online cme – an update

Online CME – An UpdateOnline CME – An Update

Review of December 2002Review of December 2002

Bernard M. Sklar, M.D., M.S.Bernard M. Sklar, M.D., M.S.

www.cmelist.com/list.htmwww.cmelist.com/list.htm

[email protected]@netcantina.com

Plan of PresentationPlan of Presentation

Results of Recent and Past SurveysResults of Recent and Past Surveys

Types of InstructionTypes of Instruction

Physician Use of CME and Online CMEPhysician Use of CME and Online CME

Obstacles to Physician UseObstacles to Physician Use

Master’s ThesisMaster’s Thesis

This review is based on a recent update of the This review is based on a recent update of the database that I created for my master’s thesis, database that I created for my master’s thesis, The Current Status of Online Continuing Medical The Current Status of Online Continuing Medical Education (June 2000). Find the thesis online at Education (June 2000). Find the thesis online at http://http://www.cmelist.com/mastersthesiswww.cmelist.com/mastersthesis

The thesis was based on a review of the CME The thesis was based on a review of the CME literature and a survey of online CME done in literature and a survey of online CME done in February 2000.February 2000.

How Was the Survey Done?How Was the Survey Done?

Internet search of multiple search engines Internet search of multiple search engines using search string “online + continuing + using search string “online + continuing + medical +education”medical +education”

Following up leads from those searchesFollowing up leads from those searches

Information from ACCMEInformation from ACCME

Email from viewers and CME providersEmail from viewers and CME providers

Description of the ListDescription of the List

Each entry shows the name and URL of Each entry shows the name and URL of the site, when I last visited, how many the site, when I last visited, how many credit hours are available, who awards the credit hours are available, who awards the credit, the cost per unit, when the credit, the cost per unit, when the educational material was last updated, a educational material was last updated, a description of the site and its contents and description of the site and its contents and links to individual courses found at the links to individual courses found at the site.site.

Extensive UpdatesExtensive Updates

I have been maintaining the list for about I have been maintaining the list for about six yearssix years

The list was updated for my master’s The list was updated for my master’s thesis in February 2000, again in August thesis in February 2000, again in August and December 2000, in December 2001, and December 2000, in December 2001, in June 2002 and December 2002.in June 2002 and December 2002.

Annotated List of Online CME SitesAnnotated List of Online CME Sites

Database Created from ListDatabase Created from List

Based on examining each site, I created Based on examining each site, I created an Access database of the 229* sites an Access database of the 229* sites offering CME in December 2002. The DB offering CME in December 2002. The DB contains the number of activities, number contains the number of activities, number of hours of instruction, types of instruction, of hours of instruction, types of instruction, specialty audiences, cost to users, specialty audiences, cost to users, sources of financial support and other sources of financial support and other parameters.parameters.

Results of Study IResults of Study I

The number of sites and activities The number of sites and activities continues to increasecontinues to increase

April 1997 – 13 sitesApril 1997 – 13 sites

December 1997 – 18 sitesDecember 1997 – 18 sites

August 1998 – 61 sitesAugust 1998 – 61 sites

May 1999 – 69 sitesMay 1999 – 69 sites

December 1999 – 87 sitesDecember 1999 – 87 sites

Results of Study IIResults of Study II

February 2000 February 2000 96 sites, 96 sites, 1874 1874 activitiesactivities, 3064 credit hours , 3064 credit hours

August 2000August 2000 135 sites, 3659 135 sites, 3659 activitiesactivities, 5659 credit hours, 5659 credit hours

December 2000December 2000 150 sites, 3510 150 sites, 3510 activitiesactivities, 6553 credit hours, 6553 credit hours Because of overlap, duplication, and Because of overlap, duplication, and

miscounting , the “true number” of hours miscounting , the “true number” of hours should have been about 5500.should have been about 5500.

Results of Study IIIResults of Study III

December 2001December 2001

197 sites197 sites

12026 activities12026 activities

17523 hours17523 hours

Results of Study IVResults of Study IV

• June 2002

• 209 sites

• 10952 activities

• 18266 hours

Results of Study VResults of Study V

• December 2002

• 229* sites (200 sites for certain counting purposes)

• 11485 activities

• 19105 hours

Size of Sites – December 2000Size of Sites – December 2000

No. of Credit-No. of Credit-HoursHours

Number of Number of SitesSites

Number Number of Hoursof Hours

% of % of SitesSites

% 0f % 0f HoursHours

Greater than 100Greater than 100 66 40824082 44 6262

50-9950-99 1212 779779 88 1212

25-4925-49 2121 717717 1414 1111

10-2410-24 4141 681681 2727 1010

5-95-9 2929 193193 1919 33

< 5< 5 4141 100100 2727 22

TotalTotal 150150 65536553 100100 100100








50-9950-99 99 596596 55 33

25-4925-49 2929 10461046 1515 66

10-2410-24 5656 918918 2828 55

5-95-9 3838 271271 1919 22

< 5< 5 5151 103103 2626 11

TotalTotal 197197 1826618266 100100 100100

Size of Sites – June 2002Size of Sites – June 2002No. of Credit-No. of Credit-HoursHours






50-9950-99 1616 11191119 88 66

25-4925-49 3131 11371137 1515 66

10-2410-24 6262 10361036 3030 66

5-95-9 3333 227227 1616 11

< 5< 5 5454 129129 2626 <1<1

TotalTotal 209209 1826318263 100100 100100




Number of Number of HoursHours




50-9950-99 1818 12531253 99 77

25-4925-49 3535 12301230 1717 66

10-2410-24 4646 785785 2323 44

5-95-9 3939 304304 2020 22

< 5< 5 4646 125125 2323 <1<1

TotalTotal 200200 1910519105 100100 100100

The Largest Sites December 2000The Largest Sites December 2000

Name of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours

HealthStream*HealthStream* 907907 13601360

ChallengerChallenger 77 901901

CMEWebCMEWeb 507507 759759

Medscape**Medscape** 539539 726726

ArcMesaArcMesa 6363 232232

Milliman/Robertson***Milliman/Robertson*** 66 104104

The Largest Sites December 2001The Largest Sites December 2001


eMedicine CMEeMedicine CME 65006500 1000010000

CMEWebCMEWeb 976976 14001400


cmecourses (HS)cmecourses (HS) 300300 500500

WEBMD Just in TimeWEBMD Just in Time 14001400 350350

Medscape CMEMedscape CME 200200 300300


The Largest Sites June 2002The Largest Sites June 2002


eMedicine CME*eMedicine CME* 65006500 1000010000

CMEWeb*CMEWeb* 976976 14001400


TheAnswer.com*TheAnswer.com* 55 300300

cmecourses (HS)*cmecourses (HS)* 300300 500500

JournalBytes (All Spec)JournalBytes (All Spec) 108108 372372

Medscape CME*Medscape CME* 200200 300300


Radcourses (HS)Radcourses (HS) 2828 128128

RSNA Educ. ExhibitsRSNA Educ. Exhibits 127127 127127

Natal UNatal U 8383 122122

Mypatient.comMypatient.com 109109 109109

The Largest Sites December 2002The Largest Sites December 2002Name of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours

eMedicine CME*eMedicine CME* 65006500 1000010000

CMEWeb*CMEWeb* 10261026 15431543

Challenger*Challenger* 2020 10001000

JournalBytes (All Spec)JournalBytes (All Spec) 108108 348348

TheAnswer.com*TheAnswer.com* 55 300300

Natal U^Natal U^ 200200 300300

Medscape CME*Medscape CME* 200200 300300


Cleveland Clinic All SitesCleveland Clinic All Sites 171171 284284

RSNA All SitesRSNA All Sites 275275 268268

Cyberounds*Cyberounds* 143143 143143

NEJM Weekly CME*NEJM Weekly CME* 140140 140140

American Acad FP All SitesAmerican Acad FP All Sites 4747 135135

Radcourses (HS)Radcourses (HS) 2828 128128

MCP Hahnemann All SitesMCP Hahnemann All Sites 7878 122122

Cmecourses (Healthstream)*Cmecourses (Healthstream)* 5050 100100

Fee Structure by Site Dec 2000Fee Structure by Site Dec 2000Dominant or Average FeeDominant or Average Fee Number of SitesNumber of Sites % of Sites% of Sites

FreeFree 7474 4949

<$5 per hour<$5 per hour 22 11

$5 per hour$5 per hour 66 44

$6-9 per hour$6-9 per hour 1616 1111


$11-14 per hour$11-14 per hour 66 44


$16-19 per hour$16-19 per hour 55 33


$21-24 per hour$21-24 per hour 22 11


>$25 per hour>$25 per hour 44 33

Fee Structure by Site Dec 2001Fee Structure by Site Dec 2001Dominant or Average FeeDominant or Average Fee No. of SitesNo. of Sites % of Sites% of Sites

FreeFree 9898 5050



$6-9 per hour$6-9 per hour 1313 77


$11-14 per hour$11-14 per hour 99 55


$16-19 per hour$16-19 per hour 33 22


$21-24 per hour$21-24 per hour 22 11



Fee Structure by Site June 2002Fee Structure by Site June 2002Dominant or Average FeeDominant or Average Fee No. of SitesNo. of Sites % of Sites% of Sites

FreeFree 105105 5050





$11-14 per hour$11-14 per hour 88 44


$16-19 per hour$16-19 per hour 44 11


$21-24 per hour$21-24 per hour 11 <1<1



Fee Structure by Site December 2002Fee Structure by Site December 2002Dominant or Average FeeDominant or Average Fee Number of SitesNumber of Sites % of Sites% of Sites

FreeFree 122122 5353





$11-14 per hour$11-14 per hour 99 44


$16-19 per hour$16-19 per hour 55 22


$21-24 per hour$21-24 per hour 11 <1<1



Hourly Fee Structure Dec 2000Hourly Fee Structure Dec 2000Dominant or Average FeeDominant or Average Fee No of HoursNo of Hours % of Hours% of Hours

FreeFree 15871587 2424



$6-9 per hour$6-9 per hour 11831183 1818

$10 per hour$10 per hour 10501050 1616

$11-14 per hour$11-14 per hour 524524 88

$15 per hour$15 per hour 15051505 2323

$16-19 per hour$16-19 per hour 170170 33


$21-24 per hour$21-24 per hour 1818 00



Hourly Fee Structure Dec 2001Hourly Fee Structure Dec 2001Dominant or Average FeeDominant or Average Fee No of HoursNo of Hours % of Hours% of Hours

FreeFree 19781978 1111


$5 per hour$5 per hour 1028510285 5959

$6-9 per hour$6-9 per hour 17121712 1010

$10 per hour$10 per hour 14471447 88

$11-14 per hour$11-14 per hour 470470 33


$16-19 per hour$16-19 per hour 5555 <1<1

$20 per hour$20 per hour 8787 <1<1

$21-24 per hour$21-24 per hour 99 <1<1


>$25 per hour>$25 per hour 155155 11

Hourly Fee Structure June 2002Hourly Fee Structure June 2002Dominant or Average FeeDominant or Average Fee No of HoursNo of Hours % of Hours% of Hours

FreeFree 17631763 1010


$5 per hour$5 per hour 1020310203 5656

$6-9 per hour$6-9 per hour 21532153 1212

$10 per hour$10 per hour 16431643 99

$11-14 per hour$11-14 per hour 434434 22

$15 per hour$15 per hour 10091009 55

$16-19 per hour$16-19 per hour 137137 11


$21-24 per hour$21-24 per hour 77 <1<1

$25 per hour$25 per hour 115115 <1<1

>$25 per hour>$25 per hour 177177 11

Hourly Fee Structure December 2002Hourly Fee Structure December 2002Dominant or Average FeeDominant or Average Fee No of HoursNo of Hours % of Hours% of Hours

FreeFree 22362236 1212


$5 per hour$5 per hour 1021710217 5454

$6-9 per hour$6-9 per hour 23652365 1212


$11-14 per hour$11-14 per hour 450450 22

$15 per hour$15 per hour 18931893 1010

$16-19 per hour$16-19 per hour 189189 11


$21-24 per hour$21-24 per hour 77 <1<1


>$25 per hour>$25 per hour 190190 11

Financial Support Dec 2000Financial Support Dec 2000

Source of SupportSource of Support No. of SitesNo. of Sites % of Sites% of Sites

Commercial CompaniesCommercial Companies 4343 3232

University/Medical SchoolUniversity/Medical School 5454 4040

GovernmentGovernment 77 55

Medical/Specialty AssociationMedical/Specialty Association 1313 1010

FoundationFoundation 77 55

Insurance or Managed CareInsurance or Managed Care 44 33

User Fees/Partial or CompleteUser Fees/Partial or Complete 7676 5151

Financial Support Dec 2001Financial Support Dec 2001







Insurance or Managed CareInsurance or Managed Care 55 33


Financial Support June 2002Financial Support June 2002








Financial Support December 2002Financial Support December 2002








Specialty – Primary Care December 2000Specialty – Primary Care December 2000

No. of SitesNo. of Sites % of Sites% of Sites

Primary Care SitesPrimary Care Sites 9393 6262

including:including:

Family PracticeFamily Practice 8383 5555

Internal MedicineInternal Medicine 8080 5353

PediatricsPediatrics 2222 1515

Obstetrics/GynecologyObstetrics/Gynecology 2222 1515

Specialty – Primary Care Dec 2001Specialty – Primary Care Dec 2001








Multiple SpecialtiesMultiple Specialties 66 33

Specialty – Primary Care June 2002Specialty – Primary Care June 2002








Multiple Specialties (>6)Multiple Specialties (>6) 1010 55

Specialty – Primary Care DecemberSpecialty – Primary Care December 2002 2002








Multiple Specialties (>6)Multiple Specialties (>6) 1010 44

Subspecialties Dec 2000Subspecialties Dec 2000

Subspecialty sitesSubspecialty sites Number of SitesNumber of Sites % of Sites% of Sites

including:including: 113113 7575

NeurologyNeurology 2121 1414

PsychiatryPsychiatry 2323 1515

CardiologyCardiology 2020 1313

OncologyOncology 1313 99

Infectious DiseaseInfectious Disease 1313 99

Radiology*Radiology* 1010 77

DermatologyDermatology 77 55

GastroenterologyGastroenterology 77 55

PulmonaryPulmonary 99 66

SurgerySurgery 77 55

General InterestGeneral Interest 2626 1717

Subspecialties Dec 2001Subspecialties Dec 2001


including:including: 140140 7171






RadiologyRadiology 1212 66

GeriatricsGeriatrics 1212 66



General InterestGeneral Interest 2626 1717

Subspecialties June 2002Subspecialties June 2002


123123 5959








UrologyUrology 1111 55

EndocrineEndocrine 1010 55




Subspecialties December 2002Subspecialties December 2002









UrologyUrology 77 33

EndocrineEndocrine 1010 44




Sites by Specialty-2001- OtherSites by Specialty-2001- Other

26 sites (13%) offer subjects of interest to many 26 sites (13%) offer subjects of interest to many different specialties; for example, ethics, legal, different specialties; for example, ethics, legal, practice management, genetics, and basic sciencepractice management, genetics, and basic science

Many other specialties were included at 5 or fewer Many other specialties were included at 5 or fewer sitessites

Sites by Specialty-June 2002- OtherSites by Specialty-June 2002- Other

33 sites (16%) offer subjects of interest to many different 33 sites (16%) offer subjects of interest to many different specialties: for example, ethics, legal, practice management, specialties: for example, ethics, legal, practice management, risk management, tobacco cessation, genetics, basic sciencerisk management, tobacco cessation, genetics, basic science

Many other specialties are included at 5 or fewer sitesMany other specialties are included at 5 or fewer sites

Sites by Specialty-December 2002- OtherSites by Specialty-December 2002- Other

36 sites (16%) offer subjects of interest to many different 36 sites (16%) offer subjects of interest to many different specialties: for example, ethics, legal, practice management, specialties: for example, ethics, legal, practice management, risk management, tobacco cessation, genetics, basic sciencerisk management, tobacco cessation, genetics, basic science

Many other specialties are included at 5 or fewer sitesMany other specialties are included at 5 or fewer sites

Five “Different” Sites IFive “Different” Sites ICE CE MedicusMedicus has no CME of its own, but offers access has no CME of its own, but offers access without fee to about 550 activities at five sites (apparently without fee to about 550 activities at five sites (apparently by special arrangement)by special arrangement)

DigiscriptDigiscript contains many hundreds of audio and video slide contains many hundreds of audio and video slide lectures recorded at medical meetings. The yearly charge is lectures recorded at medical meetings. The yearly charge is $400. Some$400. Some activities offer CME and others do not. The site activities offer CME and others do not. The site is searchable by medical topic and by sponsoring is searchable by medical topic and by sponsoring organization. You may have to pay an additional fee for organization. You may have to pay an additional fee for CME credit by any given sponsor.CME credit by any given sponsor.

Doctor’s Guide Doctor’s Guide also has no CME of its own, but offers also has no CME of its own, but offers descriptions of over 900 activities (free and fee) with links descriptions of over 900 activities (free and fee) with links to those coursesto those courses

Five “Different” Sites IIFive “Different” Sites II

•University of Wisconsin Professional Courses offer credit for courses on non-medical subjects which could be expected to improve your practice or your life.

•Stanford SKOLAR offers credit for performing Internet literature searches on topics of your own interest

Sites I Could Not ViewSites I Could Not View

There are a number of proprietary sites, e.g., staff model HMOs, There are a number of proprietary sites, e.g., staff model HMOs, like Kaiser-Permanente, where access to instruction is limited like Kaiser-Permanente, where access to instruction is limited to staff members of that organization. Those sites are not to staff members of that organization. Those sites are not reviewed in this report.reviewed in this report.

Email Reminders June 2002Email Reminders June 2002

About 25 sites send out regular email reminders About 25 sites send out regular email reminders about additions to their lists of activities on about additions to their lists of activities on request by users: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

Email Reminders December 2002Email Reminders December 2002

About 24 sites send out regular email reminders About 24 sites send out regular email reminders about additions to their lists of activities on about additions to their lists of activities on request by users: Audio Digest, Boston request by users: Audio Digest, Boston University, cmecorner, cmecourses, University, cmecorner, cmecourses, CMEcybersessions, Cyberounds, Doctor’s Guide, CMEcybersessions, Cyberounds, Doctor’s Guide, eMedHome.com, eMedicine, GAMA Longevity, eMedHome.com, eMedicine, GAMA Longevity, Medsite, Journal of Clinical Psychiatry, Medsite, Journal of Clinical Psychiatry, Medinfosource, Medscape, Meniscus, MMWR, Medinfosource, Medscape, Meniscus, MMWR, mypatient.com, Natal U, pedsref, psychLINK, mypatient.com, Natal U, pedsref, psychLINK, Serono, University of Wisconsin, Virtual Lecture Serono, University of Wisconsin, Virtual Lecture Hall, World Medical LeadersHall, World Medical Leaders

Types of Instruction-DefinitionsTypes of Instruction-Definitions

Text-OnlyText-OnlyText-and-GraphicsText-and-GraphicsSlides-Only (or Slides and Text)Slides-Only (or Slides and Text)Slide-AudioSlide-AudioSlide-VideoSlide-VideoQuestion-and-AnswerQuestion-and-AnswerCase-Based InteractiveCase-Based InteractiveGuideline or Consensus (usually text only)Guideline or Consensus (usually text only)CorrespondenceCorrespondenceGamesGamesJournal with Multiple TopicsJournal with Multiple Topics

Types of Instruction – Dec 2000Types of Instruction – Dec 2000

Text only -- 37 sites; 25%Text only -- 37 sites; 25%

Text-and-graphics – 45 sites; 30 %Text-and-graphics – 45 sites; 30 %

Slide-audio – 45 sites; 30 %Slide-audio – 45 sites; 30 %

Slide-video – 21 sites; 14 %Slide-video – 21 sites; 14 %

Guidelines – 5 sites; 3 %Guidelines – 5 sites; 3 %

Question-and-answer – 6 sites; 4 %Question-and-answer – 6 sites; 4 %

Case-based Interactive – 27 sites; 18 %Case-based Interactive – 27 sites; 18 %

Many sites have more than one type of instructionMany sites have more than one type of instruction

Types of Instruction – Dec 2001Types of Instruction – Dec 2001

Text only -- 47 sites; 24%Text only -- 47 sites; 24%Text-and-graphics – 59 sites; 30 %Text-and-graphics – 59 sites; 30 %Slide-audio – 57 sites; 29 %Slide-audio – 57 sites; 29 %Slide-video – 21 sites; 11%Slide-video – 21 sites; 11%Guidelines – 5 sites; 3 %Guidelines – 5 sites; 3 %Question-and-answer – 9 sites; 5 %Question-and-answer – 9 sites; 5 %Case-Based-Interactive – 26 sites; 13 %Case-Based-Interactive – 26 sites; 13 %Correspondence – 3 sites; 2 %Correspondence – 3 sites; 2 %Games – 2 sites; 1 %Games – 2 sites; 1 %Slides-Only – 4 sites; 2 %Slides-Only – 4 sites; 2 %Many sites have more than one type of instructionMany sites have more than one type of instruction

Types of Instruction – June 2002Types of Instruction – June 2002

Text only -- 57 sites; 27%Text only -- 57 sites; 27%Text-and-graphics – 71 sites; 34 %Text-and-graphics – 71 sites; 34 %Slide-audio – 60 sites; 29 %Slide-audio – 60 sites; 29 %Slide-video – 23 sites; 11%Slide-video – 23 sites; 11%Guidelines – 8 sites; 3 %Guidelines – 8 sites; 3 %Question-and-answer – 6 sites; 3 %Question-and-answer – 6 sites; 3 %Case-Based-Interactive – 31 sites; 15 %Case-Based-Interactive – 31 sites; 15 %Correspondence – 2 sites; 2 %Correspondence – 2 sites; 2 %Games – 2 sites; 1 %Games – 2 sites; 1 %Slides-Only – 4 sites; 2 %Slides-Only – 4 sites; 2 %Slides-and-Text – 4 sites; 2 %Slides-and-Text – 4 sites; 2 %


Types of Instruction – December 2002Types of Instruction – December 2002

Text only -- 62 sites; 27%Text only -- 62 sites; 27%Text-and-graphics – 70 sites; 31 %Text-and-graphics – 70 sites; 31 %Slide-audio – 66 sites; 29 %Slide-audio – 66 sites; 29 %Slide-video – 27 sites; 12%Slide-video – 27 sites; 12%Guidelines – 8 sites; 3 %Guidelines – 8 sites; 3 %Question-and-answer – 7 sites; 3 %Question-and-answer – 7 sites; 3 %Case-Based-Interactive – 41 sites; 18 %Case-Based-Interactive – 41 sites; 18 %Correspondence – 5 sites; 2 %Correspondence – 5 sites; 2 %Games – 2 sites; 1 %Games – 2 sites; 1 %Slides-Only – 5 sites; 2 %Slides-Only – 5 sites; 2 %Slides-and-Text – 6 sites; 3 %Slides-and-Text – 6 sites; 3 %Journal with Multiple Subjects – 19 sites; 8%Journal with Multiple Subjects – 19 sites; 8%


More about Question & Answer InstructionMore about Question & Answer Instruction

Only 6 sites (3%) feature Q&A, BUT the number of Only 6 sites (3%) feature Q&A, BUT the number of hours is relatively largehours is relatively largeChallenger - 1000 hoursChallenger - 1000 hoursTheAnswerPage – 300 hoursTheAnswerPage – 300 hoursEcore – 36 hoursEcore – 36 hoursFamilypractice.com - 27 hoursFamilypractice.com - 27 hoursInteractive Testing in Psychiatry – 7 hoursInteractive Testing in Psychiatry – 7 hoursFamily Practice Image Quiz – 3hoursFamily Practice Image Quiz – 3hours

Total about 1373 hours (7 % of all CME hours)Total about 1373 hours (7 % of all CME hours)

CME Participation by Location Based on CME Participation by Location Based on ACCME Figures for 2001ACCME Figures for 2001

Live meetings and conferences account for 76% of Live meetings and conferences account for 76% of “physician-registrants”“physician-registrants”

Home study CME (“enduring materials”) and Home study CME (“enduring materials”) and journals account for 19.6% of physician-registrantsjournals account for 19.6% of physician-registrants

Online CME accounts for only 4.4% of physician-Online CME accounts for only 4.4% of physician-registrantsregistrants

Physician Usage of Online CMEPhysician Usage of Online CME

Physician usage of online CME is increasing, but Physician usage of online CME is increasing, but still accounts for less than 5% of all CME still accounts for less than 5% of all CME

According to ACCME:According to ACCME:

1997: 1997: 13,115 physician-registrants (0.34%)13,115 physician-registrants (0.34%)

1998: 37,879 physician-registrants (1.03%)1998: 37,879 physician-registrants (1.03%)




Changes and Trends IChanges and Trends I

There is a gradual upward trend in the numbers There is a gradual upward trend in the numbers of sites, courses and hours (about 9% over the of sites, courses and hours (about 9% over the past year)past year)

Some of that upward trend is “new”; some is Some of that upward trend is “new”; some is accounted for by counting sites not previously accounted for by counting sites not previously foundfound

There has been very little change in the pricing of There has been very little change in the pricing of credits, the specialty groups targeted, types of credits, the specialty groups targeted, types of instruction or the sources of financial support.instruction or the sources of financial support.

Changes and Trends IIChanges and Trends II

Number of physician-registrants for online CME Number of physician-registrants for online CME went up from went up from 181,922 (3.57%) to 230,055 (4.44%)181,922 (3.57%) to 230,055 (4.44%)

Glass half full or half empty?Glass half full or half empty?

Why is Online CME use So Low? IWhy is Online CME use So Low? I

Some physicians are still uneasy with computers Some physicians are still uneasy with computers and the Internet (but rapidly improving)*and the Internet (but rapidly improving)*Many physicians are unaware of online CME or don’t Many physicians are unaware of online CME or don’t know how to find itknow how to find itMuch live CME, especially at the hospital, is Much live CME, especially at the hospital, is convenient, free and offers collegial interactionconvenient, free and offers collegial interaction

Why is Online CME Use So Low? IIWhy is Online CME Use So Low? II

A series of “gates” for the user to pass throughA series of “gates” for the user to pass through

Navigation; Download and install plug-insNavigation; Download and install plug-ins

Registration hassleRegistration hassle

Fear of giving out license, DEA, credit cardFear of giving out license, DEA, credit card

Paying in advance for content you can’t viewPaying in advance for content you can’t view

Get content free, leave without payingGet content free, leave without paying

Each site has a different procedure and passwordEach site has a different procedure and password

Why Choose One Online CME Site Over Why Choose One Online CME Site Over Another?Another?

PricePrice

Preference for Type of InstructionPreference for Type of Instruction

Email remindersEmail reminders

Part of larger medical sitePart of larger medical site

Help with CME reportingHelp with CME reporting

Recommendation by colleagues, medical groupRecommendation by colleagues, medical group

Special arrangements with physician groupSpecial arrangements with physician group

A Long Term SolutionA Long Term Solution

Eventually, CME will be totally integrated with the Eventually, CME will be totally integrated with the physician’s daily practice lifephysician’s daily practice lifeSystems will be developed which allow a computer Systems will be developed which allow a computer program to “know” when a physician is making a program to “know” when a physician is making a mistake or needs additional informationmistake or needs additional informationThe system will present instruction on the spot to The system will present instruction on the spot to help the physician do the right thinghelp the physician do the right thing

Other Problems to SolveOther Problems to Solve

Another problem will be to prove that a given CME Another problem will be to prove that a given CME activity actually improves physician performance.activity actually improves physician performance.

For now, CME providers and evaluating groups will For now, CME providers and evaluating groups will need to settle for some lesser measure, such as the need to settle for some lesser measure, such as the difference in scores between pre-tests and post-difference in scores between pre-tests and post-tests, or statements by “experts” that the course will tests, or statements by “experts” that the course will correct the deficiency.correct the deficiency.

Opportunities for ResearchOpportunities for Research

More sophisticated (and expensive) methods of More sophisticated (and expensive) methods of evaluation exist, such as reviewing physician charts evaluation exist, such as reviewing physician charts or interviewing patientsor interviewing patients

This is a great opportunity for research. There is This is a great opportunity for research. There is grant money available for research into effective grant money available for research into effective CME.CME.

Conclusions IConclusions I

The number of online CME activities and credits is The number of online CME activities and credits is growing rapidly (but not so rapidly as in the previous growing rapidly (but not so rapidly as in the previous periods)periods)

Online CME is becoming nicer to look at, with more Online CME is becoming nicer to look at, with more graphics, lots more audio and video, and a bit more graphics, lots more audio and video, and a bit more interactive programminginteractive programming

Conclusions IIConclusions II

The percentage of CME hours earned online is still only The percentage of CME hours earned online is still only about 4.4%about 4.4%

Barriers to usage are still majorBarriers to usage are still major

Almost no proof that any kind of standalone CME, Almost no proof that any kind of standalone CME, whether live, home study or online, and regardless of whether live, home study or online, and regardless of mode of instruction, is useful in changing physician mode of instruction, is useful in changing physician practicepractice

Conclusions IIIConclusions III

The future lies in the integration of medical practice, The future lies in the integration of medical practice, quality assessment and user-specific CMEquality assessment and user-specific CME

The challenges and opportunities are greatThe challenges and opportunities are great

Important URLsImportant URLs

Master’s thesis: Master’s thesis: www.cmelist.com/mastersthesiswww.cmelist.com/mastersthesis//My home page: My home page: www.cmelist.comwww.cmelist.comOnline CME list: Online CME list: www.cmelist.com/list.htmwww.cmelist.com/list.htmDefinitions of types of online CME instruction: Definitions of types of online CME instruction: www.cmelist.com/Instruction_Types_defined.htmwww.cmelist.com/Instruction_Types_defined.htm

online cme – an update

Documents

size of sites

sites197 sites

survey of online cme

activitiesthe number

online cme obstacles

hours of instruction

online cmephysician

cme providersemail