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Online CME – An Update

Online CME – An Update. Review of December 2006 Bernard M. Sklar, M.D., M.S. www.cmelist.com/list.htm bersklar@netcantina.com. Plan of Presentation. Results of Recent Surveys Types of Instruction Physician Use of CME and Online CME Obstacles to Physician Use Predictions. Master’s Thesis.

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Online CME – An Update

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  1. Online CME – An Update • Review of December 2006 • Bernard M. Sklar, M.D., M.S. • www.cmelist.com/list.htm • bersklar@netcantina.com Bernard Sklar, MD: Online Continuing Medical Education December 2006

  2. Plan of Presentation • Results of Recent Surveys • Types of Instruction • Physician Use of CME and Online CME • Obstacles to Physician Use • Predictions Bernard Sklar, MD: Online Continuing Medical Education December 2006

  3. Master’s Thesis • This review is based on the December 2006 update of the database initially created for the master’s thesis, The Current Status of Online Continuing Medical Education (June 2000). Find the thesis online at http://www.cmelist.com/mastersthesis • The June 2000 thesis was based on a review of the CME literature and a survey of online CME done in February 2000. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  4. How Was the Survey Done? • The original survey was done by searching multiple search engines using the search string “online + continuing + medical +education” • Following up leads from those searches • Information from ACCME • Email from viewers and CME providers Bernard Sklar, MD: Online Continuing Medical Education December 2006

  5. Updating the Database • For the past several years, I have relied on contacts from Online CME providers and users to add sites to my list • I add 3-4 new sites each month (and remove those sites that go offline • This year I also searched the Internet again for “online + continuing + medical + education” Bernard Sklar, MD: Online Continuing Medical Education December 2006

  6. 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, a statement about financial support, a description of the site and its contents and links to individual courses found at the site. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  7. Extensive Updates • I have been maintaining the list for about nine years, beginning in 1997 • The database was updated for my master’s thesis in February 2000, and every six months since. • From March through December 2006, I visited and updated the review of each site on the list. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  8. Database Created from List The database contains information about the 300 sites offering CME in early December 2006. This information includes the number of activities, number of hours of instruction, types of instruction, target audiences, cost to users, the name of the accrediting organization and sources of financial support. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  9. Growth of Sites, Activities and Hours I Bernard Sklar, MD: Online Continuing Medical Education December 2006

  10. Growth of Sites, Activities and Hours II Bernard Sklar, MD: Online Continuing Medical Education December 2006

  11. Explanation of calculations on next several slides • Although the number of sites is now estimated at 300, the number used for the following calculations is 286 • This method counts only those sites which offer original content and not those sites which only link to or re-package content offered elsewhere (Nothing wrong with doing that, but I don’t want to count the same activity twice) Bernard Sklar, MD: Online Continuing Medical Education December 2006

  12. Growth of large sites (offering more than 100 Credit Hours) Bernard Sklar, MD: Online Continuing Medical Education December 2006

  13. Size of Sites – December 2006 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  14. The Largest Sites Dec 2006 - I Bernard Sklar, MD: Online Continuing Medical Education December 2006

  15. The Largest Sites Dec 2006 - 2 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  16. The Largest Sites Dec 2006 - 3 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  17. Fee Structure – Free Sites • There has been a leveling off in the number of sites offering free CME – from 177 sites (70%) to 168 sites (59%) in December 2006. • There has been a similar leveling off in the number of free credit-hours – from 5075 hours (20%) in June 2005 to 5740 (21%) in December 2006. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  18. Fee Structure – Pay for Credit Sites • There has been very little change in the median fee for a credit hour. The bulk of the fee instruction (70-80%) continues to cost $5 to $15 per credit hour Bernard Sklar, MD: Online Continuing Medical Education December 2006

  19. Fee Structure by Site Dec 2006 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  20. Hourly Fee Structure Dec 2006 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  21. Financial Support Summary: There has been very little change in relative percentages of financial support since December, 2001. As the number of free sites increases, the number of fee sites decreases Bernard Sklar, MD: Online Continuing Medical Education December 2006

  22. Financial Support Dec 2006 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  23. Primary Care and Specialty Sites • Family Practice and Internal Medicine content continues to dominate the Primary Care sites (about 40% of sites). • Cardiology, Psychiatry, Infectious Disease/HIV, and Oncology content appear most frequently (about 20% of sites for each specialty). • Many sites offer instruction for more than one specialty group Bernard Sklar, MD: Online Continuing Medical Education December 2006

  24. Specialty – Primary Care Dec 2006 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  25. Subspecialties Dec 2006 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  26. Sites by Specialty-Dec 2006- Other • 36 sites (12%) offer subjects of interest to many specialists: ethics, legal, practice management, risk management, tobacco cessation, addiction, alcoholism, genetics, basic science • Many other specialties are included at 5 or fewer sites Bernard Sklar, MD: Online Continuing Medical Education December 2006

  27. Five “Different” Sites Dec 2006- I • CE Medicus has no CME of its own, but offers access without fee to about 6100 activities (about 9000 hours) produced by 20 content providers. Instruction is free. • Doctor’s Guide also has no CME of its own, but offers descriptions of over 2000 activities (free and fee) with links to those courses • Digiscript contains many hundreds of audio and video slide lectures recorded at medical meetings. The yearly charge is $400. Someactivities offer CME and others do not. The site is searchable by medical topic and by sponsoring organization. You may have to pay an additional fee for CME credit by any given sponsor. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  28. Five “Different” Sites June 2005 II • Challenger now requires subscribers to buy a CDROM for each course. Once you purchase that CD, you have unlimited access to the website corresponding to that course. Thus, it is no longer “pure” online CME; I have included the number of Challenger’s courses and hours in this report for sake of consistency. • American College of Cardiology Self-Selected CME allows subscribers to earn credits for reading parts of articles of interest. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  29. Email Reminders Dec 2006 It is becoming increasingly common for the larger sites to send email reminders on request of the users about their new courses. At least 55 sites are doing this regularly Bernard Sklar, MD: Online Continuing Medical Education December 2006

  30. Types of Instruction • There has been little recent change in the proportion of instruction types. (But see my comments about podcasts and point-of-service models below.) • Text (with or without graphics) remains the dominant mode, followed by slide-audio or slide-video lectures, case-based interactive and question-and-answer instruction. • For definitions of these and other types of online instruction, seeTypes of Online CME Instruction Defined Bernard Sklar, MD: Online Continuing Medical Education December 2006

  31. Types of Instruction Dec 2006-I Bernard Sklar, MD: Online Continuing Medical Education December 2006

  32. Types of Instruction Dec 2006-II Bernard Sklar, MD: Online Continuing Medical Education December 2006

  33. More about Question & Answer Instruction • Only 10 sites (3%) feature Q&A, BUT the number of hours is relatively large (3545) • Challenger - 2800 hours • TheAnswerPage – 300 hours • Am Acad Pediatrics Self-Assessment – 120 hours • EMedHome Concert – 105 hours • Am Acad Orthopedic Self-Assessment – 75 hours • Orthopedics Hyperguide – 50 hours • Ecore Family Practice – 40 hours • Medical Letter – 26 hours • Medical Education Opportunities – 20 hours • Interactive Testing in Psychiatry – 7 hours • Total about 3545 hours (13 % of all CME hours) Bernard Sklar, MD: Online Continuing Medical Education December 2006

  34. Sites I Could Not View • There are a number of proprietary sites, e.g., staff model HMOs, like Kaiser-Permanente, where access to instruction is limited to staff members of that organization. Those sites are not reviewed in this report. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  35. Podcasts • I only counted five sites offering podcasts, but I may have missed some sites that added podcasts after my visit • I believe that podcasting will catch on quickly because the technology is easy to apply and because most younger doctors and many older ones have I-Pods or other portable players Bernard Sklar, MD: Online Continuing Medical Education December 2006

  36. Point of Care/Self Study • I counted only three sites offering “Point of Care” CME, but I believe some have been added since my count. • I know that some providers (Skolar, MerckMedicus) have given up the effort • Time will tell; it’s a great idea, but may be too awkward to use in practice Bernard Sklar, MD: Online Continuing Medical Education December 2006

  37. Sites that have closed • About 44 sites offering about 800 credit hours disappeared between July 2005 and November 2006 • In about half the cases, this was planned because credit expired • In the other half, the site disappeared, sometimes with an explanation and sometimes without Bernard Sklar, MD: Online Continuing Medical Education December 2006

  38. CME Participation by Location Based on ACCME Figures for 2005 • Live meetings and conferences accounted for 52% of “physician-registrants” • Home study CME (“enduring materials”) and journals accounted for 30% of physician-registrants • Online CME accounted for about 18% of physician-registrants Bernard Sklar, MD: Online Continuing Medical Education December 2006

  39. Physician Usage of Online CME • Physician usage of online CME is increasing, and now accounts for about 18% 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: 181,922 physician-registrants (3.57%) • 2001: 230,055 physician-registrants (4.44%) • 2002: 329,110 physician-registrants (6.08%) • 2004: 895,120 physician-registrants (14%) • 2005: 1,368,335 physician-registrants (18%) Bernard Sklar, MD: Online Continuing Medical Education December 2006

  40. Changes and Trends I • There is a gradual upward trend in the numbers of sites, courses and hours (about 5% increase over the past 18 months) • Some of that upward trend is “new”; some is accounted for by counting sites not previously found; about 44 sites offering about 800 hours have discontinued operation • There has been a small increase in the number of free CME hours (5740 vs. 5074) over the 18 months. There has been little change in the specialty groups targeted, types of instruction or the sources of financial support. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  41. Changes and Trends II • Number of physician-registrants for online CME went up from 181,922 (3.57%) in 2000 to 230,055 (4.44%) in 2001 to 329,110 (6.08%) in 2002 to 899,390 (14%) in 2004 to 1,368,335 (18%) in 2005. • The number of physicians registering for online CME has tripled in the past three years. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  42. Why is Online CME use Still So Low? I • Pretty soon I hope to eliminate the ”Why is Online CME Use so low?” portion of this report. • My points about the “low” use of Online CME are still pertinent, BUT much less so than just a few years ago: • Some physicians are still uneasy with computers and the Internet • Some physicians are 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 • Many doctors still find attending their yearly specialty meeting satisfying and sufficient Bernard Sklar, MD: Online Continuing Medical Education December 2006

  43. Why is Online CME Use Still So Low? II • These observations remain true, BUT, again, to a lesser extent tan in past years: • 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 Bernard Sklar, MD: Online Continuing Medical Education December 2006

  44. Why Choose One Online CME Site Over Another? • “Look and Feel” • Your specialty’s “official” site • Price (lower is better; free is best) • Preference for Type of Instruction • Email reminders (the more frequent the better) • The CME is part of a larger medical site which offers additional services for doctors (“one-stop-shopping”) • Help with CME reporting • Recommendation by colleagues, medical group • Special arrangements with physician group Bernard Sklar, MD: Online Continuing Medical Education December 2006

  45. What do Physicians Want? • Do physicians really want online CME? • (I believe that, with usage now at 18%, the answer is YES) • What do they like and dislike? • (According to most studies, lectures are still the preferred mode of instruction) Bernard Sklar, MD: Online Continuing Medical Education December 2006

  46. A Long Term Solution • I believe that: • Eventually, CME will be integrated with the physician’s daily practice life • Systems will be developed which allow a computer program to “know” when a physician is making a mistake or needs additional information • The system will present instruction on the spot to help the physician do the right thing Bernard Sklar, MD: Online Continuing Medical Education December 2006

  47. Other Problems to Solve • Another problem will be to prove that a given CME activity actually improves physician performance. • For now, CME providers and evaluating groups will need to settle for some lesser measure, such as the difference in scores between pre-tests and post-tests, or statements by “experts” that the course will correct the deficiency. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  48. Opportunities for Research • More sophisticated (and expensive) methods of evaluation exist, such as reviewing physician charts or interviewing patients • This is a great opportunity for research. Bernard Sklar, MD: Online Continuing Medical Education December 2006

  49. Conclusions I • The number of online CME activities and credits is growing rapidly. Online CME is becoming nicer to look at, with more graphics, lots more audio and video, and a bit more interactive programming Bernard Sklar, MD: Online Continuing Medical Education December 2006

  50. Conclusions II • The percentage of CME hours earned online has risen to about 18% • Barriers to usage are coming down • There is very little proof that any kind of standalone CME, whether live, home study or online, and regardless of mode of instruction, is useful in changing physician practice • Results of most studies indicate that a coordinated set of educational interventions will be needed to accomplish behavior change Bernard Sklar, MD: Online Continuing Medical Education December 2006

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