Elizabeth Loder: The medical conference of the future

Elizabeth LoderThere’s nothing like a gigantic medical meeting to make one feel inconsequential. I certainly did as I milled about the cavernous San Diego convention center with thousands of other doctors at the 2011 American College of Physicians (ACP) meeting. Tolstoy would have approved: “How good it is to remember one’s insignificance.” The ACP is the second largest physicians’ group in the US. Attendance at this meeting appeared high in spite of the lingering effects of the recession and rising travel costs.

While the future of such large medical meetings is probably not in doubt, these gatherings have undergone many changes in recent years, some gradual and others abrupt. I noticed a few things that would surprise a 2001 ACP conference-goer transported through time to this meeting. For starters, that doctor would almost certainly be impressed by substantial changes in the players, messages, and promotional tactics on display in the exhibit hall.

A trip through the exhibit hall is still a must at these meetings, but the days of lavish gifts, free drug samples, and elaborate display booths are truly gone. Pens and mouse pads are still available by the bucketful, but the logos have changed. In the past these things frequently bore the names of drugs or the pharmaceutical companies that marketed them; in the politically correct atmosphere of today they are more likely to come from government agencies or hospitals.

Among others, I chatted with representatives of the National Library of Medicine, the Office of Latin American Cancer Program Development, and hospital staffers trying to recruit doctors to underserved areas of the country. It is unquestionably more virtuous to hand out free pens trying to address the problem of physician maldistribution rather than to hawk drugs. Thus I had few moral qualms about gathering a few, even though the likelihood that I will join the staff of a rural hospital as a result is rather low.

Although the pharmaceutical and device presence in the Exhibit Hall was noticeably less prominent than in years past, there were still a few heavy-handed marketing campaigns. “Penile health for every man” trumpeted the signs behind one booth. I didn’t stop to seek details. Possibly the poorest taste, though, was shown by the US Center for Disease Control in its efforts to promote a new “healthy travel” initiative.  “Don’t flush your travel dreams,” advised a large poster adorned with a toilet. Note to BMJ Group Award organizers: Is there a prize for the tackiest medical marketing slogan of the year?

A time-traveling doctor might also notice the rising importance of the formerly humble conference badge, even though many of the worst features of these badges remain unchanged. For example, there is no end in sight to the fad of nursery school-style name badges. These prominently display the wearer’s first name in extremely large letters. In contrast, important things that ELIZABETH’s potential professional contacts might actually want to know – such as last name, employer or affiliation, and home state or country – are displayed in small type that can only be read by someone who invades personal space to closely scrutinize the badge. Badges are still prone to flip over so they can’t be read, and the problem of how to attach them has not been solved either. It’s still generally a choice between a flimsy elastic cord whose thickened ends won’t stay in the holes or a bulky metal clip for a jacket pocket I rarely have.

No, what’s new is the nearly ubiquitous use of bar codes, magnetic stripes, or other tagging shortcuts that allow information about the wearer to be obtained with a quick scan of the badge. At the ACP meeting our tagged badges were of most interest to those manning exhibit booths, who presumably use them to show the number of “contacts” they made at a meeting. Already, wags on the web are complaining about exhibitors who are more interested in the badge than the person wearing it: one comments that “if you talk to an exhibitor, the first thing they do is ‘scan you’ no doubt to track interest in their stand, so forget names etc: perhaps we all just have a bar-code stamped on our foreheads!” Another recounts feeling like a “victim” when “someone stepped in front of me and asked ‘can I scan you’? She got to NO fast.”

It won’t surprise me if at the ACP meeting of 2021 badge scans are used to track attendance at educational sessions. This is already done by the Association for Medical Imaging Management, which advises attendees that “the bar code on your badge will be scanned as you enter a session and as you leave the session.” And this shouty, uppercase warning shows that they mean business: “You must get BOTH scans in order to receive CE credit. You must be ON TIME for every session or you will NOT BE ELIGIBLE FOR CE CREDIT AND WILL NOT BE SCANNED INTO THE SESSION. There is no “buffer” time.” And woe to those who lose or misplace their badges, as there are many ways to punish them. Another organization does it this way: “Students who do not have their barcode badges must stand in line (a time penalty) in order to sign a manual sheet and present some form of ID such as a drivers license…” Hmm…maybe those barcode conspiracy theorists are on to something!

Another big trend is the move towards e-syllabi. Sometime between 2001 and 2011 the printed syllabus for the ACP meeting disappeared. Doctors now download lecture information and materials from the internet. The move away from a printed syllabus is accelerating and it seems inevitable that paper syllabi will soon be a relic of the past, like lantern slides. For example, the announcement for the Washington Academy of Eye Physicians and Surgeons Ophthalmic Medical Personnel Program announces the following: “In moving towards a green meeting, there will be no printed syllabus this year. Instead, one week prior to the meeting, you will receive an email with a link for access to your e-syllabus.

What hasn’t changed at these meetings is the method of instruction. Yes, there’s an increase in the use of audience response systems, and there is more interaction between speakers and audiences. But the bulk of the “teaching” is still done through the traditional lecture method, even though research makes clear that listeners retain very little of what’s taught this way.

There is hope, though. The Accreditation Council for Continuing Medical Education is moving towards standards that require continuing medical education providers to track educational outcomes and show the effects, if any, of teaching activities on clinical practice. This seems likely to force reappraisal of traditional instruction methods and rapid changes in practice. All of this leads me to predict that when it comes time to blog about the 2021 ACP meeting I will have lots to say about new and exciting teaching techniques. After all, teaching is (or should be) the core business of every medical conference.

Elizabeth Loder is the BMJ’s US based clinical epidemiology editor.