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INTERNET IN PRACTICE

Introduction to Online CME

Bernard M Sklar,MD

Internet Health 2003;1:4

 

Introduction


Every physician knows that he or she must earn continuing medical education (CME) credits to maintain licensure, hospital privileges, specialty membership or membership in insurance payment plans. 


Until recently, you could earn CME credits by attending live meetings and conferences or with home-study materials such as books, audiotapes, videotapes or CD-ROMs. 
During the past few years, an exciting new form of CME has emerged: Online Continuing Medical Education (Online CME). 


What is Online CME?


Online CME is a way to earn CME credits, over the Internet, using your computer, from home or office.
Online CME has some great advantages: There is a wide variety of courses available (over 12,000 courses at this time); Online CME is available 24 hours a day, 7 days a week, from the comfort of your home or office; you can view courses at your own speed, stopping and starting as you like, going back to view or listen as often as you wish. It is extremely affordable; many courses are free or cost $5-15 per credit hour.
What do I need to get started?
You need a computer (preferably not older than 3 or 4 years), an Internet connection, speakers and a printer. You probably already have all of these, so for most doctors, you will need no additional equipment.
What are the types of instruction I may find in Online CME?
There is a wide variety of instruction types, to suit every doctor's preferences. You will find: 


* Simple Text or Text-and-graphics (like reading a textbook or journal)
* Slide-audio or slide-video lectures (like being at a lecture)
* Case-based interactive (like treating a "real" patient); you get to make choices according to the clinical presentation
* Quiz questions and answers (the program asks you a question, waits for your answer, and then gives you explanations and information based on your answer)
* Games where you gain or lose points for your answers 
* Correspondence courses (a group of doctors study material and correspond with each other by email)

Type of Instruction

Definition of Type of Instruction

Text-Only

The instruction is like a journal or book chapter. Often, the instruction is many pages long, and you may find it convenient to print the instruction and read it offline. An increasing number of sites use pdf format for their text-based instruction. "Text-only" instruction may also include a few tables.

Text and Graphics

This kind of instruction is similar to Text-Only, but in addition to text and tables, there may be charts, drawings, photographs, x-ray pictures, pathology slides and animations. Many Text and Graphics sites present the user with a "thumbnail" of the graphic; to see the full graphic, the user must click on the thumbnail.
Text-and-Audio You hear the speaker giving his presentation and you also can read or print a text summary of the lecture content.

Slides-Only (OR Slides and Text)

You view the speaker's slides, usually PowerPoint. Sometimes you can also can read a full-text transcript of the speaker's words.

Slide-Audio Lecture

This kind of course attempts to simulate attendance at a live lecture. You see the speaker's slides. You hear the speaker's words. You may also see a full-text transcript of the speaker's words. Sometimes you see "still" pictures of the speaker. Often you are able to pause the speaker or go back and listen and look at the slides again. Three common formats are RealAudio, Windows Media Player and QuickTime.

Slide-Video Lecture

Similar to slide-audio lecture, but you see video pictures of the speaker and sometimes of the content (e.g., a surgical procedure).

Guideline-Based

The main thrust of this kind of instruction is to describe and explain an evidence-based guideline or consensus statement. These instructions are usually text-based or text and graphics-based.

Question-and-
Answer

The program asks the student a question or series of questions (usually multiple choice), then gives immediate feedback about the answer and an explanation of the correct and incorrect choices with some (brief or extended) instruction about the topic. 

Case-Based Interactive

A sample or simulated "patient" is presented. The program presents a small amount of information about the patient and waits for your response. The program gives positive or negative feedback on your answers and presents some additional information or teaching points before allowing you to proceed to the next piece of information and set of questions or choices.

Correspondence

A group of students is assigned to read or view an instruction during a specific time period. Then there are synchronous or asynchronous discussions between the instructor and the students or between the students.

Game

The program is presented in game format; as you answer questions or make choices, your score goes up or down. You may compete against yourself or against other players.
Self-directed search You search the literature (Medline, textbooks, guidelines, etc) to find answers to your own questions generated by patient interaction. You receive credit for the time that you spent doing that search.


How much does Online CME cost?


Online CME is surprisingly inexpensive! There are more than 2000 credit-hours of Online CME available without charge. Another 16,000 hours cost $5 to $15 per credit-hour while a small minority of Online CME courses cost more than $15 per credit-hour.
What is required of me when I visit an online CME site?
Many doctors may fear a loss of privacy or hidden fees when visiting Internet sites. This is not the case with Online CME sites. There is almost never any fee to look at the site or the list of courses. The site will usually ask you to give some basic information about yourself and to choose a user name and password before going too far. In many cases, you can view the instruction without giving any personal information. However, to earn CME credit, you will need to tell them who you are, so they can issue your CME certificate. If there is a fee for credit, you usually pay by credit card.


"I get all the CME I need at live meetings; why should I bother doing CME on the Internet?"


Live meetings are important, and they will never be completely replaced by the Internet. But there are some distinct advantages to Online CME: Online CME is always there, waiting for you, 24 hours a day, 7 days a week, at home or at the office


* You can proceed at your own speed, going back to hear or see important points you might not have picked up the first time through
* You have the opportunity to hear lectures by experts, no matter where you or they may be located
* There are no travel costs and no costs for closing your office or finding coverage
* It is very inexpensive


"I am not very good at the computer. Is it hard to do Online CME?"


It is not at all difficult to do Online CME. If you have the most basic Internet skills, such as pointing and clicking, going forward and back in your browser, opening and closing windows and two-finger typing, you will do just fine. 


How do I find the CME courses that I want to look at?


Finding the CME courses you want to look at can be challenging when you first get started, because there are more than 200 web sites offering more than 10,000 activities and more than 19,000 credit hours. There is no single central place on the Internet which will show you exactly the instruction you want. However, here a few places to start.


Visit the Annotated List of Online CME www.cmelist.com/list.htm ,Choose your area of interest or medical specialty from the list at the top of the page; then choose from the sites or courses that interest you. 


For example, a family doctor might start from the Family Practice section http://www.cmelist.com/family_practice.htm  of the Online CME List and then go to the American Academy of Family Physicians site http://www.aafp.org/x3297.xml  or to FamilyPractice.com http://www.familypractice.com/ , a very nice site produced by the American Board of Family Practice. 


An internist could start at the Internal Medicine section http://www.cmelist.com/internal_medicine.htm  of the Online CME List, and then go to Clinical Problem Solving Cases http://cpsc.acponline.org/ , sponsored by ACP/ASIM, or to Johns Hopkins Advanced Studies in Medicine http://www.asimcme.com/htmlfiles/cme_prog.html .


A cardiologist might start at the Cardiology section http://www.cmelist.com/cardiology.htm  of the Online CME List and then go to CardioVillage (University of Virginia) http://www.cardiovillage.com/  or to Baylor University's extensive list of cardiology offerings http://www.baylorcme.org/specialty.cfm?menu_id=38. 


Other specialists will find web sites offering CME in 22 additional specialty areas, from Allergy to Urology, linked from the main page of the Online CME List http://www.cmelist.com/list.htm.  


Some other ways to find Online CME 


The Online CME List, described above, is a good way to find Online CME sites (collections of many CME courses or activities). To find specific individual CME courses (usually one to two hours in length), visit one of the sites described below. Each of these sites gives you the ability to search for individual courses by entering keywords or choosing from a list of subjects. 


Medscape
Medscape www.medscape.com  has about 150 CME courses in multiple specialties at any one time; most courses offer 1.5 free credit hours; most are text or slide-audio lectures. Registration is unobtrusive and easy. Once you have registered and chosen your medical specialty, each time you re-visit Medscape, you will automatically be taken to your specialty area. With your permission, Medscape will send you periodic emails about CME courses that may interest you.
Doctor's Guide


Doctor's Guide www.dcoguide.com  offers descriptions of, and links to, about 1000 online CME courses. These courses you find are not produced by Doctor's Guide, but Doctor's Guide gives you enough information to help you decide whether to visit the course. When you visit the linked course, you may have to register again, and if the instruction is not free, you will have to pay for credit. As with Medscape, you can set up a home page for your specialty and receive emails about courses of interest.


CE Medicus
CE Medicus http://www.cemedicus.com/  offers access and free CME credit to about 450 online CME activities created by six CME providers. Once you register at CE Medicus, all courses are free and no additional registration is needed. CE Medicus will also keep track of all your CME requirements and all your CME activities if you wish.


What do I do now?


Follow the links to any of the Online CME sites described or to your specialty society's home page or to any online CME site you may have heard about. I'm sure you will find it an interesting and informative experience.

 

  
  Bernard Sklar ,MD, is a Medical Informatician by profession. He has a good track record in research and software development.He is the creator of PAIGE software. His Masters thesis was on Online CMEs.He is the creator of CMEList http://www.cmelist.com, regarded as the largest annotated list of CME websites.

 

E-Mail: Bersklar@netcantina.com
Address:
Bernard M. Sklar, M.D., M.S.
1133 Amador Avenue
Berkeley, CA 94707
510-526-4018

 

 
This article reviewed by Vinod Scaria  and accepted for publication on April 1 2003.Free reprinting and archival in any media permitted provided the original source and a hyperlink to the article URL maintained  

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