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Online CME for Primary Care Physicians

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... and conferences account for 78% of 'physician-registrants' ... Physician usage of online CME is increasing, but still accounts for less than 4% of all CME ... – PowerPoint PPT presentation

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Title: Online CME for Primary Care Physicians


1
Online CME for Primary Care Physicians
  • Bernard M. Sklar, M.D., M.S.
  • www.cmelist.com
  • bersklar_at_netcantina.com

2
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

3
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

4
www.cmelist.com/list.htm
5
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.

6
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

7
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

8
The Largest Sites December 2001
9
Fee Structure by Site Dec 2001
10
Hourly Fee Structure Dec 2001
11
Financial Support Dec 2001
12
Sites by Specialty Primary Care Dec 2001
13
Sites by Specialty Subspecialties Dec 2001
14
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

15
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

16
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

17
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

18
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)

19
Why is Online CME use So Low? I
  • Many physicians still uneasy with computers and
    Internet
  • Many physicians unaware of online CME or dont
    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

20
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 cant view
  • Get content free, leave without paying
  • Each site has a different procedure and password

21
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

22
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.

23
Text-and-Graphics
  • Physicians Assistant Journal
  • Lower Extremity Rotational Disorders in Children
  • Main page tells you everything you need to know
    to decide whether you want to read it
  • Hours of credit, price, expiration date, sponsor

24
Lower Extremity Rotational Disorders in Children
25
Learning Objectives
  • Objectives After reading the article, the reader
    should be able to1. 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.

26
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
    extremityexternal tibial torsion, external
    femoral torsion, internal tibial torsion, and
    internal femoral torsionpresent 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.

27
CME Quiz
28
Slide-and-Text Serono Multiple Sclerosis
29
Slide-and-Text Serono Multiple Sclerosis
  • Note that you see the authors slides and the
    complete transcript of the speakers words, but
    there is no audio

30
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

31
Vaccine Safety
32
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
    dont 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.

33
World Medical Leaders- Osteoarthritis
34
Baylor College of Medicine's Online CME Courses
  • A very nice set of lectures in cardiology,
    surgery, diabetes and womens 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.

35
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

36
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.

37
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

38
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?

39
Familypractice.com ABFP In-Training Exam Questions
  • Answer choices
  • Buspirone (BuSpar)
  • Amantadine (Symmetrel)
  • Alprazolam (Xanax)
  • Propranolol (Inderal)
  • Desipramine (Norpramin)

40
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.

41
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.

42
Guideline- APA Alzheimers
43
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

44
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)

45
Mypatient.com Maxillary Pain
46
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.

47
Skipping to Most Likely Diagnosis
48
Mypatient.com Key Concepts
49
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

50
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

51
Some Conclusions II
  • The percentage of CME hours earned online is
    still only about 3.5
  • Barriers to usage are still major

52
Some Conclusions III
  • The future lies in the integration of medical
    practice, quality assessment and user-specific
    CME
  • The challenges and opportunities are great

53
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

54
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 bersklar_at_netcantina.com
  • Bernard Sklar MD MS
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