How COVID has transformed CME and the way doctors keep learning
“I have been an American Heart Association (AHA) instructor for more than 10 years but training on the HeartCode Complete platform has been a very rewarding experience. I could complete cognitive and psychomotor skill sessions at my own time and convenience. What would normally take a full day of classroom sessions was completed in 35-40 minutes,” says Dr Meghna Mukund, Associate Professor of Anaesthesiology and Chief Coordinator for Skills Lab at Yenepoya Medical College Hospital, which has appointed MedLern as its learning partner.
A digital learning solution for hospitals and healthcare professionals, MedLern serves healthcare training needs in hospitals, colleges and for individual professionals.
As published in Edugraph, MedLern launches innovative, online resuscitation training in India states that Yenepoya Mangalore (deemed to be University) is the first university in India to adopt this programme.
Co-developed by the American Heart Association and Laerdal Medical, the HeartCode Complete Program combines adaptive online learning with hands-on skills training to deliver cardiopulmonary resuscitation (CPR) training across organisations.
The Medical Council of India (MCI) has made it mandatory for doctors to complete 30 hours of CME (Continuing Medical Education) every five years to renew their licence by attending workshops and seminars, which are organised by various healthcare institutions in India.
CME helps medical and health professionals engage in activities designed to support their continuing professional development.
In her 2017 article, Online medical education gaining momentum in India, published in ETHealthWorld, Priyanka V Gupta writes that according to a 2002 WHO study, Promoting Rational Use of Medicines, CME opportunities are limited in developing countries like India, unlike developed countries like the US.
Although popular globally, online CME is still in its rudimentary stage in India.
One of the challenges is the fact that the MCI is yet to recognise online medical education content. This means that a student passing a course at an online CME platform can’t practise but can assist a medical practitioner. So, there continues to be a cardinal difference between formal medical education and add-on medical educational learning support, as provided by CME players.
However, it seems the pandemic changed the evolving CME conversation.
How COVID-19 changed the CME landscape
The doctor-population ratio in India is 1:1456 against the World Health Organisation (WHO) recommendation of 1:1000, according to the Economic Survey 2019-20.
This signals the need for validated online CME platforms to ensure last-mile delivery of upgraded medical education content, bridging barriers of distance and time. This also perhaps suggests that an online mode of CME can help medical practitioners stay abreast with developments in their field.
If before COVID, a leading live CME platform like Clirnet had 25,000 doctors, the pandemic led to an overhaul.
“COVID changed everything. Nobody knew anything about the disease; nothing was available in medical journals. So, during the first three months of 2020, all clinical experiences doctors were amassing were circulated in the entire medical community,” says Saurav Kasera, Co-founder of Kolkata-based Clirnet, a doctor-generated content platform founded in 2018.
He adds that the platform has witnessed an aggressive surge in doctor enrolment in the past three years, with the number shooting up to 250,000 from a mere 25,000 pre-COVID.
“On an average, around 8,000-10,000 doctors join our platform every month. By this year-end, we expect the numbers to be around 300,000, and around 350,000 by next June,” Saurav says.
However, the aim is not to mindlessly gain numbers but to target doctors with meaningful content. Doctors join the platform as it addresses their need to stay updated.
Saurav credits this growth to the platform’s digital partnership with several medical associations, which has helped Clirnet gain credibility and enjoy traction among the medical community.
In fact, the platform now has a deep COVID content bank, with “infectious diseases” one of the fastest-growing focus areas. “Most people didn’t even know that there are infectious diseases specialists before the pandemic,” Saurav says.
Describing how the platform was born with a passion to discuss real-world medicine, he gives an example. Consider an oncologist in Ziro, Arunachal Pradesh, treating a cancer patient. A report, released by the Indian Council of Medical Research (ICMR) and National Centre for Disease Informatics and Research (NCDIR), stated that Papumpare district in Arunachal Pradesh recorded 219.8 per one lakh cancer cases among females. Meanwhile, a 2021 news report in Times of India called the Northeast the “cancer capital” of India, recording the highest age-adjusted cancer incidence rates of newly diagnosed cancer cases.
Saurav says the Ziro oncologist - previously only in contact with friends and fellow oncologists in Guwahati and Kolkata - could now make valuable interactions with counterparts in Delhi and Mumbai.
Given the way diseases and medical science are evolving, a doctor from Hapur in Uttar Pradesh can learn from one in Kolkata and vice versa, Saurav says, disrupting the notion of hierarchies woven in the urban-versus-rural discourse.
Elaborating on the Ziro example, Saurav says the platform’s vision is that the local doctor should help a patient access the collective wisdom of doctors, or the “software of healthcare”.
To give an idea of the volume, he says every month Clirnet has 40,000 doctors discussing diverse medical problems, and sharing clinical knowledge, experiences, and new developments.
As per Deccan Herald’s 2021 article, How Doctors Can Earn Continuing Medical Education Credits, some private players like Omnicuris offer CME courses that are approved by the MCI. Its portal lists around 209 CME courses and it has tied up with 12+ state governments.
For online CME players, producing globally accepted content remains a market challenge.
A platform like MedLern provides CME courses to diverse healthcare professionals such as doctors, nurses, paramedics, allied health professionals, home care, physiotherapy, laboratory and emergency workers, technicians, and people in front office operations, hospital management, and quality control.
Experts suggest that apart from credibility, acceptability of online medical education continues to be a barrier among medicos.
Post COVID information and interest
Most doctors have hectic lifestyles, which is why peer-to-peer physical conferences have long been popular – they let the medical professionals upgrade and fraternise.
Even if one argues that getting answers for a specific patient case has a faster turnaround on a digital platform, why would a doctor first not reach out to their vetted communities/peer groups a call/text away? How does a CME platform solve that problem?
Dr Priya Ganesh, Clinical Advisor, Women’s Health, GenWorks Health, says, “Doctors with their busy schedule would definitely like to have an upgradation of their skill sets and knowledge. With new things coming up, a digital platform is one click away to reach out to the community.”
Unlike lay audiences or several other professionals, doctors are a learned target audience. To ensure that the platform targets these super-busy professionals with the right content, Clirnet leverages artificial intelligence (AI) enabled technology.
The content engagement mechanism, which Saurav describes as “intelli-targeting”, intelligently targets doctors on the basis of the “discovery” of their browsing behaviour, personality traits, usage, and consumption patterns through AI. It is geared towards curating individualised content, and the tech provides “minimal but meaningful touch points” for positive patientcare outcomes.
Dr Priya says that COVID-19 has made the medical community well versed with online CME, which when conducted physically previously although successful was limited in its reach.
The smartphone and data revolution has led to deeper internet penetration in Tier II and Tier III India, which is also helping medical practitioners. They are now more receptive to digital modules such as webinars and video conferencing interfaces such as Zoom and Microsoft Teams.
“Not everyone is lucky enough to enjoy the facility of a corporate hospital where you have a counsellor. So ultimately, a doctor himself has to take out time to talk. This is where the dissemination of information using technology for public awareness on topics as diverse and as significant as male infertility, polycystic ovarian disease (PCOD), adolescent health, menstrual hygiene, cancer awareness, self-breast examination in layman language is important,” Priya says.
Talking about “Google era” patients, says most patients now visit doctors with some preparation, which makes disseminating authentic knowledge equally critical for medical practitioners and patients.
Serving underserved populations
MedLern claims to bring high quality healthcare training and skilling resources to diverse healthcare professionals and settings — from large multi-city hospital chains in major cities to sub-50 bed hospitals in Tier II and Tier III cities.
“We are currently in 310 hospitals and 50 colleges, with a small footprint in the Middle East, and cover over 83,000 healthcare professionals,” says Deepak Sharma, CEO, MedLern.
Meanwhile, GenWorks has, for the last one and a half years, been conducting webinars to target Tier II and Tier III demographics and disseminate knowledge about cervical cancer prevention, HPV (human papillomavirus) vaccination etc.
“More than 15,000 doctors have attended these webinar sessions so far,” Priya says. Had it been the past era where doctors had to physically travel, they would have seen one-tenth of these numbers, and even those one-tenth would be the key opinion leaders (KOLs) themselves, she adds.
Deepak says MedLern has created tailored programmes in healthcare settings in specific areas like critical care, patient safety, service excellence, infection control and quality management.
“These are delivered through e-learning, expert-led classrooms and simulation-based skill modules combined with rigorous assessments to measure impact.”
Saurav of Clirnet credits the commitment of the medical community, as there are doctors who due to a time constraint make the effort to share any new observation in their field in a self-recorded video to be posted on the platform. The motto is to ensure “information outreach is democratised”.
While the CME space is abuzz several interventions, only time will tell how it is able to critically disseminate information with authenticity, nuance, and ethics, and impact last-mile delivery.
(The copy was updated to correct a typo.)
Edited by Teja Lele