PROFESSIONStill loading: There's quite a ways to go for Web-based continuing medical educationOnline CME was going to be the next big thing, but reading journals on the Web is boring, and you need broadband to walk through a virtual lab. Solutions look to wed education and technology in new ways.By Myrle Croasdale, amednews staff. Oct. 14, 2002. Sheree Starrett, MD, treats HIV patients at a correctional facility in New Jersey. When it comes to continuing medical education, she gets most of hers via the Internet. "I've been doing CME online for as long as I've had access," the internist said. "It's been four or five years, maybe longer. Being in corrections and somewhat divorced from mainstream medicine, I don't have access to grand rounds or hospital functions." Dr. Starrett is the perfect audience for online CME. She's outside of the typical medical environment and doesn't have easy access to traditional CME activities. Armed with a cable modem, she avoids the delays common to those bound to phone lines. But even she isn't instantly drawn to the newer, more interactive programs that CME providers are hoping will lure more physicians to online CME. "They can be hard to maneuver," she said, with some not allowing her to pick up where she left off or forcing her to listen to the whole lecture instead of letting her navigate to the section she needs. "I get frustrated with more of the high-tech stuff," she said. "Slides and video are entertaining, but if you want to get to the meat it's easier to just read the text."
Dr. Starrett's experience may explain why physicians who, unlike her, have a bevy of opportunities for garnering CME credits have yet to embrace it online. According to the Accreditation Council for Continuing Medical Education, online CME constituted only 4.4% of credits gathered in 2001, while 76% came from meeting attendance and 19.6% from journal reading and home study. But online CME providers believe there is a way to successfully tap into technology in delivering education. Nancy Davis, PhD, director of CME at the American Academy of Family Physicians, believes quality improvement is the next frontier for CME. The AAFP is working with the American Medical Association on a pilot project to measure physician performance. "This is a Web-based self-assessment of a disease, say how to manage migraines," she said. "The physician goes through the educational intervention, which includes downloading patient education tools, work sheets and protocols to follow." The doctors get a postassignment benchmark comparing their work against themselves, others in the program and national norms. Then they're asked to report their outcomes using evidence-based guidelines, she said. Another participant in an AMA pilot is the American College of Physicians--American Society of Internal Medicine, which is using a wireless pocket personal computer linked to a central server to get information into doctors' hands as they need it. Physicians can pull out the handheld computer to find answers to questions that arise while examining patients. If the issue is complex, the computer will establish a route to do further research later.
The challenge is how to measure CME credit so it includes the process of looking for information and then applying it. One option is combining the amount of time spent on the computer with outcomes or demonstrated learning. Other AMA pilots give physicians access to database search engines in their office. The eScholar version, developed by Stanford University, includes e-mail feedback with Stanford faculty. Dennis Wentz, MD, director of the AMA's continuing physician professional development group, said such trials are the road to successful future online CME endeavors. "Information when you need it. That's the holy grail of CME," he said. "You use it and remember it forever." Until then, physicians can expect CME, whether it's online or not, to be easier to digest and more applicable to clinical practice. Some surfing going onHerbert Waxman, MD, senior vice president for education at the ACP-ASIM, believes CME of all types will shift from delivering a broad range of information to delivering highly focused presentations. "We've found physicians have a greater interest in chunks of information, not in the fact that they have access to 20,000 pages of content," he said. "They just want what they want, when they want it. I think everybody in this business is making a similar observation. Physicians want more digestible format -- focused, brief presentations from an expert on the topic." For CME offered by ACP-ASIM, that means lectures where the speaker answers four to five questions based on clinical situations, with just 15 minutes spent on each answer. This format has drawn more than 2,000 physicians per event during major meetings. The ACP-ASIM intends to take what it's learned in updating traditional CME and apply it to online CME. "We're still putting resources into electronic [CME] products," Dr. Waxman said. "We don't want to risk missing the boat, but the boat hasn't left the dock yet." That's not because physicians aren't using the Internet. They just haven't made the leap from e-mail and surfing for information to getting CME credits on the Web. A recent AMA study showed 78% of physicians in 2001 used the Web, up from 70% in 2000. Physicians said they used it to access medical and pharmaceutical information, communicate with professional associations and create Web sites. Looking at CME material also made the list, though while 64% of those who go online said they look at CME, it appears few actually take it for credit. (Only 4.4% of CME credits are from online activities.) CME providers are banking on the rise in computer use by physicians to eventually translate into more activity in online CME, despite the fact that most physicians who use online CME now do so only when they find themselves needing to meet their quota ahead of a licensing deadline. Teaching institutions and medical societies have been the traditional suppliers of CME, but commercial support is growing for online endeavors. According to Bernard Sklar, MD, a Berkeley, Calif., family physician who has been tracking online CME since the mid- 1990s, 54% of CME Web sites were sponsored by commercial firms as of June 2002, compared with 32% in December 2000. Dr. Sklar recorded 150 CME sites in December 2000 offering 3,510 activities for 5,500 credit hours of CME. By June 2002 this had grown to 209 sites, 10,952 activities and 18,263 credit hours. While much of the content is electronic versions of printed articles, Dr. Sklar said more multimedia programs are being offered, and their quality is rapidly improving. "They're really getting better in terms of audio, video and attention to detail," he said. "Some are almost on the order of a TV or movie production." Besides the need for more engaging courses online, the time it takes to find relevant CME may also explain why doctors aren't logging on. "We suspect part of the reason doctors aren't using online CME is that it's difficult to know where to go find a particular course on a particular topic," Dr. Sklar said. A database of 2,000 courses he has compiled, which can be searched by topic, but requires registration, is available online (http://www.professionallearningcenter.com/). Even if online CME does live up to past predictions, printed materials are unlikely to be replaced anytime soon. Dr. Waxman said when it comes to reading an article, sitting and scrolling pages in front of a computer just doesn't cut it. "We've been surprised that the print versions of educational programs are outselling the electronic versions 20 to 1, and that's been true over a period of five or six years," he said. "There's still a real attractive aspect of having a booklet you can stick in your pocket and read when you have the chance. People who access education programs through the Internet use it as a bookstore and then print it out and spend time with the hard copy." ADDITIONAL INFORMATION:Slowly catching onThe number of physicians taking continuing medical education courses online has grown over the past several years but still makes up a small portion of the total number of CME registrants each year. 2001: 230,055 (4.44%)
Source: Accreditation Council for Continuing Medical Education Getting the most onlineContinuing medical education Web sites offering the largest number of credit hours EMedicine (http://cme.emedicine.com/) 10,000 hours
Source: Bernard Sklar, MD, based on data as of June WeblinkBernard Sklar's online CME presentations (http://www.cmelist.com/) Professional Learning Center, requires registration (http://www.professionallearningcenter.com/) Copyright 2002 American Medical Association. All rights reserved.
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