The Current Status of Online CME
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Transcript of The Current Status of Online CME
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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
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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.”
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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
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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
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CME Accreditation
• All CME is accredited by the ACCME (Accreditation Council for Continuing Medical Education)
• COPE is the optometric equivalent of ACCME
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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
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CME: Meetings
• Most CME presented at meetings is not effective in changing MD behavior.
• Peer-reviewed Journals: Often sponsored by specialty society
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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
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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
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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)
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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.
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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
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Online CME: Types of Instruction
• Text only or Text plus graphics
• Slide-audio or Slide-Video lectures
• Question/Answer
• Guideline-Based
• Non-Interactive
• Interactive
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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.
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Medicine and Behavior Text Only
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Cine-Med Asthma Presentation Text-Graphics
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Online CME: Slide-Audio Presentations
• Greater investment in time and technology
• Record speaker during lectures
• American Psychiatric Association: Choosing an Antidepressant
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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
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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)
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American Society of Clinical Oncology
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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
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Influenza Vaccine Question/Answer
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Influenza Vaccine-Incorrect Answer
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Influenza Vaccine-Correct Answer
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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.
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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
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Teenager with wheezing, Question
• What is the most likely diagnosis?
• A) Upper respiratory infection• B) Exercise-induced asthma• C) Chronic bronchitis• D) Pneumonia
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Teenager with wheezing, Correct Answer
• If you give correct answer, program says” Correct” and gives no other feedback.
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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.
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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
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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
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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
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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
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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
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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
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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
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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
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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]
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Quality Issues
• I will discuss three systems for ensuring or measuring quality:HON (Health on the Net)
Medical Matrix
Silberg and Lundberg
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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
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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
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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?
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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).
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Retinal Manifestations of Systemic Disease
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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.
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Getting the Angle on Heterophoria
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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.
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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
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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”
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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
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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.”
![Page 64: The Current Status of Online CME](https://reader031.fdocuments.us/reader031/viewer/2022012919/56813d21550346895da6e2e2/html5/thumbnails/64.jpg)
Thanks for Listening
Questions?
Comments?
Broken Links?
Please contact me.
Thanks.