{"id":10487,"date":"2022-07-22T13:18:24","date_gmt":"2022-07-22T17:18:24","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=10487"},"modified":"2025-10-07T17:18:32","modified_gmt":"2025-10-07T21:18:32","slug":"the-paperwork-demands-for-academic-medical-teaching-are-out-of-control","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/the-paperwork-demands-for-academic-medical-teaching-are-out-of-control\/2022\/07\/22\/","title":{"rendered":"The Paperwork Demands for Academic Medical Teaching Are OUT OF CONTROL"},"content":{"rendered":"
\"\"

Playing at Bubbles, Piercy Roberts, 1803.<\/p><\/div>\n

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.<\/p>\n

The requirement to submit a veritable truckload of forms, documents, attestations, and summaries, all due months before the actual event.<\/em><\/p>\n

Let’s explore in more detail what this might involve — and I assure you, what is outlined below is no exaggeration.<\/p>\n

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\u00a0\u00a0“Internal Medicine Administrative Services” or “Medical School Education Coordinator.”<\/p>\n

You know those emails that you dread to open because they have so many attachments that you barely know where to start?<\/p>\n

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<\/a> on the Road Runner cartoons, the 16-ton weight from Monty Python<\/a>, or Laurel and Hardy’s pianos<\/a>.<\/p>\n

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: \u00a0A person’s reluctance to open an email and deal with it promptly is proportional to the square of the number of attachments. Example:<\/em> \u00a0An 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.<\/p>\n

Now let’s review the required items:<\/p>\n

    \n
  1. Last name, first name, degree(s).<\/strong><\/li>\n
  2. Hospital and academic titles.<\/strong><\/li>\n
  3. Head shot.<\/strong> 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.<\/li>\n
  4. Presentation title and date.\u00a0<\/strong>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.<\/li>\n
  5. Updated Curriculum vitae.\u00a0<\/strong>Got to check those qualifications!<\/li>\n
  6. Abbreviated biography.<\/strong> 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<\/em> — or was it the Boston Phoenix<\/em>? — 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.<\/li>\n
  7. PHI query and permission form.<\/strong>\u00a0PHI 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<\/em>. 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.<\/li>\n
  8. Three (sometimes four) learning objectives.<\/strong> 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<\/strong>, not Office of the Chief Medical Examiner<\/a><\/strong>, or Orange County Model Engineers<\/a><\/strong>. 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<\/a><\/strong>. 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.<\/li>\n
  9. OCME disclosure of relevant financial relationships.<\/strong> 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.<\/li>\n
  10. OCME mitigation of relevant financial relationships<\/strong>.\u00a0And if you do<\/em> 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.)”\u00a0<\/em>Easy for me — I’m one of those nutty ID docs who says “trim-sulfa” rather than Bactrim, “cephalexin” rather than Keflex, and \u00a0“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<\/a>, <\/strong>which is distracting.<\/li>\n
  11. A list of references, and a PDF of a relevant published paper.<\/strong> If you’re really unlucky, there will be a requirement for an annotated<\/em> 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<\/a><\/strong>, not Probability Density Function<\/a><\/strong>, or Pigs Do Fly<\/a><\/strong>. Just so you know.<\/li>\n
  12. Speaker agreement form.<\/strong> \u00a0This 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<\/em> 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.<\/li>\n
  13. Four “board-style” multiple choice questions related to the talk material.<\/strong> 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. Crafting high-quality “board style” questions — with one right answer, and plausible alternatives — is particularly challenging, time consuming, and painful. Reminder:\u00a0 “Good enough but completed” wins here every time over “Excellent but time consuming”.<\/li>\n<\/ol>\n

    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.<\/p>\n

    But wow, is it ever a disincentive to teach.<\/p>\n

    OK, I’ve complained enough.\u00a0Now it\u2019s time for a solution to this\u00a0quagmire.<\/p>\n

    How about this approach, which was taken by a very kind person who invited me to give a lecture earlier this year?<\/p>\n

    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.<\/p>\n

    Thank you for considering!<\/p>\n

    Ellen<\/p><\/blockquote>\n

    And thank you, Ellen, for making it so easy! And for the record, your email was light as a feather.<\/p>\n