Clinical and Health Affairs
Engaging Physicians in CME
The Power of Theater
By Carl A. Patow, M.D., M.P.H., FACS, and Debra J. Bryan, M.Ed.
Abstract
HealthPartners Institute for Medical Education has developed an innovative continuing medical education model that uses elements of theater to explore complex issues in health care and increase participant engagement. The model was recently used during a hospital medicine retreat. The learning event included a four-part monologue in which an actor portrayed a patient, interactive didactic sessions, a game show titled “Who Wants to be Hospitalized a Million Times,” computerized simulations, and a call for clinicians to help patients adopt healthier behaviors. Post-event evaluations demonstrated that participants gained valuable clinical knowledge and appreciated the combination of active learning and theater.
Continuing medical education (CME) providers struggle to plan learning activities that engage physicians and include content that they will remember when they return to work. CME directors say they routinely watch physicians reading, emailing, and doodling during conferences. The general consensus is that interactive teaching strategies that employ multiple media are more effective than traditional didactic methods in capturing physicians’ attention and changing their behavior and patient outcomes.1-6 However, many CME activities are still built around lectures and PowerPoint presentations.
To better captivate physicians and improve the chance of influencing their day-to-day practice, HealthPartners Institute for Medical Education developed an interactive CME format called BlackBox CME. “Black box” is a term used in theater to describe a space devoid of props, lighting, and a set, within which other creative techniques are used to bring a play to life. We use the term to describe the integration of CME and a variety of interactive educational activities that include the use of actors, props, sets, clinical simulators, audience response systems, and audience participation.
The HealthPartners Institute for Medical Education used this new approach during a retreat for 50 hospitalists from Regions Hospital in August of 2009. The purpose of the event was to help hospitalists better understand the patient experience and to increase their knowledge of preoperative assessment, management of perioperative medical conditions, treatment of deep venous thrombosis, the latest Advanced Cardiac Life Support protocols, and how to influence patient behavior. The event took place at the Mixed Blood Theater in Minneapolis.
The BlackBox Experience
At the start of the retreat, participants were summoned from the foyer into the theater by an unexpected and booming recorded voice. Strips of light guided them through the hallways and into the seating area. After they took their seats, the theater went dark. Slowly, the lights came up on an actor playing Howie, a patient who is sitting on an exam table in his physician’s office. During the first of his four short monologues, participants learned a bit about his life and what had brought him to the clinic. Howie described how he had been driving trucks for 30 years and how an old knee injury was making it difficult to drive and enjoy walks with his wife. He talked about possibly having knee surgery and his reluctance to go to the hospital. Through Howie’s monologues, the audience experienced the fears, anxiety, courage, and curiosity of a patient who realized he needed the help of the health care system.
Howie set the stage for the first didactic portion of the retreat. After the first monologue, a physician expert presented a lecture on preoperative patient assessment and management of perioperative medical conditions. The lecturer discussed new clinical research on cardiac and pulmonary care during the perioperative period, adrenal insufficiency, and postoperative fevers. Participants used an electronic audience response system to answer questions that connected the lecture and Howie’s monologue.
In his second monologue, Howie described his visit to his physician and remarked on his physician’s surprisingly good listening skills. Immediately following the monologue, participants took part in a game show called “Who Wants to Be Hospitalized a Million Times.” In a way that was intended to be both fun and meaningful, an actor portraying a zany game show host explored options for deep venous thrombosis prophylaxis and treatment. A physician from the audience (who agreed ahead of time to participate) was summoned to the stage to be the contestant. Slides, music, lighting, and the audience response system were used to simulate the game show experience. The contestant was allowed to poll the audience before answering each question. After the correct response was revealed, a subject matter expert provided additional information and further explanation.
In his third monologue, Howie revealed that he needed open-heart surgery prior to his knee replacement. He shared his fears about handing over control of his life while undergoing surgery and being surrounded by strangers. Afterward, the audience was divided into teams that were directed to one of two learning stations. The instructors at Station 1 informed participants about Advanced Cardiac Life Support updates using a whole-body computerized simulator. The simulation illustrated complications that might occur while Howie was undergoing surgery. At Station 2, a series of heart rhythms were posted, and participants discussed the significant findings on each rhythm strip. Content experts helped facilitate those discussions.
The fourth monologue found Howie in recovery after surgery. He talked about “dying” on the table and reflected on his emotions as he struggled to regain control over his body and mind while waking from anesthesia. Howie described his entire perioperative journey, from preoperative anxiety through setbacks and success, and how he emerged a healthier person. The four monologues allowed the audience to experience what he thought about in each step. The final monologue was followed by a lecture on what physicians can do to improve the health outcomes of their patients and the community.
Results
Pre- and post-program assessments of physicians’ attitudes about the program and their knowledge of the subject were conducted. Prior to the program, more than half of the participants stated that they preferred lectures to experiential learning; but they indicated they were comfortable learning outside a traditional lecture environment. Survey responses indicated that participants responded positively to the BlackBox CME approach. They enjoyed the combination of active learning and watching an actor depict a patient’s experience. Eighty-five percent of the participants stated they would attend another experiential program like this and would recommend it to others. The level of engagement was highest during the game show, with 88% of participants reporting it as being a favorable experience. In addition, the responses suggested that the retreat achieved its objective of expanding physician understanding of the patient experience. Sixty-five percent of participants stated that they expected to change the way they interacted with patients as a result of the program. Their knowledge about the various topics discussed increased between 7% and 15% from pre-program levels.
Some participants indicated they were initially nervous about possibly being called on in front of their peers and sat in the rear of the theater. Once they were assured they would not be singled out, those participants seemed to relax. All participants had the opportunity to move around the theater during the program, and the simulation activities got everyone out of their seats. Unlike at most traditional CME events, very few, if any, of the participants were noted to be emailing or doodling during the presentations, and almost none of them left the theater before the program was over.
Final Thoughts
Elements of theater can be used in CME to engage learners and help them better understand the patient’s perspective. It appears that the BlackBox CME approach effectively conveyed information about critical clinical issues and helped participants learn new skills. Because traditional lectures and slide presentations are deeply embedded in the culture of medical education, it may be difficult for physicians to envision other ways to learn and present information. Faculty presenters likely will need to develop new approaches and skills in order for this to change.
This BlackBox CME event not only was more effective than traditional lectures in engaging participants, it also promoted greater understanding of the topics covered and better retention of the information presented. In addition, participants said they planned to apply what they had learned to their clinical practice. Above all, they said it was fun. MM
Carl Patow is executive director and Debra Bryan is program manager for interactive learning at the HealthPartners Institute for Medical Education.
References
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