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Online CME for Family Practitioners


Online CME for Family Practitioners Bernard Sklar MD MS January 2002 Plan of Talk I am going to show you about 13 web sites which offer CME ... – PowerPoint PPT presentation

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Title: Online CME for Family Practitioners

Online CME for Family Practitioners
  • Bernard Sklar MD MS
  • January 2002

Plan of Talk
  • I am going to show you about 13 web sites which
    offer CME specifically designed for FPs
  • I have chosen the sites based on ease of access
    and appropriateness for FPs
  • I have chosen at least one example of the various
    types of web-based instruction

Online CME An Overview
  • At last count (December 2001), there were about
    200 web sites offering CME there were about
    12,000 courses and about 17,500 hours of CME
    credit available.
  • Well over half of the sites have instruction
    oriented to primary care physicians.

Online CME Types of Instruction
  • Although many educators believe that
    Case-Based-Interactive instruction is the
    best form of CME, whether live or online, I
    think that different doctors have different
    learning styles, and that different modes of
    instruction may suit you at different times.

Online CME Types of Instruction II
  • I classify online CME into10 instruction types
  • Text-Only
  • Text-and-Graphics
  • Slides-Only (or Slides and Text)
  • Slide-Audio
  • Slide-Video
  • Guideline or Consensus (usually text only)
  • Question-and-Answer
  • Case-Based Interactive
  • Correspondence
  • Games

Types of Instruction Defined
  • The types of instruction are pretty obvious by
    looking at the names, but if you want to see how
    I have defined them, you can visit

How to find these sites (and others)
  • All the sites shown in this talk (and all the
    other active online CME sites that I have found)
    are listed in alphabetical order and described at
  • http//

  • This is the easiest type of site to put up, and
    not very interesting. It is essentially the same
    as reading a journal article or a textbook
    chapter. If the text is long, it is often better
    to print it and read it offline.

Text-Only Medbytes
Text-and-Graphics AFP
  • The next step up is text-and-graphics.
  • I like American Family Physician online version
    for lots of reasons

American Family Physician
  • Almost all FPs are subscribers
  • Reflects the official view of AAFP
  • Two issues per month
  • Online Quiz has questions on most of the articles
    in each issue
  • Regular use can satisfy requirements for AAFP
    membership and ABFP recertification
  • AAFP keeps track of the CME hours you earn
  • CME is free to AAFP members

American Family Physician December 15, 2001
American Family Physician
  • You can read online or print html or pdf versions
  • Disadvantages not interactive you must read
    all articles in an issue to get credit
  • You could read print version just as easily (but
    you have to remember where you put it, and put a
    stamp on the card)

American Family Physician Quiz
American Family Physician Quiz
  • You can check your answers online and get
    feedback on incorrect answers before submitting
    for credit
  • Should definitely be a part of your regular CME
    (unless you prefer the print version)

  • Texas Medical Association Stroke Project

Texas Stroke-Slide 3

Texas Stroke Accompanying Text
  • Stroke is expensive as well as dehumanizing. 
    Economic models and regional costs vary
    (reflected in the broad range of estimates on the
    slide). An average lifetime cost of
    60,000/stroke is a reasonable figure.  However,
    some strokes leave no functional deficits while
    others result in total dependency for basic
    activities of daily living, so an "average" can
    be misleading.  Preventing stroke in using most
    current, proven therapies is cost-effective and
    often cost-saving.

  • 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

Vaccine Safety
  • 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.

World Medical Leaders- Osteoarthritis
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.

Avoiding Osteoporotic Fractures
  • 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// to 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 University of Michigan.

University of Michigan Clinical Guidelines
  • 15 guidelines offering free CME (1 hour each)
  • Some examples
  • Asthma in Adults and Children
  • Lipid Screening and Management in Adults
  • Otitis Media in Children and Adults
  • Peptic Ulcer Disease in Adults
  • Pdf format download, print, read and return for
    quiz and evaluation

(No Transcript)
Three Question-and-Answer Sites
  • If you like to challenge yourself, all of these
    sites are fun.
  • ABFP In-Training Exam
  • Family Medicine Review II
  • eCore - The Core Content Review of Primary Care

29 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.

30 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

31 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'

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

33 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.

Family Medicine Review II
  • This is a "study tool for family physicians
    preparing for certification and recertification
    examinations." A question/answer type of
    instruction featuring 224 questions. Each
    question presents a clinical situation and a set
    of multiple choice questions. 

Family Medicine Review II
  • You may go through all 224 questions and answers
    without a fee. You have to pay 75 to receive a
    CME certificate (10 hours)

Family Medicine Review II
  • Which of the following statements about varicella
    immunization is FALSE?
  • a. The vaccine contains live, attenuated
    virus. b. Immunization provides 70 to 90
    protection against chickenpox infection. c.
    Immunization provides 95 protection against
    severe disease. d. Herpes zoster occurs after
    immunization at a slightly higher rate than after
    chickenpox infection. e. Immunization provides
    protection against chickenpox infection for at
    least 7 to 10 years after vaccination.

Family Medicine Review II
  • The answer is d. Varicella vaccine does contain
    live, attenuated virus. After review of the
    available data on vaccine efficacy, the Advisory
    Committee on Immunization Practices (ACIP) stated
    that vaccination provides 70-90 protection
    against chicken pox infection and 95 protection
    against severe disease. Immunization appears to
    provide this protection against varicella-zoster
    virus infection for at least 7-10 years after
    vaccination." Herpes zoster can occur following
    both varicella immunization and infection.
    However, the rate of occurrence of zoster after
    immunization is lower.

eCore - The Core Content Review of Primary Care
  • This course will
  • Test your knowledge against 242 questions in
    Family/General Practice.
  • Provide you with one hour (10) of AAFP
    Prescribed credit (equivalent to AMA Category 1
    credit) for each 10 questions you answer.
  • Answers are much more thorough and detailed than
    in the first two programs discussed.

eCore - The Core Content Review of Primary Care
  • You are asked to perform a preoperative
    evaluation on a healthy 55-year-old man who is
    scheduled for an elective inguinal hernia repair.
    During the examination, he relates that he is
    allergic to rubber. He reports getting a red
    scaly dermatitis that lasts for several days
    around his abdomen after wearing underwear with
    an elastic waistband. He also gets a similar rash
    on his hands after wearing rubber gloves. He has
    never had associated breathing difficulties,
    lightheadedness, or hives. Which of the following
    is TRUE? (Select the single best answer.)

eCore - The Core Content Review of Primary Care
  • 1.You should recommend that the surgery be done
    with absolute latex-free operating room
  • 2.He is at significant risk for latex-associated
  • 3.He is most likely allergic to natural latex
  • 4.This patient is having a T-cell-mediated
  • 5.This patient is also likely to have a reaction
    to kiwi fruit and bananas.

eCore - The Core Content Review of Primary Care
  • This selection is correct!
  • Natural rubber latex (NRL) comes from sap of the
    rubber tree Hevea brasiliensi and contains a
    complex mixture of more than 100 organic
    proteins. In its raw state, latex sap is not
    commercially useful, and several chemicals called
    accelerators or vulcanizing agents need to be
    added during manufacturing to produce functional
    rubber products. A few rare individuals are
    allergic to latex proteins. These true
    "latex-allergic" individuals have a type I,
    eosinophil-mediated allergic reaction
    characterized clinically by the relatively
    immediate appearance of urticaria, angioedema,
    airway swelling, vascular collapse, shock, and/or
    anaphylaxis (and 3 more pages of discussion.)

  • The first example, Cleveland Clinic Online
    Journal of Medicine, is a text instruction with
    some CBI features. It represents a fairly easy
    way to put in some interactivity.

Cleveland Clinic Online Journal of Medicine
  • Each module begins with a brief case presentation
    followed by a set of 7-10 questions. You receive
    feedback on your answers, then proceed to a
    didactic discussion of the case. You then have a
    quiz. You receive feedback on the answer to each
    quiz question before proceeding to the next. You
    receive one hour of credit (free) for each module.

Cleveland Clinic Online Journal of Medicine
  • An example is
  • Diabetic gastropathy A practical approach to a
    vexing problem

Brief Case Presentation
Pre-Instruction Quiz
Feedback on your answers
The Didactic Presentation
Post-Instruction Quiz
Feedback on Quiz
  • is the industry standard on CBI
  • You can access these cases free through
  • Go there, register, then go to CEMedicus, search
    content by Content Host and choose

  • 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

(No Transcript)
  • 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
Key Points
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

  • Games are really a form of question-and-answer or
    Case Based Instruction, but done in a fun way.
    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.

Cardio Country Club
  • Click on "Cardio Country Club" to start this
    game, a set of brief case presentations on
    hypertension and arrhythmias. Each case is
    followed by multiple choice questions. Your score
    climbs with each incorrect answer. You may "play"
    by yourself or in a group. You may also join a
    discussion group with one of the authors and
    other students. Primary care practitioners play
    an easier game, while cardiologists are urged to
    play at the "master's" level.

A case and a question
Finally a correct answer (but too many strokes)
Correspondence Courses
  • Only one good example at present
  • University of South Florida Business of Medicine

University of South Florida Business of Medicine
  • Presents a Mini-MBA in 4 courses
  • 24-96 credits about 40 per credit
  • Slide-Audio lectures, assignments, email
    discussion groups
  • Groups start every month and you have 2 months to
    complete any one course

University of South Florida Business of Medicine
  • Four courses
  • Marketing and the Management of Service Quality
  • Managing People and Developing Strategies
  • The Business Environment of Health Care
  • Data Driven Management

  • We have looked at about 13 online CME sites for
  • 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 185
    others, as well as descriptions, can be found at
  • Contact me at
  • Bernard Sklar MD MS