online cme for primary care physicians
TRANSCRIPT
Online CME for Primary Care Physicians
• Bernard M. Sklar, M.D., M.S.• www.cmelist.com• [email protected]
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
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
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.
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
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
The Largest Sites December 2001Name of Site No. of Courses No. of Hours
eMedicine CME 6500 10000CMEWeb 976 1400Challenger 10 897cmecourses 300 500WEBMD Just in Time 1400 350Medscape CME 200 300ArcMesa 80 293
Fee Structure by Site Dec 2001Dominant or Average Fee Number of Sites % of SitesFree 98 50<$5 per hour 6 3$5 per hour 6 4$6-9 per hour 13 7$10 per hour 22 11$11-14 per hour 9 5$15 per hour 19 10$16-19 per hour 3 2$20 per hour 5 3$21-24 per hour 2 1$25 per hour 10 5>$25 per hour 4 2
Hourly Fee Structure Dec 2001Dominant or Average Fee No of Hours % of HoursFree 1978 11<$5 per hour 365 8$5 per hour 10285 59$6-9 per hour 1712 10$10 per hour 1447 8$11-14 per hour 470 3$15 per hour 845 5$16-19 per hour 55 <1$20 per hour 87 <1$21-24 per hour 9 <1$25 per hour 114 1>$25 per hour 155 1
Financial Support Dec 2001
Source of Support No. of Sites % of Sites
Commercial Companies 99 50
University/Medical School 83 42
Government 11 6
Medical/Specialty Association 47 24
Foundation 17 9
Insurance or Managed Care 5 3
User Fees/Partial or Complete 99 50
Sites by Specialty – Primary Care Dec 2001
No. of Sites % of Sites
Primary Care Sites 114 58 including:Family Practice 95 48Internal Medicine 86 44Pediatrics 29 15Obstetrics/Gynecology 25 13Multiple Specialties 6 3
Sites by Specialty – Subspecialties Dec 2001Subspecialty sites Number of Sites % of Sites including: 140 71Neurology 14 7Psychiatry 21 11Cardiology 19 10Oncology 10 5Infectious Disease 14 6Radiology 12 6Geriatrics 12 6Pulmonary 9 5Surgery 6 5General Interest 26 17
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
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
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
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
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%)
Why is Online CME use So Low? I
• Many physicians still uneasy with computers and Internet
• Many physicians unaware of online CME or don’t 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
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 can’t view• Get content free, leave without paying• Each site has a different procedure and password
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
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.
Text-and-Graphics
• Physician’s Assistant Journal• Lower Extremity Rotational Disorders in C
hildren• Main page tells you everything you need to
know to decide whether you want to read it:• Hours of credit, price, expiration date,
sponsor…
Learning Objectives
• Objectives: After reading the article, the reader should be able to:1. 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.
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 extremity—external tibial torsion, external femoral torsion, internal tibial torsion, and internal femoral torsion—present 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.
CME Quiz
Slide-and-Text Serono Multiple Sclerosis
Slide-and-Text Serono Multiple Sclerosis
• Note that you see the author’s slides and the complete transcript of the speaker’s words, but there is no audio
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
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 don’t 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.
Baylor College of Medicine's Online CME Courses
• A very nice set of lectures in cardiology, surgery, diabetes and women’s 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.
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
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.
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
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?
Familypractice.com ABFP In-Training Exam Questions
• Answer choices:• Buspirone (BuSpar)• Amantadine (Symmetrel)• Alprazolam (Xanax)• Propranolol (Inderal)• Desipramine (Norpramin)
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.
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.
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
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)
Mypatient.com Maxillary Pain
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.
Skipping to “Most Likely Diagnosis”
Mypatient.com Key Concepts
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
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
Some Conclusions II
• The percentage of CME hours earned online is still only about 3.5%
• Barriers to usage are still major
Some Conclusions III
• The future lies in the integration of medical practice, quality assessment and user-specific CME
• The challenges and opportunities are great
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
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 [email protected]• Bernard Sklar MD MS