Overview of Online CME

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Overview of Online CME

• The Seventh Annual Meeting
• of the
• Global Alliance for Medical Education
• June 23-25, 2002
• The McGill Faculty Club

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(No Transcript)
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Online CME An Update

• Review of June 2002
• Bernard M. Sklar, M.D., M.S.
• www.cmelist.com
• bersklar_at_netcantina.com

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Plan of Talk

• Results of Survey
• Types of Instruction
• Physician Use of CME and Online CME
• Obstacles to Physician Use

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Masters 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.

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How 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

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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, a description of the site and its
  contents and links to individual courses found at
  the site.

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Extensive 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.

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List of Online CME
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Database 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.

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Results 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

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Results 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.

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Results of Study III

• December 2001
• 197 sites
• 12026 activities
• 17523 hours

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Results of Study IV

• June 2002
• 209 sites
• 10952 activities
• 18266 hours

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Size of Sites December 2000
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Size of Sites December 2001
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Size of Sites June 2002
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The Largest Sites December 2000
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The Largest Sites December 2001
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The Largest Sites June 2002
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Fee Structure by Site Dec 2000
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Fee Structure by Site Dec 2001
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Fee Structure by Site June 2002
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Hourly Fee Structure Dec 2000
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Hourly Fee Structure Dec 2001
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Hourly Fee Structure June 2002
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Financial Support Dec 2000
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Financial Support Dec 2001
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Financial Support June 2002
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Sites by Specialty Primary Care Dec 2000
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Sites by Specialty Primary Care Dec 2001
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Sites by Specialty Primary Care June 2002
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Sites by Specialty Subspecialties Dec 2000
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Sites by Specialty Subspecialties Dec 2001
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Sites by Specialty Subspecialties June 2002
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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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Sites 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

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Five 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

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Five 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.

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Sites 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.

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Email 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.

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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 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

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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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Types 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

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More 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 )

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CME 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

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Physician 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)

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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

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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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A 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

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Other 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.

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Opportunities 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.

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Conclusions 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

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Conclusions 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

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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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Important 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