Building a Global CME/CE Program

Alex Howson [00:00:01]:
Welcome, Helen.

Helen Fosam [00:00:02]:
Thank you.

Alex Howson [00:00:04]:
It's good to see you. So let's start with sharing a little bit about who you are and what you do. If you could just tell listeners of right medicine who Helen Fossum is and the work that you do.

Helen Fosam [00:00:19]:
Sure. I'm a medical writer and I have been doing medical writing for the past close to 20 years. I started off in academia, that was back in the UK, and then when we relocated here to the United States, that's when really my medical writing career started, because before then I had no idea what medical writing was all about. So as a medical writer, I first was employed. I worked with a small company, initially called Ince, or interactive network for consumer education, and then I went on to work with WebMD and I was there for about six years. And when I left WebMD, I joined another small company that lasted under a year because I love the remote working which WebMD allowed me to do.

Helen Folsam [00:01:24]:
WebMD Medscape. And when I left the small company, Robert Michael Educational Institute, I then became a freelancer. That was back in 2011, and I've. Been there ever since.

Alex Howson [00:34:27]:
So I appreciate you sharing your perspective, for sure. So let's talk about the Milo initiative.

Helen Folsam [00:34:36]:
Sure.

Helen Fosam [00:34:36]:
Absolutely. Milo stands for the missing link to improved health outcomes. And it all started.

Helen Folsam [00:34:47]:
That was back in, it didn't formally.

Helen Fosam [00:34:50]:
Start as Milo, but back in 2015, someone reached out for me from Africa asking me to help them put together a CME program. They had a one month to do everything. I said, no, that doesn't happen. In one month, maybe three months, but not one month. So I provided them with the guidance. This was, like, around August time frame. I provided them with what a proper CME program would look like, requires three months lead in. And I did that, and then I didn't hear again.

Helen Fosam [00:35:26]:
And then in December, they came back and said, oh, we want to put.

Helen Folsam [00:35:31]:
Together an ongoing curriculum.

Helen Fosam [00:35:34]:
Can you help us? And that was really the start of me thinking, there's a problem here that we need to solve. And what the person shared with me at the time was that this was actually in Nigeria. The person in Nigeria told me that a lot of physicians were not being able to keep up with their medical knowledge and skills because there were just no opportunities. And he was at a point where he had to fly his sick mother to India to get medical care because it was just not available. And I thought, well, really, okay, if he can afford to take his mother to India, what about people who can do that? What happens? So I did some research, and as it turns out, CME is something that is not. They call it CPD because you're professional development.

Helen Folsam [00:36:37]:
There's not that much of it.

Helen Fosam [00:36:39]:
So I thought, oh, okay, with my skills, I can actually try and figure something out. Why not start creating these courses? And that's how Milo actually came into being. And I kind of stumbled along between 2015 and 2000. And because I really didn't know what I was doing, I was experimenting, trying all sorts of things.

Alex Howson [00:37:05]:
Sure.

Helen Fosam [00:37:05]:
2019, that's when I would say formally took off, because I created my first pilot course that was on type two diabetes. I fielded it out. I did some surveys with the african population, with healthcare professionals in Africa, and they told me the results of that survey told me, yes, there was a need. So I started saying, ok, let's create content that anybody can take. It's online, which means as long as you have the Internet, you can take it. And that was a problem that in Africa, because a lot of the opportunities for CME that they had, you had to go to a physical location. It was part of a conference. So if you are in the village somewhere or if you are a junior doctor or a nurse or, for example, you can go to those places.

Helen Fosam [00:37:56]:
So it was exclusive for those who can, maybe for the registrars who had the money and who had the clout and who could just go. So with an online course, we made it so that anybody who has Internet can access it. So that was 2019, and then that's what I've been doing ever since. But then, in creating those courses, I.

Helen Folsam [00:38:20]:
Realized that the people who write those.

Helen Fosam [00:38:25]:
Content and review those content is just as important as the content itself. For example, there was a course that would working on reproductive health. I use a professor in Zambia to do the review. I used a writer in Nigeria to.

Helen Folsam [00:38:43]:
Help me do that.

Helen Fosam [00:38:45]:
And the first draft I did, I wrote it know with my american hat on. And the reviewer, the professor read it and said, well, it's beautiful what you've written, but none of this applies to us. We don't have this medicine. We don't do this. We don't do that.

Helen Folsam [00:39:04]:
So it told me that content writers.

Helen Fosam [00:39:08]:
Have to be on the ground because they know. I call it where the shoe hurts. They know what needs to be done. There's not only influence of culture, there's influence of beliefs. There's all sorts that come together, influence whether a practitioner will, whether the content will resonate with the practitioner, and whether a patient will listen and do what the practitioner is doing. That's really when I realized that all the content that's developed has to be from the ground. And that's where this mentor thing we're talking about, because I need content developers. I said, okay, you're interested in medical writing.

Helen Fosam [00:39:58]:
Let's get you to where you need to be. Work with me and we'll do that. So if you go to the Milo website, there's a blog that we write. Every single name on there is an african name because they are the writers, right? We have patient information leaflets. The writers, the reviewers are all right from there. The graphic designer that we use is right from there. And right now we're in Kenya doing some pilot. The people on the ground, you really need those people who understand how the system works.

Helen Fosam [00:40:36]:
So that's kind of milo. And there's a whole bunch of things about it that I haven't said, but essentially, it's creating content for healthcare professionals in Africa and for patients. There's patient information leaflets that we do translated currently to eight different languages.

Alex Howson [00:40:57]:
So have you had to write grants to get funding for this initiative?

Helen Folsam [00:41:01]:
Can you talk a bit about that?

Helen Fosam [00:41:03]:
Right now? Where I am with this is that I had to prove to myself that.

Helen Folsam [00:41:12]:
This is viable because my company is.

Helen Fosam [00:41:19]:
The edge medical writing, and this is what has sustained me as a medical writer. Milo is. My husband calls it a hobby. That's your hobby? That's not really work.

Helen Folsam [00:41:32]:
And I had to prove or demonstrate.

Helen Fosam [00:41:39]:
That this is something not only a.

Helen Folsam [00:41:41]:
Need, but it can also be a business.

Helen Fosam [00:41:47]:
And that pilot that we are doing.

Helen Folsam [00:41:48]:
In Kenya is my way of again.

Helen Fosam [00:41:51]:
Proving to myself that this is a viable business because the pilot is looking at ways to sell advertising space. So up to now, I haven't applied for grants because the first thing that they will ask for grant is you need to know what you need the money for. Sure. I want to be able to. Maybe it's my stubbornness.

Helen Folsam [00:42:19]:
I need to demonstrate that there's not.

Helen Fosam [00:42:24]:
Only a need, but this is the process that we need to follow, and these are the outcomes that we need to achieve.

Helen Folsam [00:42:35]:
So it has been a journey for.

Helen Fosam [00:42:39]:
Me to identify all those things.

Helen Folsam [00:42:41]:
So now if I go to a sponsor, I can tell them these are.

Helen Fosam [00:42:46]:
The data that we have.

Helen Folsam [00:42:47]:
Because in Kenya, we're not only doing a marketing pilot, we are also doing.

Helen Fosam [00:42:55]:
An outcomes, not outcomes, we are also doing an impact.

Helen Folsam [00:42:59]:
Oh, okay.

Helen Fosam [00:43:00]:
Yes, because I want to be able to demonstrate to a potential sponsor that, look, all these hospitals are so engaged.

Helen Folsam [00:43:09]:
In this project that we're doing, and we are testing our initiative on this.

Helen Fosam [00:43:17]:
Population of patients, and this is what we are finding. So it's a three month pilot, and we are in the second, end of the second month. So we have one more month to go.

Helen Folsam [00:43:28]:
Right.

Helen Fosam [00:43:29]:
So once all that is in place.

Helen Folsam [00:43:31]:
Then applying for those grants will start.

Alex Howson [00:43:35]:
Well, that's pretty amazing, Helen. And you're obviously not the average medical writer in CME, because not only are you kind of developing content, but you are also creating curricula and developing impact studies at outcomes frameworks as well. And I think one of the things that new to the field writers ask me is, are we supposed to design the education? And I say, no, there's usually someone on the educational strategy site who's going to do that. You will have to put together an agenda, but not the actual education design itself. But you are actually doing that. And so that is pretty amazing. And one of the things that strikes me about the way you're describing, using local writers for context and making sure that the content resonates with the people who are going to consume it and be educated by it is also a great model for us based CME and CE as well, because the US is such a vast place that is with all sorts of cultural, racial and ethnic differences and language differences that CME has started to kind of pay a lot more attention to over the last few years and certainly now has a little more clarity of focus. And I want to hear what you think about this on diversity, equity and inclusion, so that hopefully the content that writers will be engaged in creating will be more nuanced, will be more contextualized will be more appropriately aligned with the people who are actually going to be using it.

Alex Howson [00:45:36]:
Is that something that you see beginning to occur in the US context?

Helen Fosam [00:45:43]:
Absolutely, yes. The last two, our freelance workshop, we actually had presenters talk about de I, diversity, equity and inclusion. And this is something that is not only beginning to trickle into the medical writing arena, especially with CME included, but it's also something that is embraced by the pharmaceutical companies because they're now including more de I. In fact, our first, two years ago, the first time we presented, we had to speak on de I was actually someone who worked at BMS. And that person was telling me that, yes, BMS and so many other pharma companies are beginning to embrace de I. And I also believe that AMWA national has. Now they do have a statement. They do have a statement de I.

Helen Fosam [00:46:41]:
So this is something that is increasingly know the medical writing and real. And I think it's so important, as you say, there's so much diversity in the US, from culture, from sexual orientation, you name it. There's a whole spectrum. Now, if you are providing healthcare to this spectrum of people, but you only applying from one angle, you're going to miss a whole range of people. And it's not only providing health care, but we are also talking about doing.

Helen Folsam [00:47:24]:
Clinical research because there's so much underrepresentation.

Helen Fosam [00:47:28]:
I'll give you one example, one really important example. There's a population of people with benign neutropenia. It's called benign ethnic neutropenia. Normally, neutrophil levels are between 2500 and about 7000. I believe it's milligram per liter or something like that.

Helen Folsam [00:47:55]:
And it's.

Helen Fosam [00:48:00]:
For, for the patient. For those people with benign neutropenia, their.

Helen Folsam [00:48:06]:
Neutrophil is usually below one or below.

Helen Fosam [00:48:11]:
1000 milligram per liter. And it becomes a problem when they have to have chemotherapy, because the guideline says that for you to have chemotherapy, your neutrophil count must be above at least 1.5 or above. Right now, if you're permanently below one or below, it means you're denied of treatment. And that's why if you look at the statistics, if you look at the.

Helen Folsam [00:48:47]:
Research that exists, you find that these.

Helen Fosam [00:48:52]:
People with benign neutropenia are generally Africans, Caribbeans, sometimes Hispanics. The research has been done on the african population or African Americans shows that.

Helen Folsam [00:49:08]:
For breast cancer.

Helen Fosam [00:49:12]:
The population is actually.

Helen Folsam [00:49:13]:
Lower than the Caucasians, but the death rate is much, much higher.

Helen Fosam [00:49:23]:
Granted, access to care is one thing, but nobody has done any research on.

Helen Folsam [00:49:28]:
This population with permanently low neutrophil, I.

Helen Fosam [00:49:34]:
Mean, they're perfectly fine. Yeah, but I can do with a high neutrophil count.

Alex Howson [00:49:41]:
It's an exclusionary metric.

Helen Fosam [00:49:43]:
Yes, because they're excluded automatically from clinical trials. So in terms of this equity and inclusion, diversity, equity and inclusion, it's not only about your religious beliefs or your sexual orientation, whether you're male or female, whether you're older or young, rich or poor. It starts right at the beginning, at the clinical trial level.

Alex Howson [00:50:09]:
Oh, yeah, absolutely.

Helen Folsam [00:50:11]:
For both male and females, absolutely. The same problem.

Helen Fosam [00:50:17]:
But then, of course, it becomes challenging as to actually conduct these trials. It is expensive. You have to bring patients in. You have to convince them that there's a whole bunch of other challenges that.

Helen Folsam [00:50:36]:
We need to overcome.

Helen Fosam [00:50:38]:
But it's still good to actually be.

Helen Folsam [00:50:40]:
Aware that this is an issue that.

Helen Fosam [00:50:44]:
Needs to be addressed, and it's all about that diversity, equity, and inclusion.