Introduction
[0:18] Welcome to Monday Mentor, a Right Medicine series. I'm your host, Alex Housen, and today Today, Helen Fossum is back to share insights on CME medical writing.
Helen is a seasoned medical writer with over 20 years shaping her career, beginning in academia in the United Kingdom, then moving to the US where she discovered medical writing working at companies like WebMD and small remote startups. She launched her own medical writing consulting business, The Edge Medical Writing, through which she founded the Milo Initiative to provide continuing education to improve health outcomes in Africa. In today's episode, Helen dissects the nuances between medical and healthcare writing, talks about the challenges that new writers face, and shares invaluable tips on asking the right questions to provide tailored content for clients.
Academic Background and Transition to Medical Writing
[1:22] You know, I don't think I realized that you had been an academic in the UK before you moved to the US and became a medical writer, which is pretty much my trajectory as well.
So where were you in academia? What's your discipline?
I worked with Queen Mary, University of London.
That was the setting or the institution I was working in. Prior to that I worked with a small in those days it was a polytechnic but not a university because it was a transition period between polytechnics and universities yeah and yeah there I was teaching nursing students actually with the backgrounds I had so that would be my.
[2:06] Academic career so teaching and then went over to Queen Mary it wasn't actually teaching it was more more of managing, it was called the interactive, it was actually one of the satellite that was set up by the UK Department of Health.
And it was set up to promote research and development amongst healthcare professionals in the UK.
So my role there was really to managing that outfit primarily, rather than actually teaching medical students.
Oh, very cool. And so how did you find medical writing?
How did I find it in terms of the job or how did I find it in terms of?
Yeah, no. Yeah. How did you? Yeah, that's a very British thing, I think. No.
How did you find it actually in terms of, you know, you moved 3,000 miles to a new country. Then what?
Yes. Very interesting because when I, when we relocated and we actually relocated because of my husband, he came ahead of us because he had an opportunity to work with a company here in the United States.
And it's a company, it's the parent company of the one he worked with in the UK.
[3:21] And when he visited the parent company or the headquarter, so to speak, here in the United States, he thought, well, this is a great opportunity for us. Why don't we come?
As in, you know, let's all relocate. And I said, no, I don't want to go anywhere because that's fine.
Our children were very small and I had a great job that I liked.
This is when I was at Queen Mary.
And I just didn't want to move. But eventually, you know, I had to come.
That's a big undertaking.
It is. It is. The oldest at the time was six years old.
And then we had a four-year-old and literally she was two turning three when we relocated. So they were all very young.
[4:05] And when we arrived in the States, obviously, after settling down, I started looking for a job.
And when I started applying based on my you know credentials medical writing kept on popping up I had no idea what medical writing was because it just didn't exist in the UK right and I, yeah so I actually ignored a lot of those opportunities that came my way because I didn't know what medical writing was and eventually I thought okay this is coming up let me just check check out what it is. So I went for an interview.
This was with the INC Interactive Network for Medical Education.
And they offered me the job. And that's how I would say that that's when my medical writing career actually started or when I found out, oh, this is what medical writing is. It's quite nice.
And it was quite good because all the background that I have have from my career as a researcher, doing my doctorate, doing my postdoc, academia.
[5:19] Teaching with the Queen Mary, trying to promote evidence-based practice.
So I was able to combine all those skills and knowledge that I had, and I didn't really have to learn too much.
Obviously, I had to learn the ropes, but all the skills that I needed, I already had from my prior background. So I thought, yeah, this is actually something I can do, and I really enjoy doing.
So that's how, really, I found medical writing.
[5:46] And you actually find continuing medical education right at the beginning, which is interesting because it's such a subterranean world.
And I really believe strongly that if you have the kind of background that you've described, and certainly this was my experience, you know, teaching, research, maybe throw in some clinical experience there.
Some people have that as well. Then continuing medical education is really a sweet spot for those kinds of skills.
Not so much, I think, I mean, my experience certainly was, you know, at the beginning, because I was finding medical writing coming up too when I was, you know, beginning to look for jobs.
But a lot of those jobs at the time we were in California, in the Bay Area, a lot of those jobs were regulatory or on the promotional side where I think my background certainly at that time was not such a good fit for.
And I would have struggled I think in those environments as well so I'm glad that I did find you know CME and CE when when I did you you mentioned that you know you didn't know what medical writing was and you know one of the things that happens for a lot of people is that you know they confuse or they conflate medical writing with health care writing what are the differences from your perspective perspective.
[7:05] Yes, that's a great question. I actually had one young person, well, a medical writer, and he came to me and asked, well, I've been doing a lot of writing, as in health writing, and I am not getting any opportunities with CME.
Why is that? So I had to explain that CME writing and health writing are completely different things.
And when you're starting off in medical writing, many people don't understand that it covers a whole spectrum of writing from, you know, you have promotional, you have regulatory, as you say, you have publications, you have even grant writing as a specialty.
Then you have the medical education as a CME.
You have the health writing.
[7:55] So depending on where you find yourself, where you land yourself, perhaps as an incoming I mean, writer, if you're landing where it's health writing, you know, you just assume that this is medical writing. It is.
But CME is a type of medical writing that requires in-depth knowledge on the subject matter.
It requires you to be able to write as much as the, you know, the people that you're actually targeting, i.e.
Those healthcare professionals. And when we say healthcare professionals, it covers a whole spectrum from the highly specialized to the generalist.
And then we're also including the pharmacists. We're including the dentists.
So all healthcare professionals.
And with CME, and some places they call it CPD, continued professional development, really it is different from health writing because with health writing, it's more general. Right.
It's more for the lay public. I'm not saying it doesn't require research because it absolutely does.
But in terms of your sources, it doesn't have to be primary.
It doesn't have to be research, back to research evidence.
[9:15] It's generally not accredited. Whereas CME, in most cases, is accredited because this is what the doctors, healthcare professionals need.
They need those CME or CPD points.
[9:30] So I'll say generally the main difference between them is that CME is highly technical, specialized, targeted to the healthcare professionals who need to update their skills and knowledge.
Whereas health writing is more targeted to the general public.
It's generally not accredited.
You can even insert your own opinion in some cases if it's appropriate.
Appropriate. So, and yeah, both are different.
Yeah. And in some health writing, there's a looser style, isn't there?
And certainly, you mentioned WebMD. If you look at some of the kind of material on WebMD that is consumer health facing or patient facing, then there's a range of content from.
[10:19] Quite specific patient-focused education to more news-style pieces, which have more of an element of, well, they're just a little bit more fluid, maybe a little more opinion-based in some cases.
And CME is not that.
Right. And that's why there is Medscape.
Medscape is the physician arm of WebMD.
And if you go on Medscape, then you find the type of content that is CME.
Me, whereas general WebMD is really maybe for the patient consumption or for the general.
Yeah. And WebMD is perhaps unusual in the sense that it has those two arms of consumer health facing and health professional facing.
I know that you mentor medical writers who are kind of looking to move into CME.
Are these confusions in terminology technology something that are a barrier to people moving into the field? Well, I guess I think I have two questions here.
One is, one of the things that I hear a lot from new to the field medical writers who are kind of moving into CME is they'll use a lot of terms interchangeably.
So medical education agencies versus medical education companies or medical education providers.
And to me, an agency is more medcoms-based than focusing on accredited medical education.
[11:46] Other things like that, you know, I think you mentioned that conflation between health writing and medical writing.
Are these things that you see in new-to-the-field writers that you have to work with them to help sort out the different threads of meaning there?
Understanding the Terminology in Medical Writing
[12:07] Yes. You know, semantics is something that we all use, and sometimes we as the medical writers or even the agencies are part of the problem in that we also use some terminologies interchangeably.
It is something that I've come across and where I know that, for example, a medcom company is mainly, you know, continuing medical education.
It's not promotional. And whatever other terminologies that's used for that, whether it's, you know, agency or otherwise, you know, medcom agency or medcom company, it depends on what it is that they do. Right.
And if it's primarily creating content for physicians that is accredited, that follows all the guidelines of CME, then whether you're an agency or not, what we call yourself, that's what you are, as opposed to promotional.
So what I tell people who come and ask, is this an agency or is it a medcom or is it promotional?
I say, well, figure out exactly what they're doing.
What do you want to do? because some new writers don't know what they want or they don't realize all the different spectrum of writing.
[13:28] So the first thing I ask them is, what do you like writing about?
Who do you like to target when you write? In fact, I'm working with one young lady right now.
I asked her, I mean, I gave a presentation, a webinar, you know, and she was in the audience and she came to me afterwards saying that she wants to do medical writing.
I said, yes, okay, what kind of medical writing do you want to do?
So we had to, you know, break it down and distill until we got to the point that she wants to do actually health writing.
I said, okay, what kind of health writing? To who do you want to target? That kind of thing.
So it's always good to, I pay less attention on the words and the semantics.
I'm more focused on what it is you want to do.
And then based on what you tell me, then I can say, oh, actually, this is regulatory writing or this is promotional or CME.
No, it's actually patient level.
So that's how I kind of deal with it.
Yeah, no, that's a good framework.
I guess increasingly I'm seeing it less about semantics than, so for instance in the accreditation council the ACCME gosh that's just that whole acronym yeah.
[14:53] Accreditation council for continuing medical education it's, You know, if you're an entity, an organization whose primary client is a pharmaceutical manufacturer, then you can't be accredited, an accredited education provider.
And a lot of agencies do have pharmaceutical manufacturers as their primary client.
And so I guess, you know, increasingly I've been sort of caught up in that.
OK, it's not just about semantics. it's actually it is actually part of the firewall and writers have to be have to at least know what side of the firewall they're on when they're creating accredited content versus creating content for education which isn't necessarily part of an accredited package as it were so that's that's it's kind of top of mind for me at the moment I'm thinking about that a lot and we We had Graham McMahon on the podcast a few weeks ago. And so, yeah.
It's actually interesting you say that from, you know, now hearing from that angle.
I remember when I was at Medscape, we had a physical firewall in that. Yes.
[16:09] Yes, it had to be kept, i.e., you have to say all the CME folks were on one end of the building.
Building, then you have to walk across a long corridor before you can get to the other end of the building where the promotional people were.
So in terms of that, but then of course, Metscape had the luxury of space at that time. Was this the Manhattan building?
No, that was before. This was when they were at Port Authority.
Oh, okay. But then still, same building as Google, by the way.
Don't Mix Promotional and CME Content
[16:47] Enter Google. Interesting. Yes, it was very interesting. Yes, so with Medscape, with their luxury space, you can afford to do that.
Whereas with a smaller agency, as you're saying, that might be more difficult.
And yes, I understand that the rules of CME is that you can't mix promotional with, you know, country medical education, obviously.
And once you get that funding, then it's supposed to be hands-off, as far as the fund is concerned.
If you mention one drug, you have to mention them all. You can't promote one over the other, that kind of stuff.
So if a small agency has both mixed up, then it can become a little bit, you know, yeah, it becomes, I understand, you know, that if there's too much promotional in one agency, then to say you're also a CME without strict firewall, it becomes a little bit...
[17:53] It comes out to be dicey, I think. And I agree. I agree.
I think it does. Yeah, and I think there's been a, you know, waves crest and fall.
I think, you know, after the congressional hearings and the introduction of the Physician Payment Sunshine Act and some of those regulatory changes and the initial commercial standards for CME before the 2020 rework of the standards for Independence and Integrity in CME.
I think that, you know, initially there was a real, there was a physical separation between a lot of education providers who wanted to play in the accredited space versus education providers who did both promotional and accredited content.
And then I think a few years ago, you know, those boundaries have started to kind of elide a little bit again.
And there are some organizations who kind of play in both spaces.
That gets confusing for new-to-the-field writers because, as I said, I believe they need to know what side of the firewall they're on.
But you mentioned... Go ahead. And I guess that applies if you're an employee.
Be the Firewall
[19:08] Because if you are a freelancer or a consultant and you're asked to, okay, this is the document we want you to write on. on.
If it's a CME, then you're really not part and parcel of that.
You're not influenced by anything or anyone around you. You're just doing that piece of work.
So I don't know whether, you know, the firewall issue applies to employees in a physical location, you know, doing both promotional and CME type work as opposed to...
[19:47] You know, a contractor working independently. I'm not quite sure how that works, to be honest. Yeah, that's so interesting because I've always taken that literally.
And I think, and I do think there are sources of influence in, I mean, the very fact that we have to complete disclosures, you know, and conflicts of interest when we're working on accredited CME content suggests that there is the potential for bias and influence. influence.
You know, I think we, as a group of writers, definitely want to believe that we are, we're working in a way that is free from, free from bias.
But, you know, I think the potential is, I think the potential is there.
It's certainly something to be aware of.
And you do, I don't know, maybe this is a question, have you come across this?
You do read, especially if you're in that mentoring space you do read new to the field writers work sometimes where they they are slipping into that way of expressing ideas that is a little bit more promotional and doesn't adopt a fair and balanced approach to the content that you know you have to kind of school new to the field writers on I don't know is that something you see when you're mentoring new to the field writers?
[21:03] You know what? Not so much. Only because a lot of the time, the people I mentor are people who work with me, who are perhaps working on projects that I've given them.
So for example, I may be working with a client and And, The mentor will be doing aspects of that.
We'll be working together on a particular project rather than a mentor, I mean, a mentee who is in maybe the workplace looking for someone to hold their hand.
And I am not part and parcel of that workplace and I don't know what's going on. So most of the people that I work with as a mentor-mentee relationship is really content I have control over.
I know exactly who is going to, whether it's for CME or whether it's promotional.
[22:07] So I dictate, I set those boundaries right from the beginning.
Yeah, that makes total sense. Sorry, go ahead. Now, I like the point that you make about us being, you know, our integrity being front and center of, you know, the work we do.
Because if we know that this is CME and there's an external influence trying to shape the content of that CME, then if we know what the rules are, then it's for us to be able to push back and, you know, maintain that standard.
But I do understand that, especially as a freelancer, or even as an employee, you are paid by the company and you are paid to do the work.
But I think there's a way that we can all exercise that integrity just to make sure that we uphold the rules of what's CME.
Me because I truly believe that medical practice and patient care and outcomes is all reflected in what the doctor knows and the skills that they have, and they build those skills based on evidence.
So it's up to us to make sure that they have that evidence they need.
[23:26] Yeah, no, I, I, I agree with that a hundred percent.
You know, there's been a lot of chat on the American Medical Writers Association Engage platform lately around mentorship.
And so, you know, I applaud you for, for being a mentor and it sounds as though your model is, and you described it as, you know, you're working on projects.
Sustainability of Mentorship in Freelance Work
[23:45] And so you're, you're inviting or pulling people in to work on those projects with you and providing them with mentorship.
Mentorship is that a sustainable model for people who work freelance in order to provide mentorship and i guess i asked that question for two reasons on the engage platform there's been a lot of concern that that's not a sustainable model because when you're working freelance yeah you control the content but you don't necessarily have access to additional budget budget, to support the incredible investment of time and energy that it takes to actually mentor or coach somebody to do the work.
And I think there are, we might get into semantics here again, Helen, because there are differences between coaching and guiding and teaching and mentoring.
And I know from my own experience, there've been a couple of periods where I've I've taken on subcontractors and there's been an element of teaching in order to make sure that the work is.
[24:56] You know, meets the way I want things done. And it's just a lot of work.
You know, I made a decision around about 2014.
I wasn't going to do that anymore because it's such a huge investment in time.
So talk to me a little bit about how you've developed your model and what you see as, you know, in that whole debate that people are having within AMWA at the moment, where does mentoring go?
What is a potentially sustainable model for the organization to think about or for individuals within the organization to think about? Very long question.
Yes, yes, that's very interesting. I have actually been following those discussions on Engage.
And I know that Amwa National discussed it and said not at this time.
Right. And somehow I do agree with them, not yet.
Because what we are doing as mentors, we are all doing it haphazardly, including what I do.
This is just something that works for me and something that I felt was important enough for me to do.
[26:04] But you can't expect other people to do the same because as freelancers, as consultants, we are our own individual businesses and it's our job to make the money and make the revenue.
And time is money. So if you are mentoring somebody, where do you find the time to do that?
[26:28] Now, on Engage, yes, people are, I mean, one school of thought is saying, or one side of the argument is that do work for free so you can get experience.
And the other side of the argument is, no, don't do work for free because you deserve to be paid. Both of them are good arguments.
On the side of do work for free, you know, it becomes, yes, you're doing it for free, but the person who is going to provide you that guidance, do they have the time to do it?
That becomes a challenge. And you can, how much time will they invest?
I, for one, as a freelancer, you know, I'm always against a deadline.
If I have a deadline to meet, I meet that deadline. okay and sometimes it's multiple deadlines because you don't only have one client so that becomes a challenge on the side i'm glad i'm not the only one we all face the same challenges you know this feast of famine maybe on the period of my famine, then perhaps i'll have the time but when it's when you have the work you do the work and And your ability to meet those deadlines is part of your reputation, correct?
Absolutely. So you just do it.
[27:53] But then the side that is arguing for payment, now, if you pay for something, you are expecting a certain outcome or a certain reward or whatever it is that you're looking for.
We don't have a guideline on mentoring.
[28:13] Nobody says that you pay an X amount of dollars.
What is it are you getting back? And is it standardized across all the mentors? That doesn't exist.
Do we need training to be a mentor?
I don't know because nobody's discussed it.
So I agree with Amwa National that this is not the right time for us to do it.
We certainly need a mentor and a mentee relationship.
But there needs to be some level of guideline for us to follow.
Because I don't want to pay an X amount of dollars to whoever.
What am I getting for that X amount of dollars? Nobody knows.
Set Minimum Standards
[29:00] Some will be good and some will be not so good. and maybe some would be absolutely rubbish.
So we need to have a minimum standard. Now, what I do is because I have this desire to lift people up, you know, because I became a medical writer and I would say became a successful medical writer, writer, not because I'm a brilliant writer, but because of the help I was given along the way, the opportunities I was given.
Somebody taught me how to do this. Yes, I had the skills to write, but the way you write it, somebody showed me how.
I made mistakes and somebody corrected those mistakes.
Therefore, I need to give somebody that opportunity. And that's why I do what I do.
And as i say and that's why the projects that i work on with mentees is my project it's a little bit different now because of the milo initiative that we're going to talk about later we are that is part of the if you like the trajectory uh not only guiding those who i work with on the CME or even non-CME projects that I do here in the States.
[30:26] But a lot of the people that are now mentoring are not even in the United States.
But it's part of love there.
[30:34] Yeah, well, let's talk about that. And thank you for really kind of parsing that out. I think that's really, really helpful.
Pathways in Medical Writing
[30:40] It is an ongoing debate, and it's not the first time that AMWA has been engaged in this debate.
I just want to say that the mental discussion needs to continue because medical writing is almost exploding.
So many people want to do medical writing.
[30:59] There needs to be guidance. So for Amwa National and for all of us, I think we definitely need to continue that debate.
It's very important. No, I completely agree.
There are no clear pathways into medical writing.
I mean, that's partly why I started working with writers who are interested in CME. There's no clear path into CME.
And so I know I can provide some teaching around skills in order to support people who are kind of thinking about this particular specialty.
So I agree, there are needs. And in relation to CME, that's not just a debate or a discussion that Amwar are having, but also the Alliance for Continuing Education in the health professions.
There aren't clear pathways for people into CME, whether you're a writer, whether you're a program manager, a grant manager, a scientific director, an educational strategist.
And that is definitely something that the profession as a whole is kind of looking at. So I appreciate you sharing your perspective, for sure.
Be your Own Advocate
[32:10] This conversation with Helen reinforced for me how important it is for CME writers to advocate for ourselves in this field and to recognize the intellectual contributions that we make to CME and CE content. content.
CME writers are instrumental in maintaining the integrity of education content.
[32:32] So here are my key takeaways from today's conversation.
First, there are important distinctions between medical writing and health writing.
Health writing targets the general public, whereas medical writing that is specifically for accredited CME requires an in-depth understanding of subject matter and the ability to communicate complex information effectively to health professionals.
Second, if you have a background in research, academia or clinical expertise, you can parlay that expertise into CME medical writing.
Your experiences will provide a solid foundation for understanding complex medical topics and thinking about how to translate these into education activities that have an applied dimension. mention.
As writers, it's important for us to be aware of industry standards, such as accreditation requirements and the importance of developing unbiased evidence-based information in CME.
[33:38] And finally, there are ongoing debates around mentorship models within the medical writing community and the American Medical Writers Association in particular.
Providing quality quality mentorship requires a large investment time, which can be challenging for freelance writers.
So it's important to be aware of that. And organizations are discussing how to create sustainable mentorship programs for new writers in medical writing in general and in CME, including WriteCME Pro, which is a professional development membership for medical writers who want to specialize in creating CME and CE content.
[34:19] How can you put today's session into practice? Well, first of all, identify your area of interest.
Reflect on which aspect of medical writing most aligns with your skills and interests, whether it's CME, regulatory writing, or health writing.
Second, educate yourself. Engage in continuous learning to understand the nuances of your chosen area.
That could involve taking specialised courses, attending workshops and of course subscribing to Write Medicine which is the only weekly podcast for CME and CE professionals including medical writers.
And if finding a mentor seems out of reach you can at the very least connect with experienced professionals in the field.
This can provide guidance, help you avoid common pitfalls, and accelerate your career development.
And so finally, stay informed. Keep up with the latest trends and standards in CME and CE writing to make sure that your work remains relevant and compliant.
[35:25] That's it for today. Hop on over to the blog on my website at alexhousen.com for more resources on CME and CE.
Next up on Wednesday, Regina Simon-Yea is back to talk about transitions and professional identities, which is a theme in the professional development domain of the 2024 Alliance Annual Meeting that takes place in New Orleans between February the 5th and the 8th.
I'm presenting at the meeting, so if you're going, come and find me and let's find time to chat over a cup of tea or coffee.
Don't miss out on any of Right Medicine episodes.
Subscribe to the podcast on your listening platform.
The link is in the show notes. And until the next time, connect with me on LinkedIn, grab your Right CME roadmap, or subscribe to the podcast newsletter, Right Medicine Insider.
And consider joining WriteCME Pro, the professional development membership for medical writers who want to specialise in creating CME and CE content.
Stay curious and keep learning.
[36:28] Music.
