Online CME for Primary Care Physicians

1
Online CME for Primary Care Physicians

• Bernard M. Sklar, M.D., M.S.
• www.cmelist.com
• bersklar_at_netcantina.com

2
Plan of Talk

• Results of Survey
• Types of Instruction
• Physician Use of CME and Online CME
• Obstacles to Physician Use
• Examples of good sites of some types of
  instruction and for various specialties

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How to Find These Sites

• All the sites mentioned in this talk (as well as
  all the other sites I know about) can be found at
  www.cmelist.com/list.htm

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www.cmelist.com/list.htm
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Description 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, financial support information and a
  description of the site and its contents and some
  links to individual courses at the site.

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The Number of Online CME Sites I

• The number of sites and courses is rapidly
  increasing
• April 1997 13 sites
• December 1997 18 sites
• August 1998 61 sites
• May 1999 69 sites
• December 1999 87 sites

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The Number of Online CME Sites II

• February 2000
• 96 sites, 1874 courses, 3064 credit hours
• August 2000
• 135 sites, 3659 courses, 5659 credit hours
• December 2000
• 150 sites, 3000 courses, 5500 credit hours
• December 2001
• 197 sites
• 12026 courses
• 17523 hours

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The Largest Sites December 2001
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Fee Structure by Site Dec 2001
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Hourly Fee Structure Dec 2001
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Financial Support Dec 2001
12
Sites by Specialty Primary Care Dec 2001
13
Sites by Specialty Subspecialties Dec 2001
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Sites 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

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Types 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

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Types 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

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CME Participation by Location Based on ACCME
Figures for 2000

• Live meetings and conferences account for 78 of
  physician-registrants
• Home study CME (enduring materials) and
  journals account for 18 of physician-registrants
• Online CME accounts for only 3.5 of
  physician-registrants

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Physician Usage of Online CME

• Physician usage of online CME is increasing, but
  still accounts for less than 4 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 191,922 physician-registrants (3.59)

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Why 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
• No easy way to search by subject

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Why 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

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Why 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

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Good examples

• Next I will show a good example of online CME of
  some of the various instruction types and for
  some primary care specialties.
• These examples are not necessarily the best of
  each type they were chosen to be illustrative.

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Text-and-Graphics

• Physicians Assistant Journal
• Lower Extremity Rotational Disorders in Children
• Main page tells you everything you need to know
  to decide whether you want to read it
• Hours of credit, price, expiration date, sponsor

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Lower Extremity Rotational Disorders in Children
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Learning Objectives

• Objectives After reading the article, the reader
  should be able to1. describe the conditions
  that cause toeing in and toeing out in
  children2. evaluate the conditions that cause
  toeing in and toeing out in children3. educate
  parents about the conditions that cause toeing in
  and toeing out in children.

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Abstract

• Lower extremity rotational deformities are common
  among pediatric patients, and clinicians who care
  for children are likely to encounter them. The 4
  torsional deformities that affect the lower
  extremityexternal tibial torsion, external
  femoral torsion, internal tibial torsion, and
  internal femoral torsionpresent as toeing in or
  toeing out. The majority of these deformities
  spontaneously normalize over time without
  long-term sequelae. However, primary care
  clinicians need a general understanding of these
  deformities to accurately differentiate between
  pathologic and physiologic conditions.

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CME Quiz
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Slide-and-Text Serono Multiple Sclerosis
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Slide-and-Text Serono Multiple Sclerosis

• Note that you see the authors slides and the
  complete transcript of the speakers words, but
  there is no audio

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Slide-Audio Vaccine Safety

• Increasingly common
• Many lectures are recorded live
• If you visit the Vaccine Safety site, you can
  hear the sound and watch the slides advance
• You can fast forward, reverse, etc, the slides
  and the audio just like a VCR

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Vaccine Safety
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Slide-Video-Lecture

• This form of online CME is more pleasant if you
  have a high-speed connection, because the video
  can be very small or jerky and in general, you
  dont gain that much by watching the speaker walk
  around or see him forming his words. The video is
  usually in a very small portion of the screen.

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World Medical Leaders- Osteoarthritis
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Baylor College of Medicine's Online CME Courses

• A very nice set of lectures in cardiology,
  surgery, diabetes and womens health. Baylor has
  a good solution to the connection speed issue.
  According to your connection speed, you can view
  slides and text only, or add audio, or add video.
  CME credit is free. The next slide shows a screen
  shot of a lecture on osteoporosis. If you visit
  this site, you will hear the speaker, see him,
  look at his slides and see a scrolling transcript
  of his words.

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Three Question-and-Answer Sites

• If you like to challenge yourself, all of these
  sites are fun.
• Familypractice.com ABFP In-Training Exam
  Questions
• Family Medicine Review II
• eCore - The Core Content Review of Primary Care
• I will show only the first-you can visit the
  other sites later

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Familypractice.com ABFP In-Training Exam Questions

• The program presents you with multiple choice
  questions. If you answer the question correctly,
  you will have the option to view the answer
  summary and then continue on to the next
  question. If you answer incorrectly, the answer
  summary is presented for your reference and then
  you may continue on to the next question.

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Familypractice.com ABFP In-Training Exam Questions

• 1000 questions and answers start and stop
  whenever you like 25 units of CME free to
  anyone (no membership required)
• The questions are fun the answers are short but
  informative

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Familypractice.com ABFP In-Training Exam Questions

• A sample question
• A 45-year-old white male develops disabling
  tremulousness, loss of voice, and a marked sense
  of forceful and rapid heartbeat whenever he must
  speak to a large group.
• Which one of the following drugs is likely to be
  of most value in enabling him to give
  presentations at sales and stockholders'
  meetings?

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Familypractice.com ABFP In-Training Exam Questions

• Answer choices
• Buspirone (BuSpar)
• Amantadine (Symmetrel)
• Alprazolam (Xanax)
• Propranolol (Inderal)
• Desipramine (Norpramin)

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Familypractice.com ABFP In-Training Exam Questions

• Right answer Propranolol (Inderal)
• You chose Alprazolam (Xanax)
• This patient has a specific situational anxiety
  disorder called performance anxiety,
  characterized by marked and sometimes disabling
  symptoms of catecholamine excess during specific
  performance situations, such as public speaking.
  Beta blockers such as propranolol and atenolol
  block peripheral anxiety symptoms, i.e.,
  tachycardia and tremulousness, that can escalate
  subjective anxiety and impair performance.
• Drugs which are primarily psychotropics or
  antiparkinsonian agents are much less likely to
  be of value in this specific anxiety disorder,
  and may cause undesirable sedation and dry
  mouth.Ref  Kaplan HI, Sadock BJ (eds) Synopsis
  of Psychiatry, ed 8. Lippincott Williams
  Wilkins, 1998, pp 975-976.

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Guidelines

• There are thousands of guidelines for diagnosis
  and treatment, put out by various official
  organizations. Only a very few of these have been
  converted to online CME. Search
  http//www.cmelist.com/list.htmto find them.
  Usually the guideline is simply presented, and
  then you answer a few questions about the
  guideline in order to earn CME credit. I will
  show one example, from the American Psychiatric
  Association.

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Guideline- APA Alzheimers
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Case-Based Interactive Mypatient.com

• Mypatient.com is possibly the best example of CBI
  instruction.
• You can access these cases free through
  MerckMedicus
• Go there, register, then go to CEMedicus, search
  content by Content Host and choose mypatient.com

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Mypatient.com

• 109 highly interactive cases, aimed at primary
  physicians. The site helps you to assess your
  learning needs, and then suggests cases matching
  those needs in a personalized "Virtual Waiting
  Room." or you can view a catalog of all 109 cases
  (listed by chief complaint or major finding, not
  diagnosis)

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Mypatient.com Maxillary Pain
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Mypatient.com

• You progress through the case in the usual way
  from history to differential diagnosis to labs
  and tests to diagnosis to treatment plan. Each of
  these sections offers you multiple choices and
  then feedback on each of your choices. All along
  the way, you can follow links to evidence-based
  discussion of your choices.

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Skipping to Most Likely Diagnosis
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Mypatient.com Key Concepts
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Other CBI Sites

• A few other CBI sites worth visiting are
• ACP/ASIM Clinical Problem-Solving Cases
• Interactive Grand Rounds from Medsite
• Virtual Lecture Hall
• Cleveland Clinic Online Journal of Medicine

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Some Conclusions I

• The number of online CME courses and credits is
  growing rapidly
• Online CME is becoming nicer to look at, with
  more graphics, lots more audio and video, a bit
  more interactive programming

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Some Conclusions II

• The percentage of CME hours earned online is
  still only about 3.5
• Barriers to usage are still major

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Some Conclusions III

• The future lies in the integration of medical
  practice, quality assessment and user-specific
  CME
• The challenges and opportunities are great

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Summary

• We have looked at about 8 online CME sites for
  FPs
• These sites were chosen to illustrate various
  instruction types of online CME
• I hope you will want to visit some of these sites
  and take some of these courses

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Thanks for Listening

• Links to all of these sites, and about 190
  others, as well as descriptions, can be found at
  www.cmelist.com/list.htm
• Contact me at bersklar_at_netcantina.com
• Bernard Sklar MD MS