Overview of Online CME

Overview of Online CME

The Seventh Annual Meeting

of the

Global Alliance for Medical Education

June 23-25, 2002

The McGill Faculty Club

Online CME – An Update

• Review of June 2002

• Bernard M. Sklar, M.D., M.S.

• www.cmelist.com

• [email protected]

Plan of Talk

• Results of Survey

• Types of Instruction

• Physician Use of CME and Online CME

• Obstacles to Physician Use

Master’s Thesis

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

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

How Was the Survey Done?

• Internet search of multiple search engines using search string “online + continuing + medical +education”

• Following up leads from those searches

• Information from ACCME

• Email from viewers and CME providers

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 description of the site and its contents and links to individual courses found at the site.

Extensive Updates

• I have been maintaining the list for about 5 years

• The list was updated for my master’s thesis in February 2000, again in August and December 2000, in December 2001 and in June 2002.

List of Online CME

Database Created from List

Based on examining each site, I created an Access database of the 207 sites actively offering CME in June 2002. The DB contains the number of activities, number of hours of instruction, types of instruction, specialty audiences, cost to users, sources of financial support and other parameters.

Results of Study I

• The number of sites and activities is rapidly increasing

• April 1997 – 13 sites

• December 1997 – 18 sites

• August 1998 – 61 sites

• May 1999 – 69 sites

• December 1999 – 87 sites

Results of Study II• February 2000

– 96 sites, 1874 activities, 3064 credit hours

• August 2000– 135 sites, 3659 activities, 5659 credit hours

• December 2000– 150 sites, 3510 activities, 6553 credit hours– Because of overlap, duplication, and

miscounting , the “true number” of hours should have been about 5500.

Results of Study III

• December 2001

• 197 sites

• 12026 activities

• 17523 hours

Results of Study IV

• June 2002

• 209 sites

• 10952 activities

• 18266 hours

Size of Sites – December 2000

No. of Credit-Hours

Number of Sites

Number of

Hours

% of Sites

% 0f Hours

Greater than 100 6 4082 4 62

50-99 12 779 8 12

25-49 21 717 14 11

10-24 41 681 27 10

5-9 29 193 19 3

< 5 41 100 27 2

Total 150 6553 100 100

Size of Sites – December 2001

No. of Credit-Hours

Number of Sites

Number of

Hours

% of Sites

% 0f Hours

Greater than 100 14 14587 7 83

50-99 9 596 5 3

25-49 29 1046 15 6

10-24 56 918 28 5

5-9 38 271 19 2

< 5 51 103 26 1

Total 197 18266 100 100

Size of Sites – June 2002

No. of Credit-Hours

Number of Sites

Number of

Hours

% of Sites

% 0f Hours

Greater than 100 12 14615 5 80

50-99 16 1119 8 6

25-49 31 1137 15 6

10-24 62 1036 30 6

5-9 33 227 16 1

< 5 54 129 26 <1

Total 209 18263 100 100

The Largest Sites December 2000Name of Site No. of

ActivitiesNo. of Hours

HealthStream* 907 1360

Challenger 7 901

CMEWeb 507 759

Medscape** 539 726

ArcMesa 63 232

Milliman/Robertson***

6 104

The Largest Sites December 2001Name of Site No. of Activities No. of Hours

eMedicine CME 6500 10000

CMEWeb 976 1400

Challenger 10 897

cmecourses (HS) 300 500WEBMD Just in Time 1400 350

Medscape CME 200 300

ArcMesa 80 293

The Largest Sites June 2002Name of Site No. of Activities No. of Hours

eMedicine CME* 6500 10000

CMEWeb* 976 1400

Challenger 14 964

TheAnswer.com* 5 300

cmecourses (HS)* 300 500

JournalBytes (All Spec) 108 372

Medscape CME** 200 300

ArcMesa 80 293

Radcourses (HS) 28 128

RSNA Education Exhibits 127 127

Natal U 83 122

Mypatient.com 109 109

Fee Structure by Site Dec 2000Dominant or Average Fee Number of Sites % of Sites

Free 74 49

<$5 per hour 2 1

$5 per hour 6 4

$6-9 per hour 16 11

$10 per hour 14 9

$11-14 per hour 6 4

$15 per hour 10 7

$16-19 per hour 5 3

$20 per hour 6 4

$21-24 per hour 2 1

$25 per hour 5 3

>$25 per hour 4 3

Fee Structure by Site Dec 2001Dominant or Average Fee Number of Sites % of Sites

Free 98 50

<$5 per hour 6 3

$5 per hour 6 4

$6-9 per hour 13 7

$10 per hour 22 11

$11-14 per hour 9 5

$15 per hour 19 10

$16-19 per hour 3 2

$20 per hour 5 3

$21-24 per hour 2 1

$25 per hour 10 5

>$25 per hour 4 2

Fee Structure by Site June 2002Dominant or Average Fee Number of Sites % of Sites

Free 105 50

<$5 per hour 5 2

$5 per hour 6 3

$6-9 per hour 13 5

$10 per hour 24 11

$11-14 per hour 8 4

$15 per hour 25 12

$16-19 per hour 4 1

$20 per hour 3 1

$21-24 per hour 1 <1

$25 per hour 10 4

>$25 per hour 5 2

Hourly Fee Structure Dec 2000Dominant or Average Fee No of Hours % of Hours

Free 1587 24

<$5 per hour 103 2

$5 per hour 223 3

$6-9 per hour 1183 18

$10 per hour 1050 16

$11-14 per hour 524 8

$15 per hour 1505 23

$16-19 per hour 170 3

$20 per hour 51 1

$21-24 per hour 18 0

$25 per hour 61 1

>$25 per hour 79 1

Hourly Fee Structure Dec 2001Dominant or Average Fee No of Hours % of Hours

Free 1978 11

<$5 per hour 365 8

$5 per hour 10285 59

$6-9 per hour 1712 10

$10 per hour 1447 8

$11-14 per hour 470 3

$15 per hour 845 5

$16-19 per hour 55 <1

$20 per hour 87 <1

$21-24 per hour 9 <1

$25 per hour 114 1

>$25 per hour 155 1

Hourly Fee Structure June 2002Dominant or Average Fee No of Hours % of Hours

Free 1763 10

<$5 per hour 566 3

$5 per hour 10203 56

$6-9 per hour 2153 12

$10 per hour 1643 9

$11-14 per hour 434 2

$15 per hour 1009 5

$16-19 per hour 137 1

$20 per hour 57 <1

$21-24 per hour 7 <1

$25 per hour 115 <1

>$25 per hour 177 1

Financial Support Dec 2000

Source of Support No. of Sites % of Sites

Commercial Companies 43 32

University/Medical School 54 40

Government 7 5

Medical/Specialty Association 13 10

Foundation 7 5

Insurance or Managed Care 4 3

User Fees/Partial or Complete 76 51

Financial Support Dec 2001




Government 11 6


Foundation 17 9

Insurance or Managed Care 5 3


Financial Support June 2002




Government 15 7


Foundation 15 7


Sites by Specialty – Primary Care Dec 2000

No. of Sites % of Sites

Primary Care Sites 93 62

including:

Family Practice 83 55

Internal Medicine 80 53

Pediatrics 22 15

Obstetrics/Gynecology 22 15

Sites by Specialty – Primary Care Dec 2001



including:



Pediatrics 29 15


Multiple Specialties 6 3

Sites by Specialty – Primary Care June 2002



including:



Pediatrics 37 18


Multiple Specialties (>6) 10 5

Sites by Specialty – Subspecialties Dec 2000Subspecialty sites Number of Sites % of Sites

including: 113 75

Neurology 21 14

Psychiatry 23 15

Cardiology 20 13

Oncology 13 9

Infectious Disease 13 9

Radiology* 10 7

Dermatology 7 5

Gastroenterology 7 5

Pulmonary 9 6

Surgery 7 5

General Interest 26 17

Sites by Specialty – Subspecialties Dec 2001Subspecialty sites Number of Sites % of Sites

including: 140 71

Neurology 14 7

Psychiatry 21 11

Cardiology 19 10

Oncology 10 5


Radiology 12 6

Geriatrics 12 6

Pulmonary 9 5

Surgery 6 5

General Interest 26 17

Sites by Specialty – Subspecialties June 2002Subspecialty sites Number of Sites % of Sites

123 59

including:

Cardiology 23 11

Psychiatry 20 10

Oncology 17 8

Neurology 15 7

Radiology 14 7


Urology 11 5

Endocrine 10 5

Pulmonary 10 5

Geriatrics 9 4

Surgery 9 4

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

Sites by Specialty-June 2002- Other

• 33 sites (16%) offer subjects of interest to many different specialties: for example, ethics, legal, practice management, risk management, tobacco cessation, genetics, basic science

• Many other specialties are included at 5 or fewer sites

Five “Different” Sites I• CE Medicus has no CME of its own, but offers access

without fee to about 600 activities at five sites (apparently by special arrangement)

• Digiscript contains many hundreds of audio and video slide lectures recorded at medical meetings. The yearly charge is $400. Some activities offer CME and some 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.

• Doctor’s Guide also has no CME of its own, but offers descriptions of over 600 activities (free and fee) with links to those courses

Five “Different” Sites II•Stanford SKOLAR offers credit for performing Internet literature searches on topics of your own interest

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

Sites I Could Not View

• There may be 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.

Email Reminders June 2002 About 25 sites send out regular email reminders about

additions to their lists of activities on request by users: American College of Cardiology, Boston University, Cancer Education, CME Reviews, Cyberounds, Doctor's Guide Webcasts, Ecornell, EMedHome, EMedicine, cmecourses (HealthStream), Journal of Clinical Psychiatry, Medscape, Medinfosource, Medsite, MMWR, mypatient.com, Natal U, PDR.net, Pedsref.org, psychLINK, Psychiatrist.com (NetSociety), Serono, University of Wisconsin, Virtual Lecture Hall, and World Medical Leaders.

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

Types of Instruction – Dec 2000

• Text only -- 37 sites; 25%

• Text-and-graphics – 45 sites; 30 %

• Slide-audio – 45 sites; 30 %

• Slide-video – 21 sites; 14 %

• Guidelines – 5 sites; 3 %

• Question-and-answer – 6 sites; 4 %

• Case-based Interactive – 27 sites; 18 %• Many sites have more than one type of instruction

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

Types of Instruction – June 2002

• Text only -- 57 sites; 27%• Text-and-graphics – 71 sites; 34 %• Slide-audio – 60 sites; 29 %• Slide-video – 23 sites; 11%• Guidelines – 8 sites; 3 %• Question-and-answer – 6 sites; 3 %• Case-Based-Interactive – 31 sites; 15 %• Correspondence – 2 sites; 2 %• Games – 2 sites; 1 %• Slides-Only – 4 sites; 2 %• Slides-and-Text – 4 sites; 2 %Many sites have more than one type of instruction

More about Q&A Instruction

• Only 6 sites (2%) feature Q&A, BUT the number of hours is relatively large

• Challenger - 964 hours• TheAnswerPage – 300 hours• E-core – 27 hours• Familypractice.com - 25 hours

Total about 1316 hours (7 %)

CME Participation by Location Based on ACCME Figures for 2001

• Live meetings and conferences account for 76 % of “physician-registrants”

• Home study CME (“enduring materials”) and journals account for 19.6 % of physician-registrants

• Online CME accounts for only 4.4 % of physician-registrants

Physician Usage of Online CME• Physician usage of online CME is increasing, but

still accounts for less than 5% 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%)

Why is Online CME Use So Low? I

• Many physicians still uneasy with computers and Internet*

• Many physicians 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

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 can’t view• Get content free, leave without paying• Each site has a different procedure and password

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

A Long Term Solution

• Eventually, CME will be totally 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

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.

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. There is grant money available for research into effective CME.

Conclusions I

• The number of online CME activities and credits is growing rapidly (but not so rapidly as in the previous periods)

• Online CME is becoming nicer to look at, with more graphics, lots more audio and video, and a bit more interactive programming

Conclusions II

• The percentage of CME hours earned online is still only about 4.4%

• Barriers to usage are still major

• Almost no 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

Conclusions III

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

• The challenges and opportunities are great

Important URLs

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

• My home page: www.cmelist.com• Online CME list: www.cmelist.com/list.htm• Definitions of types of online CME

instruction: www.cmelist.com/Instruction_Types_defined.htm

Overview of Online CME

Health & Medicine

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