Restructuring of Multidisciplinary Scientific Meetings Improves Valuable Exchange of Information

The multidisciplinary meeting concept is well accepted in neurosurgical sub-specialties; tumor and epilepsy boards have long worked to foster collaboration and consensus among experts with diverse clinical experience to come up with individual treatment plans for individual patients.

In “Principles for the Best Multidisciplinary Meetings,” an article in the April 2011 Lancet Oncology, author Vincenzo Mazzaferro of the National Cancer Institute in Italy describes the strengths of the traditional tumor board model. He explains that in addition to the benefits of evidence-based data now available to guide tumor board members, there are “less obvious features of decision-making in multidisciplinary teams” that yield the best possible outcomes for patients.¹

Similar attributes of scientific meetings that solve problems and spur innovation are harder to identify. When scientists are invited to multidisciplinary meetings, they tend to be well-prepared to present their own work, but typically lack sufficient focus on how their expertise might contribute to finding novel solutions to a problem faced by members of the audience.

And in recent years, with less opportunity for debate and discussion in meetings, the important exchange of ideas fostered through audience questions and suggestions is also limited. Expanding neurosurgery meetings to include more non-neurosurgeon experts to increase diversity of perspectives would also require additional resources.²

For medical science to thrive, particularly in an environment of uncertain funding, where identifying revenue to coordinate and attend meetings is currently challenging, we may need to develop a better model for multidisciplinary scientific meetings applicable to neurosurgery and any medical science.

If a fresh look at a scientific field from a different perspective fuels innovation, and one of the most important sources of advancement is application of ideas from one discipline to another, then scientific meetings should be reengineered and restructured to facilitate the cross-pollination of ideas.²

Implementation of such a meeting model would foster a valuable exchange of ideas by harnessing the expertise of a diverse cadre of stakeholders and facilitating the translation of great ideas into the technologies and treatments that patients need.

Mazzaferro cites as essential clearly identified responsibilities for every member of the multidisciplinary team and leaders whose knowledge and skills are recognized by their peers.

Some of the same principles—and associated benefits—apply to multidisciplinary scientific meetings.

Multidisciplinary tumor boards and patient care conferences have proven to pay high dividends for patients, who benefit from the comprehensive and personalized review and development of their care plan. They also advance the field itself, as the contributions of a diverse panel of experts and real-time patient experiences accumulate to broaden the fundamental understanding of the disease.³

In multidisciplinary neurosurgery patient care meetings for brain tumors, for example, we have created a logical order for the various disciplines to share their data and comment on others' data. The expertise each member of the team brings to the discussion is established. The neuro-oncologist and/or neurosurgeon presents the patient's history and any relevant findings from his or her examination. The neuroradiologist reviews the studies, pre- and post-operative MRIs or interval scans, and reports on the residual or recurrent tumor from that perspective. The neuropathologist reviews the slides and provides specific tumor-type information, adding further information on rare tumor types and their expected behaviors. And the radiation oncologist and neuro-oncologist comment on additional treatment options, including discussion of clinical trials that may be available to the patient. In addition to comments from each physician specialist, the social worker and/or nurse case manager has the opportunity to discuss the family's preparedness, transportation needs, family dynamics or other information relevant to their ability to comply with and fully benefit from the planned treatment.

Unlike brain tumor boards, where individuals may have been working together for years, and where each is well familiar with the training, expertise and perspective of the other members, this is often not the case for multidisciplinary science meetings. The speakers' training, clinical expertise or laboratory skill sets and focus are not commonly appreciated, nor are their challenges generally outlined as part of their presentations. Of greater concern, is that speakers do not typically know what they themselves bring to the table that might foster scientific discovery in collaboration with members of the speakers' panel and audience.

Vijay Govindaraja, Professor of International Business at the Tuck School of Business at Dartmouth College, outlines elements essential for innovation in “Innovation's Nine Critical Success Factors,” a blog post in Harvard Business Review (July 5, 2011).⁴ These elements aimed at a business audience could guide improvement of the value of medical and scientific meetings:

• Meeting agendas should be designed with full alignment of strategic goals for innovation ensuring that all participants are starting with these same goals in mind.

• Meetings should have identified “passionate champions” who are not autocrats but people who can engage conference members.

• Multidisciplinary groups with individuals of different experience and training should be encouraged to come together and exchange ideas; often the breakthrough idea comes from the naïve, and is recognized and implemented by the expert.

• The roles of participants in medical and scientific programs should be well defined, with each providing a specific perspective managed and coordinated by the program leader, with enough flexibility to guide the interactions and discussions as they evolve.

A meeting without a clear focus or agenda can seem irrelevant and boring for the participants. Multidisciplinary science meetings should have a goal(s), and the speakers and other participants should consider their time spent to be worthwhile.

Participants should presume that new or less experienced people may be able to assimilate the data in a novel or highly effective way as compared to more seasoned participants. Time for interaction among key stakeholders and other interested parties should be reserved to explore questions and observations.

A relevant paper in Journal Engineering and Technology Management by Jerald Hage and colleagues describes a case study highlighting the strategic decisions and managerial practices in development of a co-located research unit within a national laboratory.⁵

Their observations about the challenges of integrating disciplines are applicable to the pursuit of scientific discovery and innovation in any specialty:

“Besides conflicts over expectations, a major source of difficulty was communication between people trained in quite disparate disciplines and sub-disciplines …especially true for tacit communication, that is, the unspoken assumptions involved in our models of thinking.”

Hage cites important indicators that reflect environments in which creativity, risk-taking—and innovation—can flourish.

One set of indicators focuses on power and economic resources such as authority to make decisions, resources and freedom to pursue new ideas. The second set of indicators focuses on the process of innovation: sense of challenge and enthusiasm, time to think and explore, and a commitment to critical thinking.

Practical ways to encourage integration among different groups include invitations to those involved to make presentations to the entire group, which helps develop relationships, avoid competition and break down departmental barriers.

In the case study, Hage also found that participants wanted more time for cross-fertilization of ideas and more time for internal project communication.

For multidisciplinary meetings to be productive, speakers should define their perspectives, briefly describe their educational backgrounds and research techniques, and provide their understandings of the problems the groups are attempting to tackle. They should feel free to elaborate on the challenges or limitations they have encountered to empower others to contribute openly to the problem-solving process.

That cross-pollination and problem-solving can be facilitated, according to Howard Alper, PhD, Chair of the Science Technology and Innovation Council of Canada,⁶ when “multidisciplinary groups tackle problems jointly, and rules are established to enable participants to communicate in a common vernacular.”

Innovation should not be stifled, either, from a meeting structure in which participants consider their ideas to be proprietary and of value only when they can be sold to industry. This kind of thinking slows development of new drugs and technologies and delays care for patients.⁷

In industry and in medicine, models exist for multidisciplinary approaches to finding innovative solutions to vexing problems. At well-conceived and ably led multidisciplinary meetings, physicians and scientists have the opportunity to leave their silos and use these approaches to share experience and expertise, making meaningful progress for our patients.