The Current Status of Online CME
• Presented at ASCO Critical Issues Seminar
• Santa Fe, New Mexico
• March 17, 2000
• Bernard Sklar MD
• University of California, San Francisco
A Talk and a Resource
• This talk is posted on the web at www.netcantina.com/slideshows– There are several versions to choose from, depending
on your browser, speed of connection and your preference for html or PowerPoint
• Please visit the presentation as often as you like, follow the links and study the sites. Feel free to adapt the presentation for your own use. – If you use it, please say ”Adapted from a talk presented
at ASCO Critical Issues Seminar, March 17, 2000, with permission of Bernard M. Sklar, M.D.”
Online CME:Outline of this Talk
• Focus: what is actually “out there”
• (Briefly) History of the CME Movement
• (Briefly) CME today without the Internet
• Findings from my research and surveys
• Speculations on the future of online CME
History of CME in America
• Medical life before mandatory CME• 31 states require 12-50 hours of CME per
year• 11/28 specialty societies require CME for
recertification • Most hospitals require CME to maintain
hospital privileges• Many HMOs and Insurers require CME
CME Accreditation
• All CME is accredited by the ACCME (Accreditation Council for Continuing Medical Education)
• COPE is the optometric equivalent of ACCME
Non-Online CME
• Live (80.4%):– Meetings at the hospital and specialty
conventions – Teleconferences: radio, television or telephone
• Home Study (18.6%):– Reading articles in medical journals– Home Courses which can consist of: Text,
Audiotape, Videotape, CD-ROMs
CME: Meetings
• Most CME presented at meetings is not effective in changing MD behavior.
• Peer-reviewed Journals: Often sponsored by specialty society
CME: Journals
• A common form of home-based CME is reading journal articles and answering quizzes based on these articles.
• Journal reading and quizzes accounted for 30% of all home-based CME in 1998
CME: Home Study
• Home Study courses can be:
• Text and graphics (AAFP) Home Study)
• Audiotape (Audio-Digest Foundation)
• Videotape (AAFP Video Series)
• CD-ROM– ProEd International– ArcMesa Course in Oral Pathology
CME Teleconferences
• Physicians can join teleconferences from home, office or hospital
• University or drug-company sponsored
• Interactive with immediate feedback
• Transmitted via telephone, radio or television
• OMEN (Ohio Medical Education Network)
Costs of Non-Online CME
• Can be inexpensive– hospital meetings usually free, journals free to $15 per
hour. Home Study $15 to 20 per hour.
• Can be very expensive– specialty meetings at resorts, $500-1000 for credit, plus
room, travel, meals and time away from practice
• CME is big business– 500,000 physicians x 25-50 hours per year x $10-20 per
hour = $125 to 500 million per year. And it is required.
Online CME: A Solution?
• IF properly produced and implemented, online CME can solve a number of problems:
• Timeliness and ease of production
• Cost and inconvenience to physicians
• Proof of attendance
• Assessment of learning
Online CME: Types of Instruction
• Text only or Text plus graphics
• Slide-audio or Slide-Video lectures
• Question/Answer
• Guideline-Based
• Non-Interactive
• Interactive
Online CME: Text-Only
• The easiest kind of CME site to put up. Take your print article, convert it to HTML, add a few multiple choice questions, and post.
• Articles can be long-20 to 50 pages.
• Articles are usually in HTML or pdf format.
Medicine and Behavior Text Only
Cine-Med Asthma Presentation Text-Graphics
Online CME: Slide-Audio Presentations
• Greater investment in time and technology
• Record speaker during lectures
• American Psychiatric Association: Choosing an Antidepressant
Online CME: Slide-Video Presentations
• This technology works well with fast connections
• Otherwise video picture can be “jittery”
• The picture is also quite small
• MedLecture.com demo
• CME-WebCredits Diabetes
Online CME: Guidelines
• Several sites present treatment guidelines or “consensus” statements.
• These two are text-only
• NIH Consensus Statements (Brain Injury)
• The “other” ASCO (antiemetics in cancer)
American Society of Clinical Oncology
Online CME: Interactivity
• Best use (so far) of internet technology
• Program waits for user input before continuing
• Can be text only or can use audio or video
• Examples:– Question/Answer– Case Based
Influenza Vaccine Question/Answer
Influenza Vaccine-Incorrect Answer
Influenza Vaccine-Correct Answer
Teenager with Wheezing, History
• A 12-year-old male soccer player presents to your office because of a persistent cough occurring with exertion. Symptoms are worsened during cool weather. He denies shortness of breath or symptoms at rest. Family history reveals mild maternal asthma.
Teenager with Wheezing, Vital Signs
• Temperature: 98.2Blood Pressure: 115/70Pulse: 76Respirations: 12Lungs: Clear to auscultation bilaterallyHeart: Regular rate and rhythm, no murmurExtremities: No cyanosis
Teenager with wheezing, Question
• What is the most likely diagnosis?
• A) Upper respiratory infection• B) Exercise-induced asthma• C) Chronic bronchitis• D) Pneumonia
Teenager with wheezing, Correct Answer
• If you give correct answer, program says” Correct” and gives no other feedback.
Teenager with wheezing, Incorrect Answer
• Answer B. The overall incidence of exercise-induced asthma is approximately 12% to 15%. Typical presentation may include a. coughing, wheezing, dyspnea, or chest discomfort with exercise; b. symptoms that vary by season or outdoor temperature; c. decreased or altered exercise regimen; d. complaints of limited endurance; and e. decreased problems in warm, moist environments. Patients at risk for exercise-induced asthma include those with: a. known asthma, b. allergic rhinitis, c. family history of asthma, and d. history of viral bronchitis.
Interactive Online CME
• Here’s a few more simple examples of interactive online CME for you to look at later if you wish
• VLH Menstrual Disorders
• Family Residents Interactive Abdominal Pain
• Case Study in Congestive Heart Failure
MS Thesis
• I searched the web for online CME repeatedly over 3 years
• As of early February 2000:– 96 sites– Over 3000 hours of CME credit– The number of sites found grew from 18 in
December 1997 to 96 in February 2000
MS Thesis: Size of Sites
• 3/96 sites have greater than 200 hours
• 6/96 sites have 50 to 100 hours
• 56/96 sites have 5-49 hours
• 31/96 sites have 5 or fewer hours
MS Thesis: Types of Instruction• 27/96 (28%) Text-Only
• 38/96 (38%) Text-and-Graphics
• 22/96 (23%) Slide-Audio Lecture
• 7/96 (7%) Slide-Video Lecture
• 7/96 (7%) Guideline-Based
• 4/96 (4%) Question/Answer
• 16/96 (17%) Interactive
MS Thesis: Fee Structure
• 38/96 sites offered free instruction
• 28/96 charged $10 or less per credit-hour
• 20/96 charged $11-20
• 10/96 charged $21 or more
MS Thesis: Physician Usage I
• If you build it, will they come?• Requested usage information from all sites (43)
offering 10 or more hours of credit• 23/43 responded with some useful information• A few commercial sites seem to doing well:
– HealthStream– MedScape– Virtual Lecture Hall– ArcMesa
MS Thesis: Physician Usage II
• A few of the government sites seem to be doing well– MMWR– NIH Consensus Statements
• One University Site doing OK– Cleveland Clinic, now allied with HealthStream
MS Thesis: Physician Usage III
• ACCME Report shows growth from 1997 to 1998
• 1997 - 13,115 physician-registrants • 1998 - 37,879 physician-registrants • 1999 not yet available
MS Thesis
• Many more details available by looking at the text of the thesis.
• I’ll be happy to share those details
• Contact me at [email protected]
Quality Issues
• I will discuss three systems for ensuring or measuring quality:HON (Health on the Net)
Medical Matrix
Silberg and Lundberg
Health on the Net (HON) Code of Conduct
• Authority• Complementarity• Confidentiality• Attribution• Justifiability• Transparency of authorship• Transparency of sponsorship • Honesty in advertising and editorial policy
Medical Matrix Star System
• Has a 5 star system to rate overall quality• Considers 6 qualities in its resource rating
– Peer Review– Application– Media– Feel– Ease of Access– Dimension
Silber and Lundberg
• Does the Site:– require registration by the user?– identify the author?– provide clear published references for the
content?– disclose sponsorship?– Are the pages date-stamped?– Is there peer review?– Is there testing of the user?– Does the instruction give feedback to the user?
A Few Optometry Sites I
• Pacific University CE Internet series • Five courses presently available:
Retinal Manifestations of Systemic Disease; Overlooking The Effect Of The Eyelids In Your Dry Eye Patients???; You've Got Some Nerve! A Clinical Guide to the Funny Looking Disc; Assessment and Low Vision Management of the Visually Impaired Child; and Issues In Rehabilitative Optometry: Prescribing For Diplopia. Instruction is by text and graphics (mostly photographs).
Retinal Manifestations of Systemic Disease
A Few Optometry Sites II
• Indiana University School of Optometry
• Three courses are offered: Routine Optometric Examination of the Infant (2 hours); Getting the Angle on Heterophoria (2 hours); and BLUNT SIGHT: Optometric Care of the Amblyopic Patient(Part I) (1 hour). Instruction is by text with a few graphics.
Getting the Angle on Heterophoria
A Few Optometry Sites III
• University of Missouri, St Louis• Laser Basics ( 2 hours) covers the basic physics of
lasers and the characteristics of laser light that make it so important in optometric applications. There are two classic presentations: Practical Applied Optometry by A.M. Skeffington (1949) (2 hours) and The Early Adaptive Syndrome by Appell & Streff (1963). (1 hour). Instruction is by text and a few graphics.
CME: Effectiveness I
• Review of effectiveness of CME (Davis, JAMA, Sept1, 1999). Conclusions:
• Didactic sessions do not:– Immediately change physician’s behavior
• Didactic sessions may:– Change Knowledge, skills or attitudes– Predispose to change– Improve patient care
CME: Effectiveness II
• Davis says that instruction can be effective when it is:– Interactive, enhances participant activity– Provides opportunity to practice skills– Case Discussion, role-play, hands-on– Sequential; “learn-practice-learn”
Online CME: Predictions
• CME is here to stay
• Distance CME will increase
• Online multimedia interactive CME will become the standard
• Effectiveness will be proven
• Online CME will become integrated with other live and distance methods
A Talk and a Resource
• This talk is posted on the web at www.netcantina.com/slideshows– There are several versions to choose from, depending
on your browser, speed of connection and your preference for html or PowerPoint
• Please visit the presentation as often as you like, follow the links and study the sites. Feel free to adapt the presentation for your own use. – If you use it, please say ”Adapted from a talk presented
at ASCO Critical Issues Seminar, March 17, 2000, with permission of Bernard M. Sklar, M.D.”
Thanks for Listening
Questions?
Comments?
Broken Links?
Please contact me.
Thanks.
Recommended
