July 22nd, 2022

The Paperwork Demands for Academic Medical Teaching Are OUT OF CONTROL

Playing at Bubbles, Piercy Roberts, 1803.

Why all caps in the above title? It’s to call attention to a problem that’s getting worse each year in academic medicine, especially when it involves teaching or talks.

The requirement to submit a veritable truckload of forms, documents, attestations, and summaries, all due months before the actual event.

Let’s explore in more detail what this might involve — and I assure you, what is outlined below is no exaggeration.

After accepting an invitation to teach, give medical grand rounds, or visit an academic medical center, you might receive an email from a “person” with an anonymized email such as  “Internal Medicine Administrative Services” or “Medical School Education Coordinator.”

You know those emails that you dread to open because they have so many attachments that you barely know where to start?

Some of these emails have four or more attachments, plus additional secure links (which may ask you to create usernames and passwords), and numerous deadlines for all the required documents. Can an email weigh a lot? If so, these email behemoths are comparable to the Wile E. Coyote’s anvil on the Road Runner cartoons, the 16-ton weight from Monty Python, or Laurel and Hardy’s pianos.

If such emails fill you with dread, it’s because of the Fifth Law of Thermodynamics — otherwise known as Sax’s Law of Email Avoidance:  A person’s reluctance to open an email and deal with it promptly is proportional to the square of the number of attachments. Example:  An email with four attachments is 16-times more likely either to sit unopened and/or not get completed efficiently than one with only a single attachment.

Now let’s review the required items:

  1. Last name, first name, degree(s).
  2. Hospital and academic titles.
  3. Head shot. When submitting this photograph, those of us of a certain age might be tempted to choose something from a couple of decades ago. Fountain of Youth.
  4. Presentation title and date. It’s slightly annoying that all of this information from these first four items is either already known to the inviters (certainly the date) or available via a simple web search, but I’ll grant them these requests as we’re just getting started.
  5. Updated Curriculum vitae. Got to check those qualifications!
  6. Abbreviated biography. These are those braggy paragraphs that a person writes to help with introductions. Maybe I’ll include the fact that I won an essay writing contest about yogurt several decades ago for Boston’s Real Paper — or was it the Boston Phoenix? — allowing me to be on a panel of taste testers to identify Boston’s best brand. Or that I listed in my college yearbook that I was a member of a club called the “Leverett Luggage Society,” a club that did not exist.
  7. PHI query and permission form. PHI stands for “Protected Health Information,” meaning identifying information about patients. If any of this information is in your talk, it will require an additional signed form from the patient. Note to teachers everywhere — unless absolutely necessary, try not to include PHI in your talks. Seriously. Just not worth it. You can use a case-based approach to teaching, but modify the case sufficiently so that it does not include identifying information.
  8. Three (sometimes four) learning objectives. Before submitting these, you could be referred to “OCME requirements” for guidelines on how to write good Learning Objectives — these might come on a separate attachment — or you could be referred to the OCME web site. “OCME,” in case you’re wondering, stands for Office of Continuing Medical Education, not Office of the Chief Medical Examiner, or Orange County Model Engineers. The last of these, I’ve learned, was founded in 1977 and offers free rides on trains that operate like real locomotives, but are 1/8 the size of the real thing. See what can be learned from a quick web search? And before going on, I could write an entire post on these “learning objective” requirements which, as I’ve noted before, rarely lead to more learning, but sure are annoying to write.
  9. OCME disclosure of relevant financial relationships. Every talk requires this information — it’s a list of potential conflicts of interest — but despite the universality of this requirement, there are as many different forms for this information as there are stars in the sky — like snowflakes (to shift metaphors), no two are alike. How about all these Orange County Model Engineers hop off their mini-trains and come up with a standardized form? For a while I just submitted a Word document that listed potential conflicts of interest, and wrote in caps on all the proprietary forms — “SEE ATTACHED DOCUMENT.” That worked for a while, but nobody accepts that one anymore.
  10. OCME mitigation of relevant financial relationships. And if you do have some relationships, you will need to fill out an additional form, one which includes multiple questions (often as many as a dozen) to satisfy the organizers that these potential conflicts can be resolved. Here’s an example, taken from a recent form: “If I am discussing specific healthcare products or services, I will use generic names to the extent possible. If I need to use trade names, I will use trade names from several companies when available, and not just trade names from any single company. My learning objectives may not include trade names. (Check Agree or Disagree.)” Easy for me — I’m one of those nutty ID docs who says “trim-sulfa” rather than Bactrim, “cephalexin” rather than Keflex, and  “pip-tazo” instead of “Zosyn,” both because I hate using trade names (especially when the drug is long off-patent), and because the last one always reminds me of Led Zeppelin’s 4th album, which is distracting.
  11. A list of references, and a PDF of a relevant published paper. If you’re really unlucky, there will be a requirement for an annotated bibliography, explaining why this paper was selected for this talk — oh the pain. For medical schools out there reading this post, please don’t get any ideas. “PDF,” by the way, stands for Portable Document Format, not Probability Density Function, or Pigs Do Fly. Just so you know.
  12. Speaker agreement form.  This includes permission for use of your image in pre-talk announcements, as well as miscellaneous photographs, audio, and video taping. Of course it needs a signature — one of many documents in this bundle that needs a signature, even though all this stuff flies around electronically, and “e-signing” different forms presents its own form of digital torture.
  13. Four “board-style” multiple choice questions related to the talk material. If the course organizers are in a particularly demanding mood, they might ask you also to ensure these questions specifically linked to the dreaded Learning Objectives, see item #8. And yes, careful readers coming back here to re-read this list of required items might note this one was added late — I no doubt left if off originally since crafting good “board style” questions is particularly challenging, time consuming, and painful. Subconsciously I’ve been so annoyed by this request that I couldn’t bring myself even to write “board style” questions.

I realize that these requests are not the fault of the conference organizers or education coordinators — they are responding to requirements issued by others, usually medical schools or accreditors. Anyone who runs a post-graduate course feels this pressure, including me.

But wow, is it ever a disincentive to teach.

OK, I’ve complained enough. Now it’s time for a solution to this quagmire.

How about this approach, which was taken by a very kind person who invited me to give a lecture earlier this year?

Hi Dr. Sax, hope you’re well. We’re planning our annual conference this year, and would be delighted if you would be one of our speakers on [insert ID topic here]. Don’t worry about paperwork — we’ll take care of it — just provide us the talk title and a list of your financial disclosures, if any. We’ll also send you some proposed learning objectives for your review and approval a few weeks before the conference.

Thank you for considering!


And thank you, Ellen, for making it so easy! And for the record, your email was light as a feather.

12 Responses to “The Paperwork Demands for Academic Medical Teaching Are OUT OF CONTROL”

  1. Loretta S says:

    Yet another reason to delete, without opening, those emails that begin, “Greetings of the Day” or “Dear One”. 🙂 But seriously, the word “onerous” comes to mind, yet it doesn’t quite capture what you’ve indicated these presentations require you do to. Maybe if enough people say, “No, thank you”, some changes will be made to the requirements. Shouldn’t we just be saying, “Thank you, O Knowledgeable Person About To Elucidate Some Important Stuff For Us?” and leave the ridiculous documentation requirements on the side of the road?

    • Paul Sax says:

      Thanks for your support, Loretta. I’m so grateful when conference organizers make it as easy as possible, as with the last email I quoted at the end of the post.

  2. Indira Brar says:

    And if we think this is a disincentive to teach trying doing a Full ID CONSULT note on your own without a resident or a fellow.

  3. Joel Gallant says:

    The part I hated the most were the learning objectives. At first I tried snarkiness: “To educate the audience about X.” Needless to say, that didn’t get by the CME police. Not only did I have to rewrite my objectives, but I had to do it using their list of “approved verbs.”

    The meaninglessness of these objectives becomes clear when you’re on the other side of the podium and have to fill out a speaker evaluation. All too often, you’re not asked to comment on the quality of the presentation or whether you learned anything, but on whether the speaker met the objectives. First, who in the audience actually reads and remembers the objectives, or is willing to look them up to answer the question? Second, who in the audience cares? If the speaker was engaging and taught me something I didn’t already know, I couldn’t care less whether the objectives were met.

    As for financial disclosures, how hard could it be to have a single website where you enter disclosure information. Then all you’d have to do when asked to speak somewhere is check a box saying that the online information is up-to-date.

  4. Dr. Marcus Deck says:

    I’m sorry if this come across as rude but I really don’t mean it to be. It’s just that I have really benefited from your past lectures and this blog/newsletter to stay up to date on various things ID especially around COVID but also on other topics as a family physician. Lately your newsletter has been mostly about the various challenges of practice which I agree and sympathize with. BUT, I really crave and need your insights on all the huge amount of data and experiences regarding ID issues so I feel at least a bit useful and knowledgeable in my crazy busy practice. Please, please, more clinical info and insights.


  5. Sylvain Meylan says:

    Hi Paul! While I commiserate with you on this issue (do these people actually make use of this paperwork?), I must commend you on the breadth of your cultural repertoire spanning from Wile E. Coyote’s anvil on the Road Runner cartoons to Laurel and Hardy’s pianos! Never thought of Zosyn as a conduit to Zoso, but then again, it’s been a long time since I rocked and rolled. take care!

  6. Sharon Weissman says:

    The paperwork for a research grant (even those of nominal monetary value) is worse. And then if your grant application is successful the paperwork doubles and triples. Talk about a disincentive to do research.

  7. Karen C says:

    It could be worse — you might have to sign up to be a “vendor” to receive your honorarium for teaching, which involves creating yet another username and password. Always wonder whether it’s worth the time!

  8. Jon Blum says:

    I have found that many of the best conferences don’t provide CME credit. What is the utility of “learning objectives” or a biography, and who decided these were essential to education? (I share Joel’s frustration with those verbs – ironically, they wouldn’t let me use “learn.” Maybe “cognizantificate” would be better.) The pharmaceutical industry has the time and resources to deal with ever-increasing but useless paperwork demands. The main impact of all this extra work, other than to waste time and money supporting a self-serving bureaucracy, is to encourage the delivery of more CME by pharmaceutical-sponsored speakers.

  9. Ring’s so true ! The absurdity of the unintended consequences such rules and regulations impose would be more tolerable if they were indeed effective.
    One unnamed academic medical institution had their university’s sports & entertainment handle the unrestricted educational grants for grand rounds:).

  10. Wendy says:

    Coming from the side that distributes all that paperwork – I totally get it. I have streamlined as much as possible but the entire CME process needs an overhaul!

  11. Hazel says:

    I enjoyed reading this -and so much is true -I always write an overview of what we are hoping to include in the presentation -and write the objectives (the speaker can approve them -or if they are into objectives (most are not-agreed) -they can re-write based on their presentation.

    It should be the information and education that comes across from presenter to learner that is important -and the documentation should not be as cumbersome -for the presenter or the learner -it really is helpful to know how the speaker/presenter feels when they see the request though.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

Biography | Disclosures | Summaries

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