Garth Sundem 

Welcome to this episode of the Medical Affairs Professional Society podcast series Elevate, gathering the voices of Medical Affairs thought leaders and stakeholders to explore current trends, define best practices and empower the Medical Affairs function. I’m your host Garth Sundem, Communications Director at MAPS. And today we’ll be speaking with Jessica Ingram, Managing Director of Learning and Development at Open Health and two of her team, Briony Frost, Learning Design and Development Specialist, and Rebecca Case, Account Manager. Open Health is a global full-service medical communications agency offering Medical Affairs consultancy and content, publications, medical education and internal training. Joining Jess, Becky, and Briony is Siobhan Mulhern-Haughey, currently EMEA HEMAR Manager within Neuroscience at Janssen, but previously responsible for internal training as Scientific Knowledge Manager for the EMEA region, offering insights into how internal training can support patient outcomes. Jess, I’ll hand it over to you. Can you start by laying the groundwork for us?

Jess Ingram 

Thank you, Garth, that’s great. Yes. So today we’re going to explore how internal training can be designed and delivered to support patient outcomes by positioning the patient as the ultimate priority from the outset. This is the first in a series of three podcasts we’re doing with maps, which we’ll look at three essential elements of internal training that need to be addressed to ensure that training efficiently and effectively meets the needs of all stakeholders. From the learners taking the training to senior management, to healthcare professionals and beyond to their patients would explain more about these three elements are in due course. But let’s start off by answering the big question, how can internal training ultimately prioritize patients and support better outcomes?

Briony Frost 

So I think we need to think about internal training as part of a cog in a larger machine that contributes to patient outcomes. Like the other moving parts in that machine, it has the potential to contribute to improving them. If we take some of the key factors that influence patient outcomes, we might consider things like the use of evidence based practice amongst HCPs things like preclinical data, clinical trials and clinical guidelines, which work alongside the bio psychosocial model of treatment considering not only the disease and biology, but the psychological and social impacts conditions have on their patients. The goals here are to ensure prompt early and accurate diagnosis of medical conditions, optimal treatment and monitoring using up to date evidence recommendations, and promoting continuity of care between practitioners. We might also consider things like staff well being. And that’s that’s something that ought to be self explanatory, but frequently isn’t. We might consider Patient Support and engagement, making sure they understand what their diseases how its treated, and how they can manage it. We might think about resources and costs things like health economics, intervation, interventions and evaluations, and technologies such as apps for hcps, and their patients, data analytics and outcomes, we might want to throw into that mix as well, Disease Prevention and Public Health. And each of these critical elements is influenced by both internal and external training. So we need to be very aware that internal training doesn’t live in a box somewhere, pop out for a session and then disappear. It continuously actively influences individuals and institutions, pharmaceutical companies, healthcare practitioners, and policymakers that are crucial mechanisms in this machine that determines patient outcomes. What this means is that we need to keep the patient in mind throughout the process of designing and developing our internal training, and make sure our learners are aware of the impact that their training is going to have at a variety of levels. If we take an MSL as an example here, it means that both we as trainers, and they as learners need to be able to recognize how their training is going to impact on them personally in terms of their professional development, and how they will apply that learning in their professional roles, how their performance impacts on the people who can’t they come into contact with, from their work as part of a wider manifest team, to doctors and other hcps that they interact with how the performance of their team overall impacts on the company’s KPIs. How HCP is that the team them work with work with their own colleagues and ultimately all of their patients shaping the decisions they make about treatment options and pathways for individuals. Yeah, and also thinking about the tangible impacts of internal training and using that same example of an MSL I think internal training really enables learners to better understand analyze and discuss the clinical landscape and the totality of the relevant disease, the treatment products, devices and lifestyle management strategies available both the product they’re working on but also Key competitors, so they can communicate effectively and will wholly with a HCP. It also means the MSL is a better place to select the most relevant and up to date data to explain both the efficacy and safety of new and existing treatment options to stay relevant and what is always a highly dynamic and fast moving fields and to also be alert to those cost benefit analysis as well. And the effects those choices can have. So all of this then comes together to support themselves so that they feel more confident and comfortable communicating over a variety of platforms, which at the moment is particularly vital in the context of the current global pandemic and where traditional face to face contact is not always possible. And ultimately, robust internal training means that msls can provide the right information to help hcps to make that best choice for that patient.

Jess Ingram 

Thanks, Briony Becky. So I completely agree. And I think we’ve touched on a lot of really important issues there, which we’re going to kind of unpack as we go through this, this podcast series. So firstly, curriculum design and approaches to delivery that prioritize patient outcomes. Secondly, engagement, motivation, mental health and confidence, the impact that has, and thirdly, how to use metrics to measure the impact of internal training, because we all know that we really want to understand that what we’re doing is working and learn from that. So it’s a backdrop to this open house, we design our programs based on a winning formula for internal training. And that states that when you bring together knowledge, competencies, and confidence in one program, that’s when you really can drive enhance performance. So let’s keep that in mind as we go forward. The next question would be how do we go about defining effective internal training that really focuses on outcomes? Briony, want to start us off?

Rebecca Case 

Thanks, Jess. And I think what you were saying before about the the backdrop where our training is designed to enhance individual performance, that’s really where we see the the join up happening with the potential for us to be able to influence ultimately patient outcomes. So what we need to think about at the design level is something that we would call backwards curriculum mapping. And what we’re looking at here is starting with the learning outcomes of what that training needs to achieve. And that’s obviously informed by a needs analysis of what the people who are going to be undertaking that training need to be able to do better in order to stay up to date and to be really effective in their professional roles. So what we’re looking at is thinking about creating a map from where are these knowledge gaps emerging when we’ve done this, this needs analysis work, and where are these competencies and perhaps less than we would like them to be, and maybe where our learners less confident in applying their knowledge and skills in their professional roles than we would like them to be. And what we would do for the program is to map backwards from that needs analysis through the learning outcomes, what are these learning outcomes going to be? What do our learners have to be able to do at the end of training to be really effective. And we follow that back into the way that we design our assessments or how we’re going to test them on whether they are able to meet the ultimate goals that we want them to meet, and then backwards again, into our teaching and learning activities, and how we design the training to set them up to succeed. And, and what we’re actually doing here is is somewhat unconventional, simply placing the content as the last thing that you come to, it’s not just about saying, well, they need to be able to understand the whole totality of the disease and the disease landscape in a clinical trial. It’s all things like, what do they need to be then able to do with it. So we’re coming up with really, really focused goals for our training that make sure we’re including the right content, that we’re testing the learners on the right things. And what we create is a much more streamlined process that engages the stakeholders right from the start. And when we’ve got this in play, we’re also thinking about mapping our learning outcomes outward into things like the the KPIs or the critical success factors for each company. Because those are linked to their goals, in terms of how they’re going to be, and trying to change the lives of the patients with the products that they provide, the devices that they use, and the approaches they take with their Medical Affairs teams and how they interact with healthcare practitioners. And we really want to be able to join up the dots between all of these elements for training program to make sure it’s absolutely effective. And by making sure we’re doing this really rigorous needs analysis first and making sure that we’ve got the idea of keeping this big map in mind. We have to think about getting stakeholders at every level involved in designing that training, and making sure that everything is going to line up to achieve exactly what we need to achieve to make are professionals who are going to work in this healthcare landscape and ultimately influence people who are making decisions about patient care and patient choices.

Siobhan Mulhern-Haughey 

Well, Briony, I think maybe now might be a place for me to jump in, if that’s okay, because I think listening to all this. And it’s probably really easy for me to make some reflections on my experiencing in designing and implementing training programs in my previous role in Johnson when I was the scientific knowledge manager. And I think what I think some something I heard you say there was, you have to almost consider content as the last thing you think about. And I think you called it this sort of backwards curriculum mapping. And I think reflecting on that, I think that is probably the absolutely the ideal scenario, where you work backwards from the end goal. And I think if we think about what we’re trying to talk about today, I guess our end goal is patient outcomes. And if you can do that, and use that to design Patient Centered training, I think that’s going to be your ideal scenario. But I guess I probably have to admit that this was not necessarily the approach I first took when I started naively, maybe working on training programs. And I think I think as a scientist, it’s easy to become really buried in the detail of data. And don’t get me wrong, I think knowing the data is extremely, extremely well is very important. And obviously, also a goal of really good training. But I think what I’ve learned is, it’s vital to always keep in mind the broader perspective. And you sort of mentioned that a couple of times as well, brainy thinking about that broader perspective. So, you know, you talked about the broader perspective in terms of mapping your training. But as a trainer, I think, you know, what I always tried to keep in mind is why is this data important? So why is this data going to be relevant for healthcare professional? And what might it mean for a patient and their treatment outcome? So ultimately, and and this is a this is a phrase we like to use a lot in dancing, and maybe it’s used across other pharmaceutical companies, but it’s about keeping in mind the so watch. So So why is knowing and being able to communicate this specific piece of evidence important? And what impact might a healthcare professional HCP knowing us having a treatment decision, and ultimately a patient outcome? So I think that’s kind of my reflection on some of the things you said. Now, I have to admit, when I think about this, it’s probably a really internal perspective, no, you’re really focusing on on product data. And, and the other aspect, I think of this is really, if you can try to bring a patient voice and the patient perspective into training, you know, where possible, we should, we should also try and include this in our training. And there’s various ways we can do that. But maybe we can get to that a little bit later. And maybe some more specific examples later in the discussion. And I might open it back out to you guys again.

Briony Frost 

Yeah, I completely agree with you there. shipborne. I think it’s a really common problem. That author Norio that we face, especially when we’re working with pharmaceutical products for devices that are just launching, because there’s so many activities going on to prepare medical teams for launch that sometimes the consideration of internal training is bought in slightly late within the process, or there’s just so much pressure on the training team to deliver materials quickly. So the medical team so that they are really upskilled on the therapy area and the product as fast as possible that we don’t always implement that sort of upfront design of what do we really want them to achieve from this training? And what do we really want the outcomes to be? And I think it’s a really kind of common misconception as well that that mapping and that planning out that Briony was talking about earlier. And for outcomes based training programs is a really large and daunting task, but it definitely doesn’t need to be and there’s definitely some real quick wins, you can bring in there to make it a lot easier. And a bit like that backwards design process that Briony was talking about. It may require a bit of a change of the way you think. But as soon as you start thinking in that way, and thinking about all the materials that you want to produce, and start thinking about it backwards, as actually wait a second, why do I want to produce this? It can be quite a quick thing to do and have real impact and how that training can then influence your learner’s. So one thing I actually think works really well when we work together, and shipborne was when we kind of did a bit of outcomes focused training in the sense of carrying out this periodic needs assessment surveys with our learners, and really asking them from what we’ve delivered so far, what was really successful, what didn’t work, and what do you really need in the future to kind of help you develop in your role and really support you. And actually, like more specifically, and when we worked on some of our larger projects, how you brought in those small working groups themselves as well, to work on the development of really key training resources that we had, that we knew that they’d be using a lot, or kind of at the largest scale training meetings, which are Really, we wanted to get their insights on, having their involvement was really key and making sure that those things were really tailored to definitely what they needed. And make sure that it really met their needs to support them in both their confidence and knowledge. And those competencies that were talking about earlier, so they can communicate more effectively. I think that’s a really good, sorry. Sure. Okay, I’m gonna

Siobhan Mulhern-Haughey 

jump back in as well. Sorry, Ronnie, because I think, you know, I just hear you reminded me that that was something that we did back, you know, we did these ongoing needs analysis. And I think maybe, from my perspective, it was because I’d been an MSL, you know, I’d worked out in the field, and I kind of knew when I had a gap in my training, and I think for me, you know, moving into a more training role, I realized I kind of need to be asking the MSL, what it is that they need to know, because I remember being at the other end and realizing I’m missing something here, or there’s a piece of training that I need, who do I go to? Or who do I ask to try and influence the training program? So I guess, I guess it’s again, you know, meet, you know, us together, you know, open house and youngster together, it’s sort of taking that backward approach. Okay, let’s ask the end users. So you kind of just reminded me of that when we when you were talking there about the needs analysis? Yeah. I interrupted you, Briony,

Briony Frost

You go ahead. No, no, I think it’s great. And you’re exactly talking on the right lines for how we’d think about this in a theoretical approach in actually, it’s very much about doing exactly what you’re saying is stopping and going well hang on a minute, where, where might I get this information from? And it doesn’t always have to be this big up front thing that you do. Yeah, that’s, as you mentioned earlier, it should when the ideal scenario and it’s great when you’re starting training, from scratch, when you’re designing a program that’s never been there before saying, right, okay, we’re going to start this process. Realistically, a lot of the time, we’re coming into training programs that are already part designed or part running, or they have to tie in with other training programs. And that means we have to be very adaptable with how we apply things like that the backwards design process. And in many ways, it’s just a fancy name for for conclusions that a lot of us have come to independently. And it’s really a way just of articulating and framing it to explain what we’re doing to other other learning development teams, and to people who are providing the budget for these things. And what we’re doing most of the time is going back and going well, what’s missing? Why Why don’t I find that out? Before I start designing? Absolutely. Couldn’t agree more.

Jess Ingram 

I think we’ve talked a lot about kind of engaging with it with our learners and understanding their needs. And I think one of the things that we hear really commonly is, I want to make sure that when I’m communicating with healthcare professionals, I’m telling them things that are useful that I’m talking about things that are really relevant in clinical practice. And I guess that’s about making sure that we’ve given the MSL is a really good insight into the patient experience. So I guess my question is, how do we do that? What are the best ways of integrating the patient experience into that training delivery?

Rebecca Case

It definitely and isn’t a training provider, there are kind of two main ways we keep learners engaged with the idea that the patient is the ultimate priority. And this would be through our scientific content design, but also our competencies development. From a knowledge perspective, things like storyboarding, and using a patient avatar, to help learners navigate training content can be really effective to help keep keep that patient at the focus and at the front of mind. And having that virtual patient reminding learners that this is their journey, this is how they’re going to feel when their diagnosis is their treatment. And these are those their side effects that they’re going to experience every day. And it’s a really helpful counterbalance to all of that data, heavy training and kind of ongoing acknowledgement that there is a human experience at the end of this and each disease. And treatment does have a patient at the end that we really need to keep key in front of mind. So there’s a few ways you can do this in case studies. And videos are a more elaborate way of really bringing kind of that real patient experience into training and it can bring in that HCP experience as well. And it’s a really fabulous way of keeping learners in touch with the patient is the ultimate goal. And, and these can be incorporated in a variety of ways depending on budget as well and what you have available. Yeah, absolutely. Okay. And I think one of the places that people tend to forget that either really know about this, or they really forget about this is that we can embed patient centric thinking into our assessment design as well. So whether you place and your assessment as a formative exercise scattered throughout your training module, or whether you entirely focus on doing an assessment at the end of your training module, which is more likely to be summative and have a pass mark that learners need to meet. We can always set up assessments that are in touch with the real world. The classic example of courses, either in a virtual or a face to face Context roleplay on objection handling. So we might run a roleplay, where someone pretends to be a patient with, say, a needle phobia, and someone else takes the role of the HCP explaining to them how their self administration injection device has been designed to mitigate this anxiety, and to give them confidence using it safely and effectively. And but there’s loads of other ways that we can get patients embedded into that assessment design too. And I think it’s particularly powerful when there are opportunities to get real patients involved in the training.

Siobhan Mulhern-Haughey 

I’m going to jump in again, because I completely agree with you, Briony. Yeah, and and Becky, I think getting a real patient involved is probably the ultimate in patient outcome focused training. But again, having done training, I appreciate that’s not always straightforward. And that can be compliance and ethical considerations when you’re working in pharmaceutical company. But there really are some simple and reasonably straightforward things that you can do as an alternative, or indeed, as well as and getting patients involved in your training program. And I might just run through a couple of quick examples, if that’s okay. And so one of the simpler things that we did, and again, Becky, you probably recall us working on this together. And which turned out to actually be I guess, even for me, I thought it was surprisingly impactful and successful, was to run a workshop dedicated to the treatment journey. I know, we talk a lot about treatment journeys within pharmaceutical companies, when we’re working on specific products, but I don’t know if we always bring that to life. And what we were really trying to do with this workshop was to bring that to life. And we were we were really looking at patients moving through treatment journey with major depressive disorder. So you know, as you know, as the trainer and speaking to the MSL, we know, when we had seen and read in the literature, how patients might move through their treatment journey from, you know, first describing their symptoms, and then presenting to a GP, and then maybe a diagnosis, that they then may go on treatments, perhaps they might need, their treatment changed, or they have might have to be referred to secondary and psychiatric care. But we really wanted to try and bring this to life. And I guess to help our learners understand the complexity of the treatment choices, and also the challenges, and even have an accurate diagnosis. So we created what was really actually simple workshop where the learners were presented with a number of patient descriptions, and they actually had to act effectively as an HCP. And based on the descriptions, they had to make either a diagnosis or treatment decision. And then I think they make the decisions, the patients move through the treatment pathway. And then for the details of the patients were revealed, as I guess what happened as they move through a real treatment journey. And then they, they have to sort of using that new information, make additional treatment decisions. So for some of the patients, what they found was it was actually an inaccurate diagnosis in the first instance, and they needed and this needs to be discovered. And then a treatment change needs. And for others, they have to change treatment as the patient didn’t tolerate or didn’t respond to chosen treatments. And we actually had the the learners work in groups. And I think it was fascinating to watch them to base treatment decisions in their group. And through their discussion start to understand the complexities, and therefore really what it might feel like for patients experiencing that treatment journey. So I think that’s probably one of the best examples and maybe one of the most simple and straightforward examples that we that we had.

Rebecca Case

Yeah, definitely. And I think just to jump in there. And we also did a few other activities that I think were really successful. I don’t know if you want to talk about as well, the work that we did with the Center of Excellence.

Siobhan Mulhern-Haughey 

Yeah, actually, that’s a really great point, Becky. Yeah, so we worked with the Center of Excellence. And in this case, what we actually did was we use acted cases so it actors acting as patients. And again, this was really tried to bring to life her patients, in this case, describe their symptoms, and and how impactful depression, even classified as mild or moderate can be in a patient. So I have to say, in this case, the instant the actors were there were pretty incredible. I have to say they were they from what I understand they were using insights from real patients, so they’re specifically trained actors. And as a spectator, myself, I was genuinely shocked to realize the impact even mild symptoms of depression can have on a patient. And similar to what we had previously done in the workshop I just described, we watched these actors move through treatments. So either as they improve or as their symptoms worsened, and they may be moved to more severe depression. So again, as a spectator, and and the feedback we had from our learners was that this really brought to life, not only how impactful the symptoms are, but actually what really mattered to the patient for their treatments. So what were the symptoms that they most wanted relief from, you know, When we work in pharmaceutical company, we think about these scales, and we talk about, you know how much the scale decreased. But when we heard the patient talk, we heard them, you know, say, what I really want to be able to do is I want to be able to get back to work, or I want to be able to socialize effectively with my family and friends again, or I want to be able to get up and cook a good meal. So in this case, the so watch, which I referred to previously, was really knowing what treatments might or what our treatment or what any treatment might bring help for those patients, and what improvements might be most important for those patients and what evidence we have that supports those improvements. So thanks for reminding me of that example. That’s another great one.

Briony Frost 

Yeah, and I think it was really impactful. And I agree on that, even though they are different investments are required the both of those kind of key examples that you mentioned that the workshop obviously required little upfront investment, because we wrote the content of it. But the case study videos, and the involvement of an actual patient obviously required more investment, both in the compliance side of things, but also financially, they were both really, really impactful solutions. And we’ve had such excellent feedback from them as well, on how those sessions really helped the MSL kind of change that perspective, and allowing them to really think about the product and data in a completely different point of view. And I really particularly enjoyed having that learner directly listen to the patient and their journey, because they paid for that patient had so much gravitas. And you could really feel the effect it was having on the room. And it was really impactful to see learners really absorbed in the patient experience and understand how important their role is to helping the patient get better. So

Siobhan Mulhern-Haughey 

Right back, you can even as a trainer, somebody stands up and trains you know, you always have that mixed audience and people listening, some people actively listening. So we were checking their phones, but it was probably listening to those patients was probably one of the only times you know that saying you couldn’t hear a penny drop. I mean, it was just complete, everybody focused on that story. And you just knew that everybody was taking something from us.

Briony Frost 

Exactly impactful yet, super impactful. And in terms of the development, those projects as well, it really came back to that point I made earlier about consulting with the learners themselves. Because and, and literally looking at what in what they wanted to achieve from that training program. And I think it’s really easy to forget that the majority of people that come to work for medical teams or pharma companies, they’re fundamentally driven by this desire to really help people and improve the access to treatment to patients. So by keeping them involved, and consulting them throughout the development of the training program, really allows that patient focus to, to really stay at front of mind, because it’s always ranked really highly by learners about what they want to see and what they want to hear. And it also ensures that that program as well really resonates with that fundamental desire for the learners and helps them motivate and engage them with the training and the role at the end of the day.

Jess Ingram 

Brilliant, thank you so much, guys, I think we’ve covered a lot there in terms of thinking about the kind of the some of the theoretical aspects, but also some really practical examples of what you can do. And it’s great to hear that there are actually some relatively simple steps that if you take them at the right moment can make all the difference. And it’s often the case, it’s really about getting the planning and design phase, right, and then staying focused throughout on what you want to achieve. So really, really great discussion. Thank you very much. And I’m really looking forward to our next few podcasts where we start unpacking learner engagement as another vital component of achieving these great results in this area. And certainly that it all feeds back to that staying focused on delivering internal training that really can help improve patient outcomes. So thanks very much. And I’ll hand back to Garth.

Garth Sundem 

Thank you. I wish we had another 15 hours instead of 15 minutes to explore. So thank you all for joining us today and to learn more about how your organization can partner with open health to drive positive change in healthcare communications and market access. Visit open health group.com maps members you can continue this conversation at our community portal. Don’t forget to subscribe and we hope you enjoyed this episode of the Medical Affairs Professional Society’s podcast series, Elevate.