Social Media Network Utility in Disease Education: Experience from a CML-Disease Awareness Medical Education Program
Authors: Atallah Ehab L. , Kota Vamsi , Sadek Islam , Damon Andrea , Jen Ji-May , Cakmak Berna , Landy Joshua , Vorona Sharon , Radich Jerald P. 
Published: November 2019

Background: Digital platforms designed for medical specialists have potential to enhance the delivery of continued education for healthcare professionals (HCPs). Chronic myeloid leukemia (CML) is a relatively rare disease: some HCPs may treat only a handful of patients per year, but nonetheless need to be up-to-date with the latest advances in therapy and treatment recommendations. Achievement of sustained deep molecular response with tyrosine kinase inhibitors (TKIs) is associated with improved long-term clinical outcomes, and potentially provides patients with the option of treatment discontinuation/treatment-free remission (TFR). Monitoring of molecular response - and adjusting treatment or initiating TFR - is an increasingly important part of CML management. The aim of this digital medical education program was to educate an online community of HCPs on CML using an interactive, case-based, on-demand approach to medical education. Here we report the uptake and impact of this program.
Methods: The program comprised three components. Two hypothetical case studies were developed based on typical challenges in CML management (Case study 1, molecular monitoring; Case study 2, TFR). These were shared with a digital community of HCPs who were invited by email to engage with these cases. This network included medical oncologists, hematologists, pathologists, internists, cardiologists, medical residents, nurse practitioners and advanced practice registered nurses, physician assistants, and medical students. Each case study included 3 multiple choice questions designed to assess the educational impact of the content. When an incorrect answer was selected, a detailed explanation of the correct answer was provided, ensuring that the educational gap was addressed. The third component of the CML digital education program was an expert question and answer (Q&A) session with a CML specialist. In place of a live Q&A, members of the network were invited to post questions for the specialist at any time prior to or during a scheduled Q&A. These were addressed during a 1-hour virtual event that could be followed for a real-time discussion on CML-related topics such as mutation testing, risk scores, molecular monitoring, the International Scale (IS), and sensitivity of BCR-ABL1 testing for monitoring.
Results: Case study engagement was high: 3202 recipients interacted with the cases and 2144 HCPs responded to the 6 questions relating to those 2 case studies. Overall, 41% of respondents did not know that patients with CML should be monitored every 3 months. Only 30% of respondents knew that when starting therapy, polymerase chain reaction (PCR) testing should use a threshold of at least MR4.5 (BCR-ABL1IS ≤0.0032%). Over two thirds of respondents did not know that MR3.0 (BCR-ABL1IS ≤0.01%) was the BCR-ABL1 level at which TKI therapy should be restarted in patients in TFR, and only 16% of respondents knew that BCR-ABL1 level should be assessed monthly in this population. Over half of respondents were not familiar with the eligibility criteria (MR4.5 for ≥2 years with sensitivity of PCR test at least MR4.5) that indicate a patient can discontinue TKI therapy. A total of 2844 HCPs engaged in the expert virtual Q&A forum 5989 times. Participants included medical students (46%), nursing professionals (22%), physician assistants (14%), medical residents (11%), other target physicians (6%) and hematologists/oncologists (1%). HCPs posed 17 questions/comments to the expert, including 8 questions from hematologists/medical oncologists. The expert posted 22 responses, thereby increasing the educational material shared with the participants.
Conclusions: During this medical education program, over 2100 HCPs accessed and interacted with the on-demand CML education. The proportion of correct responses to the questions about each case study indicates a gap in HCP knowledge around molecular monitoring and TFR. This digital medical education pilot supported a need for further education in these topics and provided a new approach via medical network learning, using interactive case studies and expert discussion. It illustrates the potential utility of such resources in the continuing education of HCPs on a larger scale. Further study may improve audience targeting and educational yield.

Disclosures
Atallah: Helsinn: Consultancy; Helsinn: Consultancy; Novartis: Consultancy; Pfizer: Consultancy; Jazz: Consultancy; Takeda: Consultancy, Research Funding; Jazz: Consultancy. Kota:Novartis: Honoraria; Amgen: Honoraria; Pfizer: Honoraria; Xcenda: Honoraria; Takeda: Honoraria. Sadek:Novartis: Employment. Damon:Novartis: Employment, Other: Stock. Jen:Novartis: Employment. Landy:Figure 1: Employment, Other: Shareholder and co-founder; Novartis: Research Funding. Vorona:Incyte Corporation: Research Funding; Tolero Pharmaceuticals: Research Funding; Takeda Oncology: Research Funding; Novartis: Research Funding. Radich:TwinStrand Biosciences: Research Funding; Novartis: Other: RNA Sequencing.