Title: Overview of Online CME
1Overview of Online CME
- The Seventh Annual Meeting
- of the
- Global Alliance for Medical Education
- June 23-25, 2002
- The McGill Faculty Club
2(No Transcript)
3Online CME An Update
- Review of June 2002
- Bernard M. Sklar, M.D., M.S.
- www.cmelist.com
- bersklar_at_netcantina.com
4Plan of Talk
- Results of Survey
- Types of Instruction
- Physician Use of CME and Online CME
- Obstacles to Physician Use
5Masters Thesis
- This review is based on a recent update of the
database that I created for my masters thesis,
The Current Status of Online Continuing Medical
Education (June 2000). Find the thesis online at
http//www.cmelist.com/mastersthesis - The thesis was based on a review of the CME
literature and a survey of online CME done in
February 2000.
6How Was the Survey Done?
- Internet search of multiple search engines using
search string online continuing medical
education - Following up leads from those searches
- Information from ACCME
- Email from viewers and CME providers
7Description of the List
- Each entry shows the name and URL of the site,
when I last visited, how many credit hours are
available, who awards the credit, the cost per
unit, when the educational material was last
updated, a description of the site and its
contents and links to individual courses found at
the site.
8Extensive Updates
- I have been maintaining the list for about 5
years - The list was updated for my masters thesis in
February 2000, again in August and December 2000,
in December 2001 and in June 2002.
9List of Online CME
10Database Created from List
- Based on examining each site, I created an
Access database of the 207 sites actively
offering CME in June 2002. The DB contains the
number of activities, number of hours of
instruction, types of instruction, specialty
audiences, cost to users, sources of financial
support and other parameters.
11Results of Study I
- The number of sites and activities is rapidly
increasing - April 1997 13 sites
- December 1997 18 sites
- August 1998 61 sites
- May 1999 69 sites
- December 1999 87 sites
12Results of Study II
- February 2000
- 96 sites, 1874 activities, 3064 credit hours
- August 2000
- 135 sites, 3659 activities, 5659 credit hours
- December 2000
- 150 sites, 3510 activities, 6553 credit hours
- Because of overlap, duplication, and
miscounting , the true number of hours should
have been about 5500.
13Results of Study III
- December 2001
- 197 sites
- 12026 activities
- 17523 hours
14Results of Study IV
- June 2002
- 209 sites
- 10952 activities
- 18266 hours
15Size of Sites December 2000
16Size of Sites December 2001
17Size of Sites June 2002
18The Largest Sites December 2000
19The Largest Sites December 2001
20The Largest Sites June 2002
21Fee Structure by Site Dec 2000
22Fee Structure by Site Dec 2001
23Fee Structure by Site June 2002
24Hourly Fee Structure Dec 2000
25Hourly Fee Structure Dec 2001
26Hourly Fee Structure June 2002
27Financial Support Dec 2000
28Financial Support Dec 2001
29Financial Support June 2002
30Sites by Specialty Primary Care Dec 2000
31Sites by Specialty Primary Care Dec 2001
32Sites by Specialty Primary Care June 2002
33Sites by Specialty Subspecialties Dec 2000
34Sites by Specialty Subspecialties Dec 2001
35Sites by Specialty Subspecialties June 2002
36Sites by Specialty-2001- Other
- 26 sites (13) offer subjects of interest to many
different specialties for example, ethics,
legal, practice management, genetics, and basic
science - Many other specialties were included at 5 or
fewer sites
37Sites by Specialty-June 2002- Other
- 33 sites (16) offer subjects of interest to many
different specialties for example, ethics,
legal, practice management, risk management,
tobacco cessation, genetics, basic science - Many other specialties are included at 5 or fewer
sites
38Five Different Sites I
- CE Medicus has no CME of its own, but offers
access without fee to about 600 activities at
five sites (apparently by special arrangement) - Digiscript contains many hundreds of audio and
video slide lectures recorded at medical
meetings. The yearly charge is 400. Some
activities offer CME and some do not. The site is
searchable by medical topic and by sponsoring
organization. You may have to pay an additional
fee for CME credit by any given sponsor. - Doctors Guide also has no CME of its own, but
offers descriptions of over 600 activities (free
and fee) with links to those courses
39Five Different Sites II
- Stanford SKOLAR offers credit for performing
Internet literature searches on topics of your
own interest - University of Wisconsin Professional Courses
offer credit for courses on non-medical subjects
which could be expected to improve your practice
or your life.
40Sites I Could Not View
- There may be a number of proprietary sites, e.g.,
staff model HMOs, like Kaiser-Permanente, where
access to instruction is limited to staff members
of that organization. Those sites are not
reviewed in this report.
41Email Reminders June 2002
- About 25 sites send out regular email
reminders about additions to their lists of
activities on request by users American College
of Cardiology, Boston University, Cancer
Education, CME Reviews, Cyberounds, Doctor's
Guide Webcasts, Ecornell, EMedHome, EMedicine,
cmecourses (HealthStream), Journal of Clinical
Psychiatry, Medscape, Medinfosource, Medsite,
MMWR, mypatient.com, Natal U, PDR.net,
Pedsref.org, psychLINK, Psychiatrist.com
(NetSociety), Serono, University of Wisconsin,
Virtual Lecture Hall, and World Medical Leaders.
42Types of Instruction-Definitions
- Text-Only
- Text-and-Graphics
- Slides-Only (or Slides and Text)
- Slide-Audio
- Slide-Video
- Question-and-Answer
- Case-Based Interactive
- Guideline or Consensus (usually text only)
- Correspondence
- Games
43Types of Instruction Dec 2000
- Text only -- 37 sites 25
- Text-and-graphics 45 sites 30
- Slide-audio 45 sites 30
- Slide-video 21 sites 14
- Guidelines 5 sites 3
- Question-and-answer 6 sites 4
- Case-based Interactive 27 sites 18
- Many sites have more than one type of instruction
44Types of Instruction Dec 2001
- Text only -- 47 sites 24
- Text-and-graphics 59 sites 30
- Slide-audio 57 sites 29
- Slide-video 21 sites 11
- Guidelines 5 sites 3
- Question-and-answer 9 sites 5
- Case-Based-Interactive 26 sites 13
- Correspondence 3 sites 2
- Games 2 sites 1
- Slides-Only 4 sites 2
- Many sites have more than one type of instruction
45Types of Instruction June 2002
- Text only -- 57 sites 27
- Text-and-graphics 71 sites 34
- Slide-audio 60 sites 29
- Slide-video 23 sites 11
- Guidelines 8 sites 3
- Question-and-answer 6 sites 3
- Case-Based-Interactive 31 sites 15
- Correspondence 2 sites 2
- Games 2 sites 1
- Slides-Only 4 sites 2
- Slides-and-Text 4 sites 2
- Many sites have more than one type of instruction
46More about QA Instruction
- Only 6 sites (2) feature QA, BUT the number of
hours is relatively large - Challenger - 964 hours
- TheAnswerPage 300 hours
- E-core 27 hours
- Familypractice.com - 25 hours
- Total about 1316 hours (7 )
47CME Participation by Location Based on ACCME
Figures for 2001
- Live meetings and conferences account for 76 of
physician-registrants - Home study CME (enduring materials) and
journals account for 19.6 of physician-registran
ts - Online CME accounts for only 4.4 of
physician-registrants
48Physician Usage of Online CME
- Physician usage of online CME is increasing, but
still accounts for less than 5 of all CME - According to ACCME
- 1997 13,115 physician-registrants (0.34)
- 1998 37,879 physician-registrants (1.03)
- 1999 79,536 physician-registrants (1.79)
- 2000 181,922 physician-registrants (3.57)
- 2001 230,055 physician-registrants (4.44)
49Why is Online CME Use So Low? I
- Many physicians still uneasy with computers and
Internet - Many physicians unaware of online CME or dont
know how to find it - Much live CME, especially at the hospital, is
convenient, free and offers collegial interaction
50Why is Online CME Use So Low? II
- A series of gates for the user to pass through
- Navigation Download and install plug-ins
- Registration hassle
- Fear of giving out license, DEA, credit card
- Paying in advance for content you cant view
- Get content free, leave without paying
- Each site has a different procedure and password
51Why Choose One Online CME Site Over Another?
- Price
- Preference for Type of Instruction
- Email reminders
- Part of larger medical site
- Help with CME reporting
- Recommendation by colleagues, medical group
- Special arrangements with physician group
52A Long Term Solution
- Eventually, CME will be totally integrated with
the physicians daily practice life - Systems will be developed which allow a computer
program to know when a physician is making a
mistake or needs additional information - The system will present instruction on the spot
to help the physician do the right thing
53Other Problems to Solve
- Another problem will be to prove that a given CME
activity actually improves physician performance. - For now, CME providers and evaluating groups will
need to settle for some lesser measure, such as
the difference in scores between pre-tests and
post-tests, or statements by experts that the
course will correct the deficiency.
54Opportunities for Research
- More sophisticated (and expensive) methods of
evaluation exist, such as reviewing physician
charts or interviewing patients - This is a great opportunity for research. There
is grant money available for research into
effective CME.
55Conclusions I
- The number of online CME activities and credits
is growing rapidly (but not so rapidly as in the
previous periods) - Online CME is becoming nicer to look at, with
more graphics, lots more audio and video, and a
bit more interactive programming
56Conclusions II
- The percentage of CME hours earned online is
still only about 4.4 - Barriers to usage are still major
- Almost no proof that any kind of standalone CME,
whether live, home study or online, and
regardless of mode of instruction, is useful in
changing physician practice
57Conclusions III
- The future lies in the integration of medical
practice, quality assessment and user-specific
CME - The challenges and opportunities are great
58Important URLs
- Masters thesis www.cmelist.com/mastersthesis/
- My home page www.cmelist.com
- Online CME list www.cmelist.com/list.htm
- Definitions of types of online CME instruction
www.cmelist.com/Instruction_Types_defined.htm