The team design should be comprised of a formal group of professionals that have the capabilities to formulate a change. The requirement specifies that there must be some form of information exchange or communication between these individuals. This information must be disseminated to other professionals outside the group (1). The final requirement is that the group be formed to accomplish a common goal (9). The thought leader’s goal among the group is dedicated to reducing neurological damage, reducing long-term disability, and setting directives for care.

The approach for a participant-driven network of professionals is to work to accomplish a common goal and to retain interest. Recognized objectives must align with the projected goal, and secondary goals as well, if applicable. An organization grows by acquiring knowledge, distributing this knowledge, and interpreting information in a manner that results in learning, adaptation, and change. These aspects subsequently become part of that culture (9). The meeting needs to have a platform led by two or three associated members: a CNS and a physician champion. The content is specific to fever control, projected expectations, and how the realization of this goal will be obtained (1).

Background

A participant-driven educational program using a Meet-the-Expert format is an innovative educational strategy that is focused on the learner. The purpose of such a program is to address clinical and organizational needs and issues encountered by hospital clinicians, especially those caring for patients undergoing fever control. Unsolicited questions from the participants were used to develop a curriculum and also to examine the barriers of TTM implementation in neurocritical care units around the United States. The educational format of the program also encouraged participants to have individual conversations with the experts both before and after the program. In order to help guide the expansion of fever control in US neurocritical care units we relied on a strategy of amalgamation, combining expert opinions with previously reviewed literature during the curriculum development process.

According to Weimer et al, “the transformation …. of classroom experiences requires a fundamental shift in how instructors approach teaching and learning, moving from an information-transfer, teacher-centered model to one that is concept-focused, learner-centered, and collaborative” [10]. To facilitate the discussion and creation of the agenda, program participants pre-submitted two questions that could provide jumping-off points for the continuation of discussions at the bedside during a Targeted Temperature Management (TTM) case. These questions, which were either clinical or organizational in scope, were placed into different categories upon initial acceptance. They were then given to a panel of nationally recognized experts in the field of Neurocritical Care for verification and review. Members of the lead faculty divided and assigned the verified topics among three other faculty groups, all of which were selected based upon their experience and individual contributions to the science of fever control. The contributors in the way of science possessed numerous arrays of special designations. Among the aforementioned are Key Opinion Leaders (KOL), TTM users for the purpose of neuro-protection in neurocritical care patients, world renowned speakers, authors, and educators on relevant subject matter, and active users in the critical care arena.

Most attention has heretofore been directed at the clinical utility in the neurocritical care patients, specifically those with relation to TBI, SAH, acute ischemic stroke, and fever control. Fever is of special significance according to the prevailing literature as it has a 70% rate of (co)occurrence in a number of the previously mentioned disease states [4,11-14]. However, there is limited evidence at present to specifically incorporate the application of TTM in such conditions; but through the lens of historical context there is more than enough evidence, especially insofar as previously reviewed patient care cases are concerned, to demonstrate how imperative the delivery of a timely educational message is for the greater benefit of improving patient care. An educational goal for this program was the engagement of clinicians in the critical analysis and anticipation of the needs of patients while providing resources for their individualized questions.

Design and Setting

The primary targets for the program were bedside clinicians who have direct care to a patient. Though an email invitation was sent to participants of the conference, RSVPs were limited to the first 50 due to logistic issues. The attendees from the last 4 conferences numbered in the area of 6,000 to 7,400. Anticipating that we would exceed the limit capacity of 50, we asked every prospective attendee to complete two questions in order to determine whether or not they met the criteria for acceptance. The questions are as follows: (1) what is your involvement in your TTM program? and (2) Name some reasons why you should be chosen. In the healthcare setting, the ability to work as part of a team is of paramount importance, for it encourages team members to engage in often difficult implementation practices. The smaller program sizes provide participants with a more relaxed atmosphere in which they can actively build on the expertise and talents of the group as a whole [12]. This type of informal setting can help students to acquire a greater appreciation for the role of others through group problem solving exercises and open discussions, both of which promote collaborative medicine. Groups can consist of as little as four or as many as 25 people; however, in these situations, strong leadership is needed to ensure that the group interacts appropriately and develops their interpersonal skills [15]. Perhaps most importantly, the size of the group is not as significant as what the group actually accomplishes, as a well-defined structure, taken in conjunction with the skill of the organizer as facilitator, are key to the effectiveness of small group sessions [16].

Participants

A total of 70 RSVPs were received for the “Meet-the-Experts: a participant-driven program held during a National Conference. There were 43 attendees (43/70, 61%), 2 cancellations (2/70, 3%), and 25 no-shows (25/70, 36%). The total number of participants was 51, including 8 walk-ins. As no demographic information was obtained from the walk-ins, their information was not included in the analysis of data. The majority of the participants were staff nurses (26, 61%), followed by nurse educators and nurse managers. The most common unit in which attendees were employed was a mixed ICU that admitted neuro patients. There were 27 hospitals that were represented with 12 hospitals that had 2 or more participants in attendance.

Post-Event Feedback Survey

A SurveyMonkey® post-event feedback survey link was created and emailed to the participants. The questionnaire consisted of 29 questions. The 29 questions were composed of attendee demographics (questions 1-3), speaker evaluations for 3 faculty members (questions 4-9), overall activity (questions 10-11, 20-24), educational needs (questions 12-13), the program itself (questions 14-16), program administration, facilities, and logistics (questions 17-19), and future programs (questions 25-29). An email reminder was emailed to the participants on two additional dates. SurveyMonkey is an online survey tool that provides data collection and analysis. Thirty-one participants completed the survey (31/41 (76%)) while ten did not (10/41 (24%)).

Educational Needs Questions: These questions serve as the Clinical Care Gap

Discussion

The translation of research into clinical practice will require clinicians in the field to more fully understand the benefits, implications, and ramifications related to the use of strict fever control. With the absence of scientific guidance, dialogue, and education; the bridge to close the clinical care gap from research to clinical practice remains nebulous. From the results of a literature review and the corresponding questions clinicians suggest that clinical education is in order. Moreover, given the tenure of clinicians, additional professional development resources may be needed for the adoption and implementation when innovative therapies are introduced as part of standard care protocols.

Overall Activity Questions:

Strengths and Limitations

This is a regional trend and not a national trend as defined by geographical considerations. Thirty-five out the 51 (69%) attendees practice nursing in the state of California where the California Department of Public Health has a Nurse-to-Patient Staffing ratio regulations.

Observations and Recommendations

The program demonstrates the feasibility and value of a participant-driven educational program using Meet-the-Expert educational strategy in a therapeutic space where consensus is a challenge.
A 6-month follow-up should be done to assess where participants are in the process of adopting information received from the Meet-the-Experts program.
A similar program should be conducted next year at the conference to compare regional trends in clinical and organizational issues in caring for patients undergoing TTM.

Conclusion

In conclusion, curriculum development and instructional management are at the core of the educational process and central to an educational program. These are some of the key features of the scientific infrastructure that allow this type of pedagogy to be made deliverable in an educationally executable format. Here, a participant-driven educational program using a Meet-the-Expert format provided an innovative learner-focused educational strategy that gauged the needs of the participants and care givers who link the treatment platform to this unique patient population. The implications of this forum are that building dialogue and promoting discussion will transform TTM neurocritical care into a standard of care and medical practice. There is a need for the implementation of small engagement programs as a complimentary educational strategy in medical education. Moreover, there is an immediate need for leadership programs for the purpose of arming future medical personnel with the tools to manage modern medical practice by means of the educational methods delivered at the national conference.

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No Affiliations

Authors

Philip Abenojar, RN, BSN, CCRN-K

Sam Grove, MBA, Master Black Belt

Paul C. Dieichmann, Pharm.D.

Jennifer Williams Ph.D., J.D., MBA, RN, MS

Alexander Frost

Primary Authours Philip Abenojar and Jennifer Williams

Authors: Jennifer Williams and Phil Abenojar