Education: Knowing What They Know

May 1, 2006

Pharmaceutical Executive

Volume 0, Issue 0

The key is distinguishing between what the reps know with confidence versus what they will forget.

Few things are more important to a pharma company than timely drug launches. And because making deadlines is so important, the race to get new drugs to market sometimes shortchanges sales training. Pharmaceutical companies' efforts to get new drugs out the door quickly require some companies to outsource sales to teams of professionals with just a few hours of training on a drug. In a few cases, nothing stands behind a contract sales rep's air of authority on a particular drug except a two- or four-hour PowerPoint presentation.

But this kind of training, or lack thereof, violates the public trust. In extreme cases, it can result in misrepresentations of cures and side effects, which can have serious consequences for users, not to mention legal liabilities for physicians and the company itself. Instead of outsourcing sales teams, pharma companies need to take the time to properly train sales reps so they can answer doctors' questions confidently and correctly.

The pharmaceutical industry is no place for casual approaches to training. Patients need to have confidence in the expertise of physicians and the drugs they prescribe. And the consequences of physician mistakes—class-action law suits, FDA action, legal settlements, and even patient injury or death—are so devastating that neither doctors nor drug companies should take chances.

One remedy to this problem is using confidence-based learning to determine what reps know and what they only think they know. By asking reps to not only answer questions, but to choose how confident they are in their choices, trainers can assess where learning gaps exist. Once these gaps are identified, they can create educational tools to make sure reps don't make the same mistake where it really counts—out in the field.

Where the Process Fails

Most companies are adept at dispensing the information that physicians need. They can put together the data that sales people require to adequately represent their products. The training tools and materials they use are often state-of-the-art. Where the process fails is assessment: determining whether sales reps and spokespeople actually know their stuff when they leave training—what they know with confidence versus what they "learned" but will soon forget.

All traditional training and assessment methodologies suffer from a universal shortcoming: the possibility that someone can guess the correct answers and skate through a certification without becoming fully knowledgeable. Let's say two reps, A and B, both get 85 percent on a test. They might have gotten the same score, but the difference is rep A fully understood 85 percent of the content on the test (the portion she got right) while rep B might have chosen the right answer but guessed on 50 percent of the questions. The test scores say these two people know the material equally well, and can therefore be given the same responsibilities. But their performance on the job will likely be very different. One learner may be qualified, but the other is almost certainly a risk. Assessments that cannot discriminate between guesswork and knowledgeable answers do not accurately measure what a person truly knows, let alone identify knowledge gaps that must be remediated.

Measuring Confidence

The best predictor of a person's performance is not knowledge alone, but knowledge and confidence. Confident people act on their knowledge. Less confident people do not. If we cannot measure confidence in reps, we cannot assess their potential competence when they go on sales calls. Worse still, we have no way of knowing when a rep has a high degree of confidence, while giving doctors incorrect information.

Some companies spend millions of dollars each year—tens of thousands of dollars per employee—training their sales forces. They fly them to exciting destinations, ply them with golf, food, and entertainment, and even bring in expert trainers to keep the sessions animated and engaging. The sales teams leave these sessions with some knowledge of the new products. And they have a new message for each product line. Then they are expected to walk out into the business world and "teach" their clients why they need these new products. This is where the problems start. These people don't just make mistakes because they don't know the subject matter; they very often do so because they haven't developed any confidence in it yet.

And then there are the reps who are confident they know their stuff but don't. They will give the doctor misinformation, but since they say it with confidence, the doctor is likely to believe them.

The "Misinformation" Virus

In the pharmaceutical industry, misinformation can easily creep into the mainstream dialog about a drug. Hearsay is no substitute for scientific data, and yet it finds its way into the minds of physicians and patients, and even into the detail pieces of sales people.

The problem with misinformation—aside from the fact that it isn't true—is how it spreads like a virus through organizations. One person has some wrong information but is confident that it is true, and he or she shares this with three colleagues, who in turn share it with others. This kind of harmful information travels fast and invisibly, until it surfaces in conjunction with a problem. By then the damage is done, and for the pharma industry, this misinformation doesn't affect just companies—it affects lives.

Robert E. Mittelstaedt, Jr., author of "Will Your Next Mistake Be Fatal?" talks about this problem. He explains that a business can have all the appearances of running smoothly, when in truth, it is being undermined by a chain of difficult-to-identify mistakes that eventually snowball out of control.

"Nearly all serious business problems or failures are the result of more than one mistake," he said. "If we do not 'break the chain' of mistakes early, the damage and its related costs will go up exponentially."

Learning Behavior Model

Mittelstaedt argues that identifying and correcting errors in their early stages is critical to the success of an organization. The solution to this dilemma in pharma lies somewhere in training, for if training is properly delivered and the results properly monitored, the risk of serious problems diminishes.

Scores Don't Tell The Whole Story

Confidence-based learning is derived from a study in the 1980's conducted by James Bruno, a professor at UCLA. As an alternative to the multiple choice test, Bruno created a process he called Information Reference Testing, or IRT.

The research centered on two-dimensional assessment—measuring both knowledge and confidence. Confidence has a direct correlation to the retention of information, and therefore is one of the best predictors of performance. But because traditional tests and certifications don't measure confidence, a new assessment methodology had to be developed that did so.

Bruno later revamped IRT to incorporate confidence into answers by allowing the test takers to actually choose how confident they are about their choices. (See "Unraveling IRT".) A successful guess would mask how much an individual actually knows—or doesn't know—about the topic. Without a confidence-assessment test, trainers would not know if reps were:

Unraveling IRT

Informed: Confident and guessed the correct response

Misinformed: Confident in the response but not correct

Lacking Information: Had no idea about the subject but guessed correctly.

The research illuminated the need for organizations to be aware of "invisible errors" from individuals who guess correctly on tests and are given credit for mastering what they may not know. This can happen in sales organizations or out in the field. People can be trained—even certified—but not be fully knowledgeable about the drugs they sell. Scores don't tell the whole story.

Finding an Answer

IRT and the two-dimensional assessment process have evolved from being strictly an assessment methodology to a comprehensive training system called Confidence-Based Learning, or CBL, with a patented confidence and knowledge assessment, which makes the learning process more efficient and, therefore, faster. People are not forced to endure training on material for which they already have expertise.

Another unique feature of CBL: Through its iterative learning process, learners are able to cultivate and monitor their confidence as their knowledge increases. This helps learners understand their true competence and enables management to better predict performance. In fact, with this type of training, management can monitor, in real time, the knowledge and confidence levels of every individual across the organization, as well as the knowledge profile of the entire organization or department. As opposed to traditional assessment programs, which record only the number of answers individuals answer correctly on a test, CBL maps pockets of mastery, doubt, ignorance and misinformation by topic, individual, and group.

Effectively measuring knowledge and confidence has become a vital part of training in an area where confidence is especially essential—healthcare. As a complement to training, it will help management ensure that reps are on board with corporate objectives, and that the entire sales force is competent to sell their assigned products. Sales managers can be sure that the messaging and positioning conveyed to customers are accurate and consistent. At long last, there may be a way to address both the pharmaceutical companies' need for effective training, and patients' need to be sure that the information a company provides to physicians and other healthcare providers is accurate.

Brian Webster is senior vice president of business development at Knowledge Factor. He can be reached at bwebster@knowledgefactor.com