Leading MSL Teams in Today's Changing Environment: An Interview with Stephen Valerio and Amanda Logue
Submitted by Mark Menichini, Director of Business Strategy and Lori Salamida, Instructional Designer
Stephen Valerio and Amanda Logue collaborate across continents to lead and train global Medical Science Liaison teams at AstraZeneca. Stephen is the Senior Director of Oncology Medical Training based in Gaithersburg, MD, and Amanda is the Senior Director of Global Oncology, Global MSL Excellence based in Cambridge, UK. They generously took some time to talk with our Springer Healthcare Training team members, Mark and Lori, about how they’re leading MSL teams in a changing environment, creating future models for providing value to clinicians, and adapting to our changing healthcare ecosystem.
Springer Healthcare Training: How are you and your teams adjusting to the challenges of engaging with clinicians in this new environment?
Amanda: I think it’s quite timely, actually, with the COVID situation. It really has accelerated and caused us to rethink our existing models of how we inform and communicate with clinicians. I think the lockdown and the access has actually given us opportunities to do things differently — rethink. I think it’s given clinicians pause to think about how they want to receive information as well.
We’re undertaking a big project at the moment to look at, what do we think the future of health care is going to look like? What is our ecosystem going to look like? Are we fit for purposes as a field function to be able to build that? We’ve got a younger generation of physicians who are more used to the immediacy of news flow and information and want their information in different formats, rather than waiting for a traditional publication or going to the Congress. So I think all these different external factors are going to accelerate some change.
Springer Healthcare Training: How do you and Stephen collaborate to lead MSL teams?
Amanda: Stephen and I’s team intersect like a Venn diagram that kind of looks like a peanut. We call it the power of the peanut because we are two roles. We have a significant number of MSLs across a number of therapy areas, and our primary purpose is making sure that they’re aligned to the global strategy and plan, but have the flexibility to localize that. So our core function is to provide that strategic alignment and coordination.
Most of our MSLs are PhDs, PharmDs, they have higher degrees. They could go and read a clinical paper. They understand the data, but how do we then communicate that scientific information? How do we understand what the clinicians’ needs are, what the drivers are around their clinical practice? And then, how can we then take the right pieces of scientific information, and be able to inform the clinician so they can meet their needs? It’s making sure that we take the content, but we add in the context. The intersection of that Venn diagram is the “so what”?
Stephen: The team I lead tends to be scientifically focused, data focused, particularly for our MSLs. That is foremost in our mind, when we’re building out most of our trainings. However, the reality is that the best trainings are the ones that blend in skill components, right? And the ability to actually leverage the data and the information effectively in their interactions with health care providers — that’s where Amanda’s team has expertise. Because her team is MSL Excellence. And that’s where the Venn diagram comes in. Because we meet there, and we think we do some of our best stuff there.
Springer Healthcare Training: Has the pandemic caused you to reconsider the strategies you’re using to train MSLs?
Stephen: We’ve got the inherent variability of the environment we’re in, and I think it’s even exasperating current pre-existing questions about how well we were engaging health care providers. And honestly, I think everyone’s struggling with the same aspect. I think it’s now more complicated because we don’t know what our future-facing world is going to look like. There’s theories and thoughts. Like Amanda said, the ecosystem’s changing, but no one knows what it’s going to be.
And building an organization that is able to pivot in that kind of environment is difficult when you have people distributed across the world — and giving them a flexible environment that’s also going to work in their setting. Because the setting in small countries — Asia-Pacific is going to be radically different than highly urbanized, Western academic centers. And how we mesh that is always tricky.
Springer Healthcare Training: As restrictions are starting to ease, what are the health care professionals going to want? Here in the US there’s been talk about having sales representatives make appointments to come and talk about product. Maybe now clinicians might look at the world and say, hey, I don’t need a salesperson or an MSL coming in to see me. I’m more than happy to sit down in front of my screen and have a professional dialogue and then get right back to my patients when I’m done.
Amanda: So outside of the US, I think that’s been the norm actually for some time — that the access, particularly to sales representatives, has been by appointment only. I think COVID has perhaps accelerated or exacerbated that. So hospitals just have closed up. We’ve heard anecdotally that the access to sales-facing organization has been a lot more restricted than the MSLs. The MSLs are still getting their access, but it’s predominately through email and phone.
We’ve seen the trend over the last couple of weeks that clinicians are starting to embrace virtual meeting technologies. And I think that’s probably just a reflection, really, of when the pandemic was kicking off, the clinicians just didn’t have the time, to engage.
I think now they’re starting to embrace the technology. They’re starting to see value of the virtual engagement. I can only speak to a field medical function but what we’ve seen is the MSLs have been able to maintain interaction levels, although there’s been a pivot from face-to-face to virtual interactions.
What we’re hearing back is the clinicians actually really value that. They still want to maintain the content. They value the science that our MSLs are able to provide and the information they’re able to provide.
Springer Healthcare Training: You talked earlier about how the pandemic has given us all pause to rethink and to do things differently. Have you learned anything new or surprising about how clinicians want to receive information?
And as a field function, we’re going to need a bit more flexibility because the clinicians like the fact that the MSLs can speak to them outside their normal office hours. So we’re not restricted now at having to try and grab a clinician in between busy clinics. It means that you’ve got the clinicians more open-minded and receptive to having a conversation, as well. But that means, then, we need to be flexible as a field function to work outside of traditional working hours. I’m not sure whether there’s going to be resistance in that model. But that’s something that we need to consider.
And I don’t think that face-to-face interaction is going to go away altogether. Humans want to engage with human beings, at the end of the day. But I do think that the virtual interaction is going to supplement face-to-face engagement. Often MSLs — they don’t just go in and have a call and it’s one and done. It’s a continuation of a conversation. And because their role is connecting the clinician either with other clinicians or with other people within the organization, and it’s moving them along a continuum. So I think that those kind of like connecting conversations may occur virtually. But I still think there will be face-to-face engagement, as well.
Springer Healthcare Training: Although there are aspects of face-to-face engagement that will certainly be missed, do you think there are any benefits to virtual engagements?
Amanda: MSLs are predominantly reactive, so they’re responding to clinicians’ needs. But there are definitely advantages in the fact that they don’t have to spend as much travel time, so they can spend their time preparing. One thing I have heard is that sometimes, the interactions are occurring outside the clinic, which is actually giving more focus for the physician. They don’t have a patient, necessarily, in the next room waiting for them, that their brain’s already starting to engage on.
There’s a little more of an opportunity for people to kind of slow down for a minute, get in that moment, focus on the questions they have, think them through a little more. That is one thing I have heard that has been a positive, with people flexing to a virtual environment.
I think it does allow the opportunity to engage with a more diverse clinician base than we have done in the past. We’ve traditionally, as a medical function, focused on those top-tier thought leaders, the clinical practice influencers, and as we’re moving into early alliance therapy, more complex disease areas, there is a broader, multidisciplinary team that still has information needs. We may have the opportunity to engage with them, not just through MSL channels, but maybe other remote information channels that might be automated.
Springer Healthcare Training: When do you think virtual engagements work, and when is it more critical to have face-to-face engagements with clinicians?
Stephen: If you have an established rapport and an understanding regarding a particular clinician, the virtual component is definitely a viable, robust method to have engagements at more flexible times and maintain the relationship. But any situation where an MSL is trying to establish a new relationship, they could be a new hire, moving into a new disease area — those initial contacts are critical in having face-to-face.
In my experience, even outside the MSL field — when you have an established relationship, the virtual environment can work well. There’s so much richness to the relationship when you’re just there. If you don’t have that with the physician, that richness is lost. So I think that’s something we’re going to all have to factor into this in making sure that when those early relationships are being built, that the physicians as well as the MSLs understand the importance of that face-to-face, where safe and appropriate.
Springer Healthcare Training: 2020 has been a big adjustment year for large congresses. How do you think virtual congresses are affecting the quality of scientific exchange between MSLs and clinicians?
Amanda: I think from an access to the information and the data, going virtual has made the data very democratic. It’s available to all. So one of the good things, from an MSL perspective, is that the MSLs, potentially, globally could attend ASCO — could attend the plenary sessions and access the data at the same time that clinicians were. And one of the things that the MSLs really liked at the ASCO meeting was when the data was being presented live, they were able to go into the chat function and see what clinicians were asking and saying about the data. And it’s almost like you’re in the clinician’s head. At the same times you’re seeing the data, you can see their thought processes, as well. So there are some of the benefits.
I’m still a little bit skeptical about whether virtual attendance of congress is going to replace having that ability to actually speak to a clinician when they’re out of their normal environment — We get the best, richest conversations, usually, at congress, in the coffee line or when you’re crossing the bridge over the freeway in McCormick. Because that’s when you just catch a clinician. They’re outside their normal environment, and you’re seeing the data at the same time. I think we’re going to have to go a long way to replace that virtually.
Stephen: One of the things I’m hearing pretty consistently is that the richness of the interactions just isn’t there. People were engaged during the presentation. There’s a chat. The amount of activity that was seen on social media dropped off a cliff, and instead of having those conversations with five or six other colleagues over the next day or two, everyone went and shut down their computer and interacted with their family because they’re human beings, too. And I think that’s going to be critical to getting that face-to-face component back. But if we can still open up that initial presentation of the data directly to more physicians, even if not everyone can get to the city that the actual congress is at, I see that as a win.
Springer Healthcare Training: Have you noticed any interesting trends emerging from the use of social media and the quality of the scientific exchange at virtual congresses?
Stephen: The congresses are going to have to get much better at virtually stimulating the socialization around the data, versus having a few key social influencers dominate it on Instagram or Twitter, or even within the chat box. On the other hand, you had a lot more people chiming in the chat box, versus the two or three people who get to stand at the mic during a symposium.
Amanda: Yeah, it was really interesting, especially at a recent congress, with a major release of preliminary data presented at the plenary. Twitter exploded. Everything is now like bite-sized chunks. It’s almost like opinions get polarized. You’re losing some of that richness of discussion.
Stephen: You talk about that one study. They actually did set up a debate, later on, between two of the people who took different interpretations of the data. But that is a single study. To be fully transparent, it’s an AstraZeneca study. Our company sponsored the trial.
I’m trying to find some analogs outside of, at least, our immediate sphere. Just to see what the bigger trends are. You’re always more invested in it in your own space because unlike a lot of other things– which I think you can argue about therapeutic area differences, and working with cardiologists is incredibly different than working with neurologists, which is incredibly different talking to an oncologist or a psychiatrist.
These challenges, by and large, cut across that. And I haven’t had the chance, frankly, to look at a broader context in terms of what are we seeing across these different disciplines, what has tended to resonate, what has tended to fail. And you have to look at a broader context because even within oncology, I’ve seen people badmouthing one society because they were more strongly associated with another society. And our society, I thought, did a better job.
It’s very tough for me to filter out whether that is actually genuine benefit or is that just your personal subconscious bias? So if I can look at a broad range across multiple disciplines, that starts to flatten.
Springer Healthcare Training: What do you think are some of the pros and cons of using social media platforms like Twitter and Instagram for scientific exchange and information sharing between key opinion thought leaders, physicians, researchers and patients?
Stephen: I would argue that some of the people on social media aren’t key opinion leaders. These are people who are savvy on social media and becoming a social media influencer. Not that they’re not a qualified physician — but there is a difference between someone who is at the leading edge of data, who might not be spending the time and energy to understand how they can build up their social media brand because they don’t have to. They’ve identified their career growth, and it’s through the classical research paradigm.
So I think we have to be very careful about that. And it’s one of the things we have to keep in mind — that when Professor Smith gets up on the podium. Everyone knows Professor Smith and his ability to understand the research. Dr. Jones, on the other hand, might not have that same level of savvy in terms of the cutting edge research.
Now, it doesn’t mean Dr. Jones’ opinion is less valid, because he might be reflecting the community-level issues that affect the bulk of patients, which is incredibly significant, versus the very narrow prism that get to high-level academic centers. But I just think that’s something we have to keep in mind. The two are not interchangeable.
Amanda: I think it’s a really important point you raised there, Stephen, and it’s something that we need to get to grips with as an organization, as well. We undertook some research last year, and it was really interesting — the country differences around where physicians consume their data and where they work — what they see as their traditional resources. It was quite overwhelmingly that traditional resources, publications, and congresses were highly valued, compared to online tools and resources.
I’d be really keen to see if that’s changed as a result of COVID, and does that change depending on the clinician type, as well? Because we were surveying into our top thought leaders.
I think actually, our more sophisticated MSLs have embraced social media. I’m a lurker, myself. All my Twitter feed is all physicians. I don’t post anything, but I just review. I look around and follow the chat, and you get quite diverse opinions. I know that some of our more savvy MSLs do that. We run a program at two of the major congresses, called the Ambassadors Program. These are our elite MSLs that are selected. They attend the congress and synthesize the key insights that come out from the congress, and over the last couple of years, part of that insight synthesis has incorporated social media.
Stephen: We know people consume data in different ways. Quick little snippets on social media — video type things are great, oh then here’s the hyperlink to the full conversation or things like that. Those are all things that the congresses are wrestling with and the physicians are wrestling with. And the reality is there’s no silver bullet. And then how do you grab their attention, and pull them through to the fuller information for those who want it — need it. The physician who has that complicated case, and they really need to go into the data and understand how it’s going to apply to that particular patient. I think it’s something that everyone’s struggling with.
So I can understand it, from the perspective of a busy physician. You know what? Yes, I can watch the data at a major congress. I can look at the data. But then to have an expert who can give me a pithy little take-home on it is valuable.
Springer Healthcare Training: Thank you both for sharing your time and perspective on these topics. It’s amazing how quickly you’re adapting to the new world and succeeding at it, and that’s great!
Amanda: I think we have to because if we don’t, I think we’re going to get left behind. It’s one of the things that we actually take pride of at AstraZeneca is that we’re not afraid to try something new, see if it works, and try to be the best. One of our company values is play to win. We are entrepreneurial. This is what we want to do — put it all out there.
Stephen: We’re comfortable not getting it right the first time, because we keep iterating. We’re not done. We are not a finished product right now. We will continue to learn and interact with the physicians and the other healthcare providers. And they’ll tell us what they need. And what they need today might be very different in a couple of months. And it might be very different in France than it will be in Los Angeles. So we will continue to do that. That’s kind of the expectation. And I think we have the right people on our teams who make that happen.