Online CME – An Update Review of June 2005 Bernard M. Sklar, M.D., M.S. [email protected].

Online CME – An UpdateOnline CME – An Update

Review of June 2005Review of June 2005

Bernard M. Sklar, M.D., M.S.Bernard M. Sklar, M.D., M.S.

www.cmelist.com/www.cmelist.com/list.htmlist.htm

[email protected]@netcantina.com

Plan of PresentationPlan of Presentation

Results of Recent SurveysResults of Recent Surveys

Types of InstructionTypes of Instruction

Physician Use of CME and Online CMEPhysician Use of CME and Online CME

Obstacles to Physician UseObstacles to Physician Use

PredictionsPredictions

(This report summarizes my most recent review (This report summarizes my most recent review and does not include much of the past data. (To and does not include much of the past data. (To see details of past data, please contact me at see details of past data, please contact me at [email protected])[email protected])

Master’s ThesisMaster’s Thesis

This review is based on the June 2005 update of This review is based on the June 2005 update of the database that I created for my master’s the database that I created for my master’s thesis, The Current Status of Online Continuing thesis, The Current Status of Online Continuing Medical Education (June 2000). Find the thesis Medical Education (June 2000). Find the thesis online at online at http://www.cmelist.com/http://www.cmelist.com/mastersthesismastersthesis

The June 2000 thesis was based on a review of The June 2000 thesis was based on a review of the CME literature and a survey of online CME the CME literature and a survey of online CME done in February 2000.done in February 2000.

How Was the Survey Done?How Was the Survey Done?

The original survey was done by searching The original survey was done by searching multiple search engines using the search string multiple search engines using the search string “online + continuing + medical +education”“online + continuing + medical +education”

Following up leads from those searchesFollowing up leads from those searches

Information from ACCMEInformation from ACCME

Email from viewers and CME providersEmail from viewers and CME providers

Updating the DatabaseUpdating the Database

For the past several years, I have relied on For the past several years, I have relied on contacts from Online CME providers and users contacts from Online CME providers and users to add sites to my listto add sites to my list

I add 3-4 new sites each month (and remove I add 3-4 new sites each month (and remove those sites that go offlinethose sites that go offline

Description of the ListDescription of the List

Each entry shows the name and URL of the site, Each entry shows the name and URL of the site, when I last visited, how many credit hours are when I last visited, how many credit hours are available, who awards the credit, the cost per available, who awards the credit, the cost per unit, when the educational material was last unit, when the educational material was last updated, a statement about financial support, a updated, a statement about financial support, a description of the site and its contents and links description of the site and its contents and links to individual courses found at the site.to individual courses found at the site.

Where is the List?Where is the List?

The Annotated List of Online CME is found The Annotated List of Online CME is found at www.cmelist.com/list.htmat www.cmelist.com/list.htm

Extensive UpdatesExtensive Updates

I have been maintaining the list for eight years, I have been maintaining the list for eight years, beginning in 1997beginning in 1997

The database was updated for my master’s The database was updated for my master’s thesis in February 2000, and every six months thesis in February 2000, and every six months since. since.

From November 2004 through mid-June 2005, I From November 2004 through mid-June 2005, I visited and updated the review of each site on visited and updated the review of each site on the list.the list.

Database Created from ListDatabase Created from List

The database contains information about the The database contains information about the 284 sites offering CME in mid-June 2005. This 284 sites offering CME in mid-June 2005. This information includes the number of activities, information includes the number of activities, number of hours of instruction, types of number of hours of instruction, types of instruction, target audiences, cost to users, the instruction, target audiences, cost to users, the name of the accrediting organization and name of the accrediting organization and sources of financial support.sources of financial support.

Growth of Sites, Activities and Hours IGrowth of Sites, Activities and Hours I

Date SearchedDate Searched Number of Number of SitesSites

Number of Number of ActivitiesActivities

Number of Number of Credit HoursCredit Hours

April 1997April 1997 1313 Not countedNot counted Not countedNot counted

December 1997December 1997 1818 Not countedNot counted Not countedNot counted

August 1998August 1998 6161 Not countedNot counted Not countedNot counted

May 1999May 1999 6868 Not countedNot counted Not countedNot counted

December 1999December 1999 8787 Not countedNot counted Not countedNot counted

February 2000February 2000 9696 18741874 30643064

August 2000August 2000 135135 36593659 56595659

December 2000December 2000 150150 35103510 55005500


June 2002June 2002 209209 1095210952 1826618266

Growth of Sites, Activities and Hours IIGrowth of Sites, Activities and Hours II

Date SearchedDate Searched Number Number of Sitesof Sites

Number of Number of ActivitiesActivities

Number of Number of Credit HoursCredit Hours


July 2003July 2003 253253 1134611346 2029920299

January 2004January 2004 271271 1239512395 2170021700

June 2005June 2005 283283 1496314963 2507525075

Growth of large sites (offering more Growth of large sites (offering more than 100 Credit Hours)than 100 Credit Hours)

Date SearchedDate Searched Number Number of Sitesof Sites

Number of Number of HoursHours

% of % of SitesSites

% of % of hourshours

December 2001December 2001 1414 1458714587 77 8383

December 2002December 2002 1616 1540415404 88 8181

July 2003July 2003 2121 1638816388 1010 8080

January 2004January 2004 2525 1754917549 1111 8181

June 2005June 2005 3434 2045620456 1313 8080

Size of Sites – June 2005Size of Sites – June 2005

No. of Credit-No. of Credit-HoursHours

Number of Number of SitesSites

Number of Number of HoursHours

% of % of SitesSites

% 0f % 0f HoursHours

Greater than 100Greater than 100 3434 2045620456 1313 8080

50-9950-99 2222 13921392 99 66

25-4925-49 4848 16601660 1919 77

10-2410-24 7070 11611161 1414 55

5-95-9 4141 293293 1616 11

< 5< 5 3939 112112 1515 <1<1

TotalTotal 254254 2507425074 100100 100100

The Largest Sites June 2005 - IThe Largest Sites June 2005 - IName of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours

eMedicine CMEeMedicine CME 65816581 98719871

ChallengerChallenger 4040 28002800

CMEWebCMEWeb 895895 13421342

Am CollegeCardio Cardiosource 1212 467467

BioCritiqueBioCritique 900900 450450

MedscapeMedscape 319319 422422

Free CMEFree CME 300300 400400

ArcMesaArcMesa 9595 350350

Journal BytesJournal Bytes 108108 348348

Radiologic Soc North America 300 300

TheAnswerPage 5 300

Pri-Med Online 173 220

The Oncologist 198 198

NetCE 23 183

Surgical pathology Unknowns 183 183

The Largest Sites June 2005 - 2The Largest Sites June 2005 - 2Name of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours

CardioVillageCardioVillage 1010 169169

University of WisconsinUniversity of Wisconsin 115115 166166

Pediatrix UniversityPediatrix University 110110 165165

Am Soc Clin Path Check SamplesAm Soc Clin Path Check Samples 152152 152152

AudioDigestAudioDigest 7373 146146

Johns Hopkins Advanced StudiesJohns Hopkins Advanced Studies 100100 144144

NEJM Weekly CME ProgramNEJM Weekly CME Program 140140 140140

JAMA & ArchivesJAMA & Archives 130130 130130

ACP MedicineACP Medicine 11 120120

ACS SurgeryACS Surgery 11 120120

Baylor College of MedicineBaylor College of Medicine 139139 106106

Anesoft Medical SimulationAnesoft Medical Simulation 66 106106

Ohio State UniversityOhio State University 106106 106106

cmecoursescmecourses 100100 100100

Fee Structure – Free SitesFee Structure – Free Sites

There has been a rapid growth in the number of There has been a rapid growth in the number of sites offering free CME – from 98 sites (50%) in sites offering free CME – from 98 sites (50%) in December 2001 to 177 sites (70%) in June December 2001 to 177 sites (70%) in June 2005.2005.

There has been a similar rapid growth in the There has been a similar rapid growth in the number of free credit-hours – from 1979 hours number of free credit-hours – from 1979 hours (11%) in December 2001 to 5075 hours (20%) in (11%) in December 2001 to 5075 hours (20%) in June 2005June 2005

Fee Structure – Pay for Credit SitesFee Structure – Pay for Credit Sites

There has been very little change in the median There has been very little change in the median fee for a credit hour. The bulk of the fee fee for a credit hour. The bulk of the fee instruction (70-80%) continues to cost $5 to $15 instruction (70-80%) continues to cost $5 to $15 per credit hourper credit hour

Fee Structure by Site June 2005Fee Structure by Site June 2005Dominant or Average FeeDominant or Average Fee Number of SitesNumber of Sites % of Sites% of Sites

FreeFree 177177 7070

<$5 per hour<$5 per hour 1313 55

$5 per hour$5 per hour 44 22

$6-9 per hour$6-9 per hour 1313 55


$11-14 per hour$11-14 per hour 55 22


$16-19 per hour$16-19 per hour 33 11


$21-24 per hour$21-24 per hour 55 22


>$25 per hour>$25 per hour 88 33

Hourly Fee Structure June 2005Hourly Fee Structure June 2005Dominant or Average FeeDominant or Average Fee No of HoursNo of Hours % of Hours% of Hours

FreeFree 50755075 2020

<$5 per hour<$5 per hour 785785 33

$5 per hour$5 per hour 1003010030 4040

$6-9 per hour$6-9 per hour 28102810 1111


$11-14 per hour$11-14 per hour 118118 <1<1

$15 per hour$15 per hour 43614361 1717

$16-19 per hour$16-19 per hour 186186 <1<1


$21-24 per hour$21-24 per hour 390390 1.51.5

$25 per hour$25 per hour 4545 <1<1

>$25 per hour>$25 per hour 277277 11

Financial Support Summary: There has been very Financial Support Summary: There has been very little change in relative percentages of financial little change in relative percentages of financial

support since December, 2001. But as the number of support since December, 2001. But as the number of free sites increases, the number of fee sites free sites increases, the number of fee sites

decreasesdecreases

Source of SupportSource of Support % of Sites% of Sites

Commercial CompaniesCommercial Companies 50-5450-54

University/Medical SchoolUniversity/Medical School 34-4234-42

GovernmentGovernment 6-116-11

Medical/Specialty AssociationMedical/Specialty Association 24-3124-31

FoundationFoundation 6-96-9

User Fees/Partial or CompleteUser Fees/Partial or Complete 30-5030-50

Financial Support June 2005Financial Support June 2005

Source of SupportSource of Support No. of SitesNo. of Sites % of Sites% of Sites

Commercial CompaniesCommercial Companies 137137 5151

University/Medical SchoolUniversity/Medical School 9191 3434

GovernmentGovernment 3030 1111

Medical/Specialty AssociationMedical/Specialty Association 6161 2323

FoundationFoundation 88 33

User Fees/Partial or CompleteUser Fees/Partial or Complete 8080 3030

Primary Care and Specialty SitesPrimary Care and Specialty Sites

Family Practice and Internal Medicine content Family Practice and Internal Medicine content continues to dominate the Primary Care sites continues to dominate the Primary Care sites (about 40% of sites).(about 40% of sites).

Cardiology, Psychiatry, Infectious Disease/HIV, Cardiology, Psychiatry, Infectious Disease/HIV, and Oncology content appear most frequently and Oncology content appear most frequently (about 20% of sites for each specialty).(about 20% of sites for each specialty).Many sites offer instruction for more than one specialty groupMany sites offer instruction for more than one specialty group

Specialty – Primary Care June 2005Specialty – Primary Care June 2005

No. of SitesNo. of Sites % of Sites% of Sites

Primary Care SitesPrimary Care Sites

including:including:

Family PracticeFamily Practice 107107 4040

Internal MedicineInternal Medicine 101101 3838

PediatricsPediatrics 3535 1313

Obstetrics/GynecologyObstetrics/Gynecology 2727 1010

Multiple Specialties (>6)Multiple Specialties (>6) 2828 1010

Subspecialties June 2005Subspecialties June 2005

Subspecialty sitesSubspecialty sites Number of SitesNumber of Sites % of Sites% of Sites

including:including:

CardiologyCardiology 2424 99

PsychiatryPsychiatry 2121 88

Infectious Disease/HIVInfectious Disease/HIV 2121 88

NeurologyNeurology 1515 66

OncologyOncology 2020 88

Pulmonary-Critical CarePulmonary-Critical Care 1313 55

RadiologyRadiology 1313 55

GeriatricsGeriatrics 1313 55

EndocrineEndocrine 1212 44

SurgerySurgery 88 33

UrologyUrology 1212 44

Sites by Specialty-June 2005- OtherSites by Specialty-June 2005- Other

38 sites (14%) offer subjects of interest to many 38 sites (14%) offer subjects of interest to many specialists: ethics, legal, practice management, specialists: ethics, legal, practice management, risk management, tobacco cessation, addiction, risk management, tobacco cessation, addiction, alcoholism, genetics, basic sciencealcoholism, genetics, basic science

Many other specialties are included at 5 or fewer Many other specialties are included at 5 or fewer sitessites

Eight “Different” Sites June 2005 - IEight “Different” Sites June 2005 - ICE Medicus has no CME of its own, but offers access CE Medicus has no CME of its own, but offers access without fee to about 6285 activities produced by six content without fee to about 6285 activities produced by six content providers. Instruction is free. providers. Instruction is free.

Doctor’s Guide also has no CME of its own, but offers Doctor’s Guide also has no CME of its own, but offers descriptions of over 1800 activities (free and fee) with links descriptions of over 1800 activities (free and fee) with links to those coursesto those courses

Digiscript contains many hundreds of audio and video slide Digiscript contains many hundreds of audio and video slide lectures recorded at medical meetings. The yearly charge is lectures recorded at medical meetings. The yearly charge is $400. Some$400. Some activities offer CME and others do not. The site activities offer CME and others do not. The site is searchable by medical topic and by sponsoring is searchable by medical topic and by sponsoring organization. You may have to pay an additional fee for organization. You may have to pay an additional fee for CME credit by any given sponsor.CME credit by any given sponsor.

• University of Wisconsin Professional Courses offer credit for courses on non-medical subjects which could be expected to improve your practice or your life.

Eight “Different” Sites June 2005 - IIEight “Different” Sites June 2005 - II•Stanford SKOLAR offers credit for performing Internet literature searches on topics of your own interest

•MerckMedicus CME Credit Program for Searching and Researching. Physicians can earn up to 25 CME credits per calendar year for every hour they spend researching medical questions, reading online medical references, or gathering information for patients on MerckMedicus

•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.

Email Reminders June 2005Email Reminders June 2005

It is becoming increasingly common for the It is becoming increasingly common for the larger sites to send email reminders on larger sites to send email reminders on request of the users about their new courses. request of the users about their new courses. At least 40 sites are now doing this regularlyAt least 40 sites are now doing this regularly

Types of InstructionTypes of Instruction

There has been very little change in the There has been very little change in the proportion of instruction types since December proportion of instruction types since December 2001. Text (with or without graphics) remains the 2001. Text (with or without graphics) remains the dominant mode, followed by slide-audio or slide-dominant mode, followed by slide-audio or slide-video lectures, case-based interactive and video lectures, case-based interactive and question-and-answer instruction.question-and-answer instruction.

For definitions of these and other types of online For definitions of these and other types of online instruction, see Types of Online CME Instruction instruction, see Types of Online CME Instruction DefinedDefined

Types of Instruction June 2005Types of Instruction June 2005

Instruction TypeInstruction Type Number of SitesNumber of Sites % of Sites% of Sites

Text onlyText only 9090 3434

Text-and-graphicsText-and-graphics 6262 2323

Slide-audioSlide-audio 6464 2424

Slide-videoSlide-video 4343 1616

GuidelinesGuidelines 55 22

Question-and-answerQuestion-and-answer 1111 44

Case-Based-InteractiveCase-Based-Interactive 4848 1818

CorrespondenceCorrespondence 33 11

GamesGames 33 11

JournalJournal 2121 88

Journal with multiple subjectsJournal with multiple subjects 1414 55

Board Review/Self-AssessmentBoard Review/Self-Assessment 55 22

Streaming VideoStreaming Video 22 <1<1

Self-Directed SearchSelf-Directed Search 33 11

More about Question & Answer InstructionMore about Question & Answer Instruction

Only 11 sites (4%) feature Q&A, BUT the number of hours is relatively large (3423). Some larger sites are:Challenger - 2050 hoursTheAnswerPage – 300 hoursEcore Family Practice – 40 hoursFamilypractice.com - 30 hoursAm Acad Orthopedic Self-Assessment – 75 hoursAm Acad Pediatrics Self-Assessment – 40 hoursMedical Education Opportunities – 20 hoursOrthopedics Hyperguide – 50 hoursTotal about 3423 hours (14 % of all CME hours)

CME Participation by Location Based on CME Participation by Location Based on ACCME Figures for 2004ACCME Figures for 2004

Live meetings and conferences account for 62.6% of Live meetings and conferences account for 62.6% of “physician-registrants”“physician-registrants”

Home study CME (“enduring materials”) and Home study CME (“enduring materials”) and journals account for 23.6% of physician-registrantsjournals account for 23.6% of physician-registrants

Online CME accounts for 13.8% of physician-Online CME accounts for 13.8% of physician-registrantsregistrants

Physician Usage of Online CMEPhysician Usage of Online CME

Physician usage of online CME is increasing, Physician usage of online CME is increasing, and now accounts for about 14% of all CME and now accounts for about 14% of all CME According to ACCME:According to ACCME:1997: 1997: 13,115 physician-registrants (0.34%)13,115 physician-registrants (0.34%)1998: 37,879 physician-registrants (1.03%)1998: 37,879 physician-registrants (1.03%)1999: 79,536 physician-registrants (1.79%)1999: 79,536 physician-registrants (1.79%)2000: 181,922 physician-registrants (3.57%)2000: 181,922 physician-registrants (3.57%)2001: 230,055 physician-registrants (4.44%)2001: 230,055 physician-registrants (4.44%)2002: 329,110 physician-registrants (6.08%)2002: 329,110 physician-registrants (6.08%)2004: 895,120 physician-registrants (13.8%)2004: 895,120 physician-registrants (13.8%)

Changes and Trends IChanges and Trends I

There is a gradual upward trend in the There is a gradual upward trend in the numbers of sites, courses and hours (about numbers of sites, courses and hours (about 16% increase over the past 18 months)16% increase over the past 18 months)Some of that upward trend is “new”; some is Some of that upward trend is “new”; some is accounted for by counting sites not previously accounted for by counting sites not previously foundfoundThere has been another 50% increase in the There has been another 50% increase in the number of free CME hours (5074 vs. 3380) number of free CME hours (5074 vs. 3380) over the 18 months. There has been little over the 18 months. There has been little change in the specialty groups targeted, change in the specialty groups targeted, types of instruction or the sources of financial types of instruction or the sources of financial support (except that the number of small one-support (except that the number of small one-disease free sites seems to be growing).disease free sites seems to be growing).

Changes and Trends IIChanges and Trends II

Number of physician-registrants for online CME Number of physician-registrants for online CME went up from went up from 181,922 (3.57%) in 2000 to 230,055 181,922 (3.57%) in 2000 to 230,055 (4.44%) in 2001 to 329,110 (6.08%) in 2002 to (4.44%) in 2001 to 329,110 (6.08%) in 2002 to 899,390 (14%) in 2004.899,390 (14%) in 2004.

The number of physicians registering for online The number of physicians registering for online CME has doubled in the past two years.CME has doubled in the past two years.

Why is Online CME use Still So Low? IWhy is Online CME use Still So Low? I

These observations about the causes of the “low” These observations about the causes of the “low” use of Online CME are still true, BUT much less true use of Online CME are still true, BUT much less true than before:than before:Some physicians are still uneasy with computers Some physicians are still uneasy with computers and the Internet and the Internet Some physicians are still unaware of online CME or Some physicians are still unaware of online CME or don’t know how to find itdon’t know how to find itMuch live CME, especially at the hospital, is Much live CME, especially at the hospital, is convenient, free and offers collegial interactionconvenient, free and offers collegial interactionMany doctors still find attending their yearly Many doctors still find attending their yearly specialty meeting satisfying and sufficientspecialty meeting satisfying and sufficient

Why is Online CME Use Why is Online CME Use Still Still So Low? IISo Low? II

These observations remain true, BUT, again, to a These observations remain true, BUT, again, to a lesser extent than in past years:lesser extent than in past years:A series of “gates” for the user to pass throughA series of “gates” for the user to pass throughNavigation: Download and install plug-insNavigation: Download and install plug-insRegistration hassleRegistration hassleFear of giving out license, DEA, credit cardFear of giving out license, DEA, credit cardPaying in advance for content you can’t viewPaying in advance for content you can’t viewGet content free, leave without payingGet content free, leave without payingEach site has a different procedure and passwordEach site has a different procedure and password

Why Choose One Online CME Site Over Why Choose One Online CME Site Over Another?Another?

““Look and Feel” Look and Feel”

Your specialty’s “official” siteYour specialty’s “official” site

Price (lower is better; free is best)Price (lower is better; free is best)

Preference for Type of InstructionPreference for Type of Instruction

Email reminders (the more frequent the better)Email reminders (the more frequent the better)

Part of larger medical sitePart of larger medical site

Help with CME reportingHelp with CME reporting

Recommendation by colleagues, medical groupRecommendation by colleagues, medical group

Special arrangements with physician groupSpecial arrangements with physician group

What do Physicians Want?What do Physicians Want?

Do physicians really want online CME?Do physicians really want online CME?

(I believe that, with usage now at 14%, the (I believe that, with usage now at 14%, the answer is YES)answer is YES)

A Long Term SolutionA Long Term Solution

I believe that:Eventually, CME will be integrated with the physician’s daily practice lifeSystems will be developed which allow a computer program to “know” when a physician is making a mistake or needs additional informationThe system will present instruction on the spot to help the physician do the right thing

Other Problems to SolveOther Problems to Solve

Another problem will be to prove that a given Another problem will be to prove that a given CME activity actually improves physician CME activity actually improves physician performance.performance.

For now, CME providers and evaluating groups For now, CME providers and evaluating groups will need to settle for some lesser measure, such will need to settle for some lesser measure, such as the difference in scores between pre-tests as the difference in scores between pre-tests and post-tests, or statements by “experts” that and post-tests, or statements by “experts” that the course will correct the deficiency.the course will correct the deficiency.

Opportunities for ResearchOpportunities for Research

More sophisticated (and expensive) methods of More sophisticated (and expensive) methods of evaluation exist, such as reviewing physician evaluation exist, such as reviewing physician charts or interviewing patientscharts or interviewing patients

This is a great opportunity for research. This is a great opportunity for research.

Conclusions IConclusions I

The number of online CME activities and credits The number of online CME activities and credits is growing rapidly Online CME is becoming nicer is growing rapidly Online CME is becoming nicer to look at, with more graphics, lots more audio to look at, with more graphics, lots more audio and video, and a bit more interactive and video, and a bit more interactive programmingprogramming

Conclusions IIConclusions II

The percentage of CME hours earned online has The percentage of CME hours earned online has risen to about 14%risen to about 14%

Barriers to usage are coming downBarriers to usage are coming down

There is very little proof that any kind of There is very little proof that any kind of standalone CME, whether live, home study or standalone CME, whether live, home study or online, and regardless of mode of instruction, is online, and regardless of mode of instruction, is useful in changing physician practiceuseful in changing physician practice

Results of most studies indicate that a set of Results of most studies indicate that a set of educational interventions will be needed to educational interventions will be needed to accomplish behavior changeaccomplish behavior change

Conclusions IIIConclusions III

The future lies in the integration of medical The future lies in the integration of medical practice, quality assessment and user-specific practice, quality assessment and user-specific CMECME

The challenges and opportunities are greatThe challenges and opportunities are great

Important URLsImportant URLs

Master’s thesis: Master’s thesis: www.cmelist.com/mastersthesis/www.cmelist.com/mastersthesis/

My home page: www.cmelist.comMy home page: www.cmelist.com

Online CME list: www.cmelist.com/list.htmOnline CME list: www.cmelist.com/list.htm

Definitions of types of online CME instruction: Definitions of types of online CME instruction: www.cmelist.com/Instruction_Types_defined.htmwww.cmelist.com/Instruction_Types_defined.htm

ACCME Annual Report 2004ACCME Annual Report 2004

Questions or Comments?Questions or Comments?

Send email to [email protected] email to [email protected]

Online CME – An Update Review of June 2005 Bernard M. Sklar, M.D., M.S. [email protected].

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Transcript of Online CME – An Update Review of June 2005 Bernard M. Sklar, M.D., M.S. [email protected].