 Hello everyone. I wish you welcome within the project, Child Care in Central Asia, International Training Program on Medical Training and Education in Digital Era. This project is trying to aim for better continuing education of all those involved in child care. Today we are all lifelong learners and definitely we need updating our skills and competencies all the time and I'm certain that our life today would not be possible with continuing learning and lifelong learning not only in work but also in everyday life and in our environment. Today my name is Sandra Kucina. I am President of European Distance and E-Learning Network Eden and I will be the moderator of this session. Today let me just go. This is the web page of the project so all of you interest in the project you can find more information on the web pages of the project and I'm here also to tell you that Eden is celebrating 30 years of existence and continuous work this year as three decades of serving modernization and education in Europe and we are happy that we are also contributing with this child care in Central Asia project with our presence and collaboration with the project coordinator and members. Today we are in the webinar number four which is titled Continuing Education in Practice as a tool to keep health professionals updated and speakers today are Tomaso Minerva, Professor Department of Surgery Medicine and Dentistry, Coordinator and Director of EDU NOVA at the University of Modena and Reggio Emilia, President of EDU Open and of the Italian E-Learning Society. Then Stefano De Nicolai, Professor at the University of Pavia where he's also head of the Master in BBE, Director of Executive MBA and Director of the Master in Digital Innovation Entrepreneurship. So I shorted your CVs they are all very wrong and the participants can find them on web pages of Eden or on the project as well. Then we have Antonia Memeo, Director of Pediatric Orthopedics and Traumatology Complex Operative Unit at the Giattano Pini Hospital in Milan and Stefan Frené, Strategic Advisor in Healthcare Industry with long experience in managing marketing and communication of first pharmaceutical industry. So this is an introduction from me. This session is going to be recorded. The recordings will be available of the web pages of the project and also at the Eden web pages. You can post your questions during the session in the chat so we will see how to reply to them in the due time. And now I will ask Tomaso as a first speaker to have his introduction into the session. So Tomaso please. Okay thanks Sandra. Let me share my presentation if I will be able to find it. Okay so first of all let me take again President Sandra Cuccina and also Professor Govoni and then Nacardi Rola for inviting me to participate in this webinar series. So the topic I will cover in this webinar is a sub-skill and a skill challenge in the digital era tools and methodologies. This topic concerns the adoption of a digital approach to continuing medical education both in terms of updating skills and abilities to end up adapting to new professional context and thus to need to acquire new skills. So just to start it'd be useful to outline the training process usually in Europe of an healthcare professional, a doctor, a nurse, a technician. So it includes the first phase of institutional training, a degree, PhD, specialization and so on before starting the practice and the professional life. But the continuous evolution of medical knowledge and practice involves also a process of constant updating and also realignment of knowledge and skills. This continuous updating process follows two parallels but closely interconnected paths, the daily professional practice and a continuing educational process. So practice and continuing training and education are the daily life of a medical or an healthcare professional. But if we try to go a little bit deeper, we can explore the field of continuing education. We discover that we have two groups of activities. The first is the activity to update skills and knowledge and what we call the upskills. And the second is to acquire new skills and knowledge, what we call the REST skills. Within the upskill process, we must consider the fast evolution of practices, technologies, knowledge. While within the REST skill process, we must consider facing new and unconventional new required skills able to modify the professional environment deeply. For example, in 2019, we had no COVID at all. While in 2021, we had a world pandemic, we have some new science but still no therapy. So consider how much medical teams had to modify their knowledge, habits and also expectations. This is a clear case of how to rebuild new skills in a minimum interval of time. But a process of updating and continuing education cannot be an impromptu process. Okay, it can be in an emergency phase. But we must consider to lead this process by expert instructional designers, by expert digital instructional designers. They must have specific skills for training in the medical field and at present and even more in the future with solid skills in digital learning, in its methods, in its tools. So I will not spend more time on this. To the webinar cycle, you had the opportunity to discuss how important digital learning is, to explore excellent and effective methodologies, technologies and so on. I prefer here to introduce and briefly, really briefly, describe four case studies. Four case studies related to four groups of building skills. An example related to skill updates is the eLabour project, we will see it. Another case study is the GIC project. It is a project on how to rebuild skills. Then the master in medical humanities and finally the degree in digital education in medicine. These are two degree programs from the University of Modern Regimilia to build a new professional in education in medicine. Briefly, what's the eLabour project? The eLabour project is a project from the region of Emilia-Romagna. It's the region in Italy where we work and it's a project who offers open and free courses to both professionals and citizens. Why? Certified courses are offered only to professionals with the release of an open page and a certificate at the end of the course and general courses are promoted to the population to help to reach an higher literacy. This is very important now in an area of infodemia related to the COVID-19 pandemic. This is a project of cooperation since there is a very high cooperation among all the delta institutions of the region. They are summarized here from Parma, Regimilia, Imola, Ferrara, Modena, Piacenza, Bologna and so on. The cooperation is both in terms of course design and also in content sharing among the the eight institutions. Some courses are marked as mandatory for employees within each institution while free courses are for other institutions or for people outside the health institutions. In the catalogue with the specialist course there are also courses to improve the digital learning skills. So how to approach the knowledge management, how to use digital technology to improve and validate scientific knowledge and so on. In one year of project we reached more than 40,000 users on 30 courses in the world catalogue. So this could be a project referring to a standard digital upskill program. It is very standard, the only peculiar item is the cooperation within a large-scale institution. The second one, the following case, introduces an example of how we faced the needs to reskill quickly a group of professionals. That is how to create new skills in a group of non-specialist professionals and immediately place them in a non-intensity operating operational environment. So the JIC project was instead an urgency imposed by the COVID pandemic. During the acute phases of the pandemic spread there was a significant shortage of professionals able to operate in intensive care units and emergency departments. The JIC pathway built an instant education project as prepared doctors specialized in not intensive care such as general care, pediatrics, dermatologists, ophthalmologists and so on to operate in intensive care to support specialized teams. It was a joint project of the four universities of Emilia Romagna, the University of Modena Reggio Emilia, the University of Bologna, the University of Ferrara and finally the University of Parna. So the training project started with online asynchronous lectures, it's about 40 hours of lectures on different topics related to the COVID pandemic, followed by a week on on-field training in an emergency room then they were ready to to work in the emergency department. So it was a real instant education project. We recorded all the lectures in October 2020. We used the modified big blue button plugin for moodle to separate the record video and audio tracks. Then we post-produced the lectures. The part was published in November 2020 at the beginning of November 2020. Why? At the end of November, beginning of December, we had another pandemic shop in Italy, the second way, followed by the March 2021, third way. So we were really on time to prepare this group of doctors, of specialists to help the emergency departments. So the program is still online and that's why we are planning to update lectures and also to open to general audience. Some other case we're introducing new skills is the master in medical humanities. Master in medical humanities is across between medical sciences and humanities and the underlying principle is that clinical practice must consider the human aspects of relationships, communication, narration, ethics and cultures. The goal of the master program is precisely to integrate medical and clinical skills with humanities, with psychosocial consideration and to consider the skill as a part of the medical treatment protocol. So considering the patient in an holistic and a complete vision with medical treatment and also some holistic environment with psychosocial will-being lifestyle, helping the patient to recover from the illness. Finally, the last case study is the degree program in digital education medicine. This is a four-degree program to set education experts with specific skills in the education healthcare profession. They will be specialized people with skills to design and lead paths of contents of the data. So they have skills in pedagogical and methodological learning sciences. They have skills in competencies, in pedagogical design, in methodological learning, in communicative relational, in organization, institutional topics. They have skills also in information communication and management of information communication technologies. They have juridical competencies and also quantitative skills. But mainly their profiles are cut to fit the management and the design of education in medical and healthcare. So in conclusion, just two messages. The first message is that digital learning can be useful and effective in many cases in updating or upgrading skills or ability skills for medical professionals. But we need to develop a new profile of digital learning aspect mainly devoted to face the needs of expertise in continuing education in medicine. I thank you very much. Thank you. Thank you, Sandra. Thank you, Tomasso. Very interesting and important conclusions. Maybe just to emphasize a little bit the existing experience so far gained during the COVID. We have definitely gained important experience. How do you think you will be able to integrate all those experiences gained so far into these programs you are going to develop? Okay, so if you mean... So we are working on building a continuous education program within the degree in digital education in medicine. And we are starting to think to integrate in this degree also a pathway related to emergency management where emergency is also emergency in education. So we are facing a strong emergency in education in Europe and in the world. So we are considering to include to build skills to facing emergency in the medical area, to emergency in terms of knowledge and practice, but also to face emergency in education. That's very important for us. Thank you. We have a question for you from Stefano. He asked the courses on digital learning skill has similarities with the faculty development programs we spoke about in one of the previous webinars, but looks directed to a more broad audience. Is that correct? In contrast to the... Sorry, I just skipped in the... I have a small computer this time, sorry. Okay, I can read it. Yes, please. Very unquestionable, but in reading. Yes, Stefano, the first two projects, they are directed to a very broad audience. The first one is also directed to public, since we are considering that the healthcare culture is not only something for a doctor. We must spread this knowledge. The last one, the last use, the master and also the digital education degree, they are specific courses for academics. So the first one, the master is also for a doctor, for working people, for nurses, technicians and so on. The second one is a normal first level degree, three years. Thank you. So let's move on. We will come back with a discussion later. I suggest did Stefano and then Nicolai, can you start now? You can share your presentation if you have one. Okay, I have not a presentation, but I would like to share anyway a web link if I can. Okay. Just for the introduction. Good. So you will share it in the chat? Well, I can also try to share as a screen. Do you see? Yes, we can see it. So please, Flor is yours. Okay. So thank you. Thank you so much. Thank you for organizing the community and to all the participants to this very important digital workshop. As I said before, I'm Stefano Nicolai. I'm not a doctor. I'm not a member of the medical department. I work in the Department of Economics and Management. My interest is in the innovation management, the management of new things within companies, organizational change and business transformation. Even though, yes, I'm a particular interest also in the healthcare sectors in innovation teaching. I'm also excited about everything new regarding the links between digital and teaching and learning. So let me start with my brief speech. Which is entitled Teaching and Learning Healthcare Management. So it's about management, okay? Management of healthcare organization. And in particular, what I would like to share with you is some insights, some lessons learned, some experience, some outcomes of our research in the specific field of smart learning and teaching innovation. Well, smart learning is not just, as you know, it's not just a remote working. It's everything, take the best and exploit the best you can, digital tools, technological innovation in order to boost learning experience. And specifically, the experience that I would like to share with you today regarding our master degree, EMLOS, which is dedicated to top management in healthcare. This is the website. And what is pretty interesting is that we decided to keep the audience related only to top managers. Only to top managers, we have 30 people in class per year. And they are general managers. They are directors of administration. They are social healthcare directors. Why I'm saying this? I'm saying this because the audience is the first key point in my discussion. I can also stop sharing. So this is EMLOS for who are interested is emlos.it. We are leading this master's. And as you know, what happened last year, it was that we've been forced to move to a digital platform basically overnight. It was a program totally told in presence. But not because we have not an experience in digital because we have several other programs offered at least blended the digital tools in other areas. But because we started from the feeling that this kind of audience, top managers in healthcare, general managers in healthcare, strongly feel the need of creating a community, of sharing ideas with other peers. And they appreciated our lectures. But we really felt the fact that when they enter in the room, they were like kind of kids, let me say, because they enjoyed to come back to school. They really enjoyed the atmosphere to share things with others and sharing insights out of the room of the control. I mean, often they are in the same room for other reasons because they are cold from our healthcare authority to manage crisis and this kind of stuff. But every time are very tough situation, very formal situation. While our master has become let's say room for freedom, room to be, room to test, room to experiment new things and this kind of stuff. And you cannot forget this in designing the teaching program. You cannot forget this. And you will see what I'm trying to say in the next part of my speech. My speech, I'd like to organize in two parts. First, a brief discussion regarding the key challenges that we faced during this unexpected event forced us to dramatically reorganize our teaching activities for these top managers in healthcare. Then in the second part and the final part of my discussion, I would like to share with you some solutions, some lessons learned that we put into practice in order to react to such challenges. Well, the free challenges, we face a lot of challenges, not just free as many of you, I guess. So I think that I'm going to say something that is likely to be quite popular. But if I had to select free key challenges that we faced last year during the pandemic and reorganizing everything, I selected free. The first one is the issue and the problems rise by the fact that these people, unfortunately, have a limited digital culture. As I said before, we already started offering courses online. We experienced working with Zoom, WebEx, and this kind of stuff even before the pandemic, but with young people. And so we designed and we created an experience created around the particular mindset and we react to particular requests. So the third thing we learned is that what we was good and what we were thinking was best practices wasn't with people that from one side of a different age, our attenders have about 50 years, some of them more than 60 years. I don't know in your countries, but in Italy, healthcare needs a lot of experience, lead a lot of long careers. And there are some, let's say, dynamics and mechanisms of power, let me say, according to which you can become the general manager of this organization only in the second part of your careers. So let's say above 50 years at least. And they have a different culture. I don't want to say that they don't have culture because just to give an example, they've created a WhatsApp group immediately by themselves. So it is false. It is incorrect to say that they have not a digital culture at all, but for sure they have a different digital culture. Just to give you an example, breaking rooms. I guess you know what are breaking rooms. They are a way to create separated rooms, independent rooms in parallel during digital seminars in order to create teams, discussing things, putting into the practical exercise. Our young students, the master degree in our university, literally love this. Breaking rooms has been a failure with our top managers. Okay, or at least they started appreciated this method after weeks or months, after recreating a new digital culture. I will tell you later on why in my opinion. But anyway, so there is an issue first of digital culture. Some of them have not a digital culture at all. And some of them maybe have a digital culture, but which is different. So what you learn with digital teaching, smart teaching sometimes need to be dramatically adopted. The first key issue that we say is the issue of attention. So we are talking about once again, general managers of healthcare, general managers of healthcare organization in the middle of a pandemic where a lot of people dying. So if you have that person in presence, they feel the kind of disconnection with their organization. So good or bad, they are out of their organization. If they are in front of the PC, they continuously receiving a telephone call, they need to check their email account. And the problem is that this happened all to all of us. I'm sure 100% that even the tenders to this workshop, check the emails or check some message in the smart phone. I'm sure 100% that you now already did something like that. It's okay. It may happen. The issue is that they feel a particular urgency because of their role. So everything else is a priority because people are dying. But of course, we need to understand this. Of course. However, this is dramatically affecting the quality of lectures, interactions, and this kind of stuff. So you have to take care of that. You have to take care of that. The third key issue that we face is how to keep the community alive. As I told you before, come on, let me be extremely frank with you. It was a kind of new kindergarten from them. And they were literally thrilled and excited to come in the classroom. We really felt a great enthusiasm in attending our master. But the significant part of it was to be together in the same room, share faces, share the same experience physically, the lunchtime, networking, and this kind of stuff. So how to keep this condition alive also for top managers in the healthcare industry? Well, you can probably think that these challenges are shared even for other situations, for younger people, for other sectors. But trust me, you can mention even other challenges that at least can be definitely longer. But I think that these three are particularly evident and strong in the case of managers in the healthcare industry. So what we can do to manage and to mitigate the problems raised by these challenges? Again, I would like to share with you some best practices that we put into practice. The first one is we learned that you need to create a digital, I'm talking about digital digital lectures, so something like what we are doing right now. So you have to create a lot of dynamicity. You have to create a dynamic schema. So what I appreciate, for instance, of this workshop, so thank you so much, Sandra, to all the organizers that you said, please, just 15 minutes, no more than 20, and they hope that I'm already in delay, so I'm going to accelerate a bit, because this is the time that works. You have to show different person, different person, different lecturers, with no more than 15, 20 minutes. This is what we tested and learned, and we think that this is the perfect timing. With 10 minutes, it is not enough to elaborate a strong message, especially for experienced people. You cannot tell stories to these persons. You need to have something strong and in-depth concept, so you need at least 15 minutes. But after 20 minutes, even the best person, even the best communicator, start entering, in crisis with such situations. And also because, as I told you before, that person started connecting with mobile phone, other emails, and so this is the timing that we thought that works. And we also experienced interviews, because instead of hearing Stefan Nicolai that blah, blah, for 20 minutes, and recognize that after hearing myself for a while, it became boring and annoying, so sorry for that. But an idea is to have two voices. So please, why don't you consider interviews? 20 minutes, but some questions. And so you create a break, you create dynamics, you have more voices, and also you start creating the right feeling to other person to interact and make questions because you are in the flow. It is what already happens, questions and answers. So you are not breaking the rules, you are not breaking the flows, you are continuously, you are continuously in the flow. So interviews, we face that interviews works very well. Interactions, I don't want to say a lot because I'm already in delay, so of course, interactions, but once again, taking into consideration that you have to adopt, according with regard to other similar situations, like we say that breaking rules don't work, or at least you have to manage in a different way, but you have not to forgot to also introduce some interactions. Questions and answers, but also experiences, and also ask this person to be a part of the lecture. What has been your experience in this? Would you add something according to your knowledge? Because they are very experienced people and they experience an amazing adventure called COVID-19, so they for sure they have something to say that is useful for everybody. So why we don't have to explore this resource? Third point, in my opinion, you have to strike the right balance between excellence, top excellence, and something out of the box, at the extremes, at the two extremes. So from one side, something at the top, you have to offer something at the top because, you know, healthcare lives on reputations, lives on star scientists. Reputation is super important in healthcare. So if you put in your lectures something super important, it is very appreciated because they have to feel that the counterpart is super expert in the field. For instance, we organize a lecture with the vice president of Moderna, the head of the vaccine program, but even in that case, he had only 15 minutes, 20 minutes. So of course, you cannot have every time the vice president of Moderna with you is difficult. I recognize that you cannot every single day a person like that, but you have to try to, from one side, have a super excellent people with a strong reputation. And from the other side, at the opposite side, something completely out of the box, because they need to think something different, they only need to consider to enlarge their toolbox of skills with new skills, soft skills, but even more. For instance, creativity. We organize a seminar in order to explain them that creativity is not a trait thanks to nature that you cannot modify. Creativity is a skill. And as a skill, you can train your ability in creativity. Or we offer them a lecture in managerial improvisation. What happens if you prepare the speech and the person before you say exactly the same thing? How do you react? What do you do? It's very super important for top managers, and especially in healthcare, we recognize that the ability to be agile and nimble is crucial, but they are not used to think that this could be a thing that could be trained or pitched. Or we also offered a lecture on how to control your breath to manage stressful situations. They say, oh, my God, I think that this is completely useless. At the end, they say, thank you so much. It has been great. So this is what I say. This is what I mean with striking the right balance with excellence, top excellencies in healthcare, something which fit the best with their interests and with their sectors, and something completely out of the box. This mix works a lot thanks to our experience. Finally, I have one final comment. Yes, please, finally, because we have a little bit of... I promise. I promise. A takeaway means that, yes, of course, sometimes we have to do blended situation where there are people in presence and people remotely, and I also like this situation, but we think that the best is to take your own way and one precise ways. 100% remotely or 100% in presence, because there are two completely different things, and so if you try to do both, you run the risk to do nothing. That's all. Thank you so much. Thank you, Stefano, for a very live and sincere presentation. You will definitely strike at some points. I'm not going to ask you the question, but just comment. If we take out this management out of the picture and put student there, don't you think we will have the same experience about lack of concentration, need for different things to be creative, to be innovative, to give them something out of the box? I think that your experience can be adept to a really large number of people, especially to students. Well, let me say that yes, you're right. I also said before that some of these issues, tools are shared with other situation, of course, but at the same time, I would say that they are more specific to this situation. Let me give an example. With young students, I'm really straightforward in saying, okay, during my lecture, you cannot take a look on your smartphone. You are not allowed. Okay, just to give an example. And beside this announcement, beside to say this, there are some tricks in order to reduce the risk that they take a look on the smartphone. You can do that, not with a top manager, because in healthcare, because you say, come on, Stefano, be realistic. There are people that are dying out there. If they call me, I have to reply. Just an example. You're right, but the level of the challenge is to the next level. Thank you so much. Let's move on to the profession. Now we have Antonio, who will share his experience and insight on how this continued education can be important. So Antonio, please, Flora is yours. Okay, thank you very much. I would like to present our experience in organizing the second level Master's in Pediatrics, Orthopedics and Chromatology that we have done together with the University of Padilla, Professor Satti Drotti and Dr. Elena Calderola. And we have planned to organize this Master's in 2019 before COVID. And we have already decided to organize this Master's online in the peer field. And because the organization was for all Italian orthopedic surgeons that don't have the specialty in pediatrics orthopedics, because the request on the territory of the specialist in pediatrics orthopedics was very large. So in this Master's we have involved a lot of center in Italy. And our goal is trained orthopedic specialty with a concrete presence of activity relating to pediatrics orthopedic and not only pediatrics orthopedic, but even chromatology. Discriminate between the pathological and physiological aspects of the pathology and is direct towards early diagnosis and was the choice of three table treatment on that. In Italy, we don't have a specialty school of pediatric orthopedics. So normally after the School of Medicine, the orthopedics became a specialist in orthopedic and chromatology, in general orthopedic and chromatology, but don't have the skill in pediatrics. So the goal of our idea was in collaboration with the University of Fabia, myself, because in that period I was the President of Italian Society of Pediatrics Orthopedics. Now at the moment I am the past President of the Society. So the organization between the Italian Orthopedic Society of Pediatrics and Orthopedic Pediatrics Center in all the country, we start with this our experience. It's a multi-speciality connection, inter-university collaboration, because we involved a lot of center, Fabia, Milano, Roma Genoa, and other five public hospital centers. Our master is, it will be closed at the end of this year and now I wish you're using the next slide on the program. Okay, the teaching modules is a very large modules. It is a 1500 hours online lesson and all the lesson was recorded so that the student can participate directly to the lesson or they can learn in the night and Saturday and Sunday when they have time. And this is the program that we have organized. It was approached to the patient pathology of even segment, the spine, the level, the foot, the knee. And so we have spoken about even neoplastic pathology, neuro-orthopedia, pathology orthopedic, somatology and even with the collaboration of Professor Cimac who will speak after me about the rheumatology because in our department we are on the same floor, there is an orthopedic and rheumatology department of pediatrics and even pediatric rheumatology department of rheumatology. So this is our teaching modules. It's a lot of time because 1500 hours online is a longer period of attendance. But after that we have even organized the practical internship. So we have involved a lot of hospitals in the country for the practical internship because we have divided the students in a lot of small groups. We have included 40 students in this year. 40 students because we are starting the program 12. But we have received a lot of admissions so we have asked the university to involve all our 40 students and so we have divided them in a lot of centers. Fundazioni do gnocchi in Milano, San Raffaele Hospital in Milano, Policlinico Torbergata, Rome, Istituto Giannini Genoa, Hospedale Pediatrico a Rome, Abano Terme, Istituto Clinico Clini, Pavia, Instituto Città di Pavia, Hospedale Alessane. All these are places, specialized in pediatrics orthopedics in which the student can make the practice and the practice experience with the patient. Now I'd like to Professor Szeczimac to speak about the other organization in this experience. Thank you. Thank you and I congratulate the organizers of this webinar and also I thank Dr. De Reo for including me in his master. I have to be only a teacher of this of some modules because I deal with pediatrics dermatology which is linked to pediatrics orthopedics. So I gave some lessons and in the University of Milano there are the possibilities of organizing masters and courses postgraduate. So we are thinking with Dr. De Reo to organize something similar but just from the University of Milano of Pavia and we had a very large university in Milano so we are still in the planning of the courses which will be much smaller of the ones that were organized by the National Society but we hope to have many students and hopefully it can be a joint venture between dermatology and orthopedics. So it was very interesting to listen to all the videos presentation. Okay this is our experience and we have completed the presentation. Thank you very much. Thank you. Thank you so much. It's very interesting and important. Maybe just to comment how important is that students gain so much practical experience. I saw that you have included a number of hospitals. I think that is the very important issue that they can gain in experience in different institutions in practice. Yes thank you. I agree with you because it is difficult to learn something only online or only on the books. It is a very important experience. Part of the experience so we have obligated the students to learn this practical teaching. Yeah thanks. Thank you. Thank you. Sorry I muted myself and let's move now to our last speaker Stefan. So please Floris yours can you share with us your introduction. Absolutely yes. Do you see my slide? Yes we can see them. Okay nice. So thank you for the invitation. My name is Stefan Fonex and the purpose of my presentation is to speak about I would say conflict of interest between pharmaceutical industry and clinicians in continuous medical education session. So first to start I would like to present myself very quickly. I am graduated in pharmacy and in business administration. I am working in the healthcare sector since 25 years and the first years in the pharmaceutical industries and the last 15 years in the services companies. I was head of companies supporting pharmaceutical companies to communicate to the clinician thanks to promotional activities and medical education activities. I need to disclose myself my conflict of interest today and I would say I do not have conflict of interest because even if I am a board member from several companies right now I do not have business connecting with medical education but you have to know that I am in contact with more or less 40 pharmaceutical companies right now and in the past as I told you I was head of a private provider in Italy. So even if I will do my best today and even if I disclose that I do not have conflict of interest it's clear that my point of view is affected by my background and my history. So please your capacity and your ability to assess my content today will be crucial because this is only my point of view today. Let me start to explain very shortly and very quickly what is the link between industry and clinician to introduce medical education. I would say that the main goal of the industry is to discover and to develop new entities and then after to market these new entities through these new drugs on the market. For the first step you have to remember that to develop a new drug right now you need around 10 years and one billion dollar. The development of the drugs is done thanks to the relationship and the partnership you will have with the clinicians because as you know to produce all the clinical studies you need the work from the clinician in the hospital. Second things to market the new drugs you have to train before the clinician and the pharmacist. You have to explain a new mechanism of action. You have to explain a new patient way. You have to explain what could be the adverse effects. That means that you need absolutely to have clinicians and pharmacists and every kind of care opinion leader well trained and exactly at the same level of knowledge of what you have in the industry. It's why you need to share continuously information and you need as industry to invest in continuing medical education. As I told you one billion dollars ten years to develop a new drug that means that industry has to find capital and have to find capital who want to risk of course. And this is where and when it could appear conflict of interest. That means that when the pressure from the capital is higher than the resistance from clinician and from the territory and it is quite clear. What is the purpose of continuing medical education? As I told you is to maintain develop and increase the knowledge and you know and explain to you that this is crucial to develop and to market new drugs. And I checked last week when we had the first medical education in the US and it was in year 30. And as you may see this publication it was due to the mediocrity of this initial medical training. So it has been decided after to build up guidelines and rules to have a better level and less conflict of interest to share information and to do this training session. What is the real the value of continuing medical education? Of course all the session has to be accredited in all the countries and there are four steps. The first one is to ensure that the content is valid. The second one is to prevent commercial bias. The third one is to identify and mitigate relevant financial relationship. And the last one is to manage commercial support appropriately. There is and fortunately there is a difference between promotional activities and medical education activities. But is there a real value every time? This is a good question. For example I take the example of Italy. There are more or less 1,000 companies organizing continuous medical education or societies I would say. 70% of these organizations are private ones. That means that the goal for these companies is to do business. And if we take an average of 30 sessions for each of these that means that you have 30,000 continuing medical education in Italy every year. It's impossible to check for the authorities all this session. So even if you are you have clear guidelines rules and everything it's quite impossible to avoid conflict of interest. You can only limit them. So at the end of the story it's your own ability to check and to assess content and lecturers every time. That will give you the quality. I will explain you my recommendations. This is my point of view for attendees and after for providers and then after for lecturers to avoid this kind of complication and difficulties. The first thing I think for for the attendees I wrote that it's a little bit pushed but please be sure that there is a bias or a conflict of interest. So it's better to start with this with that in mind. Don't worry about it but you have to manage it. The second one is to check absolutely who are the lecturers before the training session started. Google is a good starting point. You can use it putting the right keywords into Google with the name of all the lecturers and you will see what they have done in the past. Not only the 12 last months but the last five or 10 years and you will see a publication if they are linked with the pharma industry or not. You have to know if people get a fee or not because this is for me a fact of this is a parameter of quality. Then after checked the provider what kind of other programs he's offering and finally concerning financial grants it has to be disclosed normally even if you see that there is a foundation or a scientific society involved granting this session please do a double check. I prefer when you have more competitors sponsoring the same event. Second thing is recommendations for provider that means what I have done in the past working closely with the industry. I would say the first point is to declare all the conflict of interest even if me nor it's the best way transparency will always impact positively the attendees so you will enhance the quality of your session. Better to challenge content if possible with the open end point of view. Involve lecturers from different affiliations not only from the same scientific society but from university, from institution, independent KOP leader. Declare clearly the origin of the financial resources for the specific event and declare if spoke person are paid. At the end this is the recommendation for the lecturer. I think a lot of students and young people should be in a couple of years as a lecturer in session. I would say quite the same thing declare conflict of interest even if me nor and previous not only the last year the last two years but if you have had conflict of interest declare it. As I have done at the beginning of this session introduce yourself safe by explaining clearly the context in which you are evolving, helping the attendees to understand better what are your perspective and your point of view because this is the problem is not only conflict of interest is objectivity of what you are explaining. Challenge your content that means try to challenge it always with other lecturers or with attendees it's quite difficult right now with the virtual session. Declare if you become a fee for your performance right now today I don't get money for this presentation of course and I would say at the end transparency wins all the time. Take a message I would say that as I told you at the beginning the evolution of the industry is strictly connected with the quality of the relationship with clinicians. It's a kind of co-evolution that means no industry no new drugs no clinicians no new drugs no new drugs no patient care that means we have to work together. Conflict of interest exist will exist they have to be clearly outlined and manage. I think medical education it's a good way to keep informant well-trained also the care opinion leader and it's a good way to share information and knowledge they are established procedures and I think it's a winning situation. Even if they are accreditation you have to be vigilant and always challenge and check the content from the lecturers. At the end transparency it's always better. Okay I finished my presentation. Thank you Stefan a very very good presentation I have learned a lot and really good guidance how to present and how to organize some events. I agree with you transparency is the most important issue and if you have transparency then everything else will somehow fit on right places. Stefan has been very active and he has said a few questions and so now we were speaking with you so I will address you with the questions question from him. He asks are there differences in the attitude toward the conflict of interest in various countries or attitude is uniform and a comment a question I really appreciate your suggestions to attendees indeed you are proposing a personal proactive attitude of the attendees impressionally evaluate whether or not there is a conflict of interest is this correct so please. Yeah first sign difference between countries I don't think there are difference between countries I have only the experience from France US and Italy and it's not due the rules are quite the same in all these countries it's due to the fact that you have private provider they it's a business and to the other part you have private partners there are pharmaceutical industries they have to do business you have to think about the best way to do all this business that means for me transparency it's a k-parameter for this but about the second question I do not remember. Second question is are you proposing a personal proactive attitude of the attendees impressionally evaluate whether or not there is a conflict of interest is this correct yeah yeah yeah good okay thank you so much let's see now professor Mimeo we have a question from you Stefano is asking what is the importance of distance instruments in the theoretical parts of your master sorry can you repeat what is the importance of distance instruments in theoretical parts of your master the importance is that with this instrument we have involved all the country all the people that are joined with us from place they are very very far from here so they can learn distance without coming in the university without coming to the hospital and they have the possibility to learn the experience from all the professor of kind of speciality different speciality and they come to the hospital just for the practical experience so this is my opinion thank you thank you very good and Stefano we have a question for you as well Stefano your the same name is Stefano Stefano the Nicolai so he asked I think that you are underscoring the importance of the audience composition and the build and the building community is a key issue in the case you presented what is the relevance of recorded in the case you presented what is the relevance of recorded recorded sessions if any so please can you can you answer this question Stefano are you with us I'm sorry okay so did you see the question in the chat it says the one of Stefano yes yes yes well it's a tricky answer because we recorded we recorded but to this side it's a work in progress process because I have to say that only a few take a look on take a look on recorded video okay this is related something to what we already said they feel to have a very limited amount of time their scarce attention and and so if there is one day where there is the the lecture they feel to be forced anyway there is a way to do that if they have to find out the space in their agenda in their time to review record the lecture they struggle and do that I think that there is some way to to improve from that point of view but honestly speaking is for us it's still a work in progress process okay thank you I think we have we do not have any other questions so far from the chat I think we can come to the conclusion of of these sessions so maybe for the end Tomasso maybe just your point of view is the distance is the continuing education something which is actually quite normal and is going to stay and how much it will influence the healthcare industry as well okay so just before pandemic the continuing education in medicine or in the in the healthcare environment was very very very important and also here in Italy I remember a conference from the ministry it's around 50 percent of the of the programs were were released as distance learning as digital learning now after the the pandemic I believe the digital learning environments in continuing medical education will be at 100 percent so it's we cannot go back from from these for continuing education in medicine and and this will will need a very deeper understanding of the processes from our side so from the side of experts in methodologies and technologies and also continuous relationships with professionals to to match methodologies and needs from the from the other side and and this will will influence a lot the profession the the medic the evolution of the medical profession in the future I believe so instant education or just in time or programs to to the skill people programs to upgrade skills there will be the normality in the future and they needed to to to establish a strong relationship also with industries with with pharmacologists with pharmacology industries to so we in Italy we had a a professional we called informatory scientific spread and this was a guy going in in each study to meet each doctor just to present this new treatment or so this kind of a professional will disappear and the the the industries need to to establish a very close relationship with the professional to inform but to deep inform on on new treatments on new technologies or new practice and so on so I I believe it will be a very very interesting field of development for digital learning in the future thank you Thomas so I think you have really very nicely concluded then this session so in the end I would like to thank all of the speakers today to my son Minerva Stefano de Nicolai Antonio Memeo and Stefan Frenex for very inspiring and great presentations and I would just like to announce that the next session the next webinar just let me open it is going to be on September 23rd and the title is a collaborative online trusted relationships for multicultural exchange so I wish to thank all of you for being with us today and see you next week thank you and bye thank you thank you everybody bye bye