By Alvaro Margolis, MD MS FIAHSI, Column Editor: Helena Prior Filipe, MD, MMEd
With our new virtual learning competencies, many CME providers are considering expanding their regional and national presence to an international audience. The Americas are a unique and challenging region to explore. Latin America is a large and heterogeneous middle-income region, with one million physicians. One third of the region by several counts is Brazil, where Portuguese is spoken, while the rest of the countries speak Spanish. This dynamic creates an opportunity for online regional activities to be delivered in the two native languages. In this brief article, I hope to provide you with an overview the major elements to be considered when engaging in these complex, international CPD projects, especially across the Americas.
Over a decade ago, we sought to provide much needed CME/CPD programs in a variety of specialties to a Latin American audience. Over this period, my team has implemented educational activities throughout this region (1,2). Typically, these activities offer a sequential, mostly asynchronous curriculum, delivered to large audiences, however, they are still able to provide an active learning experience through social interaction and reflection. The virtual program includes automated formats to support meaningful dialogue for large audiences (3). Some of these activities have had a North American academic partner as a part of the institutional design of the program (5, 6). Each project has had similar learning experiences and planning criteria resulting in successful educational outcomes.
American academic institutions seeking to offer CME/CPD courses in the Americas may wish to identify and recruit an academic partner institution in the region for a jointly offered activity. The advantages of a local institutional partner in the region cannot be overstated in terms of planning, marketing and implementation processes.
A number of best practices are discussed here when initiating an international program. First, the educational program curriculum should address the unmet, practical learning needs of the target audience(s). The program should not be focused solely on scientific ‘breakthrough advances’ which at the moment may not yet have any practical treatment application, especially in the non-academic and often resource-constrained, clinical practice settings of the region.
If working with a Latin American academic partner, the clinical practice needs of the target audience should be determined via a needs assessment survey preferably developed jointly by the U.S. host and the Latin American academic institutional partner/planner and their regional faculty. The challenge of addressing clinical practice needs of these diverse healthcare systems must be considered as well. To this point, the best approach we have found is to design a course curriculum that includes a live, team-based analytic deliverable where course participants from the same institution discuss how to apply what was learned in the course to their respective working environment.
Second, everything should be translated into the native language of the target audience (e.g. convening, registration, customer support, educational materials, activities, and online interactions). Sometimes people who speak English as a first language underestimate the challenge for non-native speakers to study and interact with colleagues and faculty in a foreign language, such as English. Beyond this, an awareness of the cultural differences among the countries should be considered when working with an international faculty, even in the same language such as Spanish. For example, in some countries people tend to be very polite and diplomatic, while in other countries people are quite direct. Such cultural characteristics are especially important to understand when negotiating contracts.
Third, in such a large geography as the Americas, online learning can still be complemented with face-to-face live activities, either centrally or distributed across a region (7,8), including not only formal CME but also team-based learning in the workplace, as discussed earlier.
Fourth, in general, the US-based CME accreditation is not “value added” in Latin American countries, since each country has a different accreditation system. In fact, some countries are only now developing a system. Of course, the principles behind accreditation and CME best practices should still be followed, particularly regarding educational design and management of conflicts of interest. However, the actual accreditation process itself is not typically required in most Latin American countries. When it is, it is likely to be very different than the ACCME process. If working with a regional partner, allow them take the lead for the local accreditation process.
Fifth, since there is such a large number of physicians in the region, financing a program is typically achieved through learner registration fees, although grants and vendor exhibit fees are certainly possible. Further, in the registration payment process, allowing participants to use local currencies and payment methods is highly encouraged since many will not have an international credit card.
In conclusion, large international educational programs throughout the Americas are achievable, but these projects require careful consideration of the factors discussed herein to be successful. Once an activity is established, the repetition of programs between the same partner institutions over the years creates a common procedural knowledge and a cultural experience that facilitates and improves both the work process and program quality.
References
- A. Margolis and A. López-Arredondo, Eight years of MOOCs for physicians across Latin America, 2019 IEEE Learning With MOOCS (LWMOOCS), 2019, pp. 133-137, https://ieeexplore.ieee.org/document/8939603
- Margolis A, Joglar F, de Quirós FG, et al, Hersh WR. 10×10 comes full circle: Spanish version back to United States in Puerto Rico. Stud Health Technol Inform. 2013;192:1134. PMID: 23920908. https://pubmed.ncbi.nlm.nih.gov/23920908/
- Margolis A, López-Arredondo A, García S, , et al. 2019, Social learning in large online audiences of health professionals: Improving dialogue with automated tools, MedEdPublish, 8, [1], 55, https://doi.org/10.15694/mep.2019.000055.2
- Medina-Presentado JC, Margolis A, Teixeira L, et al Online continuing interprofessional education on hospital-acquired infections for Latin America. Braz J Infect Dis. 2017 Mar-Apr;21(2):140-147. https://pubmed.ncbi.nlm.nih.gov/27918888/
- Kidney transplant course with the University of Virginia, Latin American version. https://redemc.net/renalcasos
- Palmer, B. Meeting Professionals: What Would You Do? PCMA Convene. November 30, 2020. https://www.pcma.org/medical-education-conference-simulation/
- Cohen H, Margolis A, González N, et al. Implementation and evaluation of a blended learning course on gastroesophageal reflux disease for physicians in Latin America. Gastroenterol Hepatol. 2014 Aug-Sep;37(7):402-7. https://pubmed.ncbi.nlm.nih.gov/24679378/
- Margolis A, Balmer J, Zimmerman A, López-Arredondo A, 2020, The Extended Congress: Reimagining scientific meetings after the COVID-19 pandemic, MedEdPublish, 9, [1], 128, https://doi.org/10.15694/mep.2020.000128.1
Alvaro Margolis, MD MS FIAHSI is a SACME member and president of EviMed, an international virtual provider of CME/CPD. For more information contact Dr. Margolis via email at alvaro.margolis@evimed.net
