Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Online CME – An UpdateOnline CME – An Update
Review of December 2006Review of December 2006
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
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Master’s ThesisMaster’s Thesis
This review is based on the December 2006 This review is based on the December 2006 update of the database initially created for the update of the database initially created for the master’s thesis, The Current Status of Online master’s thesis, The Current Status of Online Continuing Medical Education (June 2000). Find Continuing Medical Education (June 2000). Find the thesis online at the thesis 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.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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 multiple search engines using the search string “online + continuing + medical string “online + continuing + medical +education”+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
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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 contacts from Online CME providers and users to add sites to my listusers to add sites to my list
I add 3-4 new sites each month (and I add 3-4 new sites each month (and remove those sites that go offlineremove those sites that go offline
This year I also searched the Internet This year I also searched the Internet again for “online + continuing + medical + again for “online + continuing + medical + education”education”
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Description of the ListDescription of the List
Each entry shows the name and URL of Each entry shows the name and URL of the site, when I last visited, how many the site, when I last visited, how many credit hours are available, who awards the credit hours are available, who awards the credit, the cost per unit, when the credit, the cost per unit, when the educational material was last updated, a educational material was last updated, a statement about financial support, a statement about financial support, a description of the site and its contents and description of the site and its contents and links to individual courses found at the links to individual courses found at the site.site.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Extensive UpdatesExtensive Updates
I have been maintaining the list for about I have been maintaining the list for about nine years, beginning in 1997nine years, beginning in 1997
The database was updated for my The database was updated for my master’s thesis in February 2000, and master’s thesis in February 2000, and every six months since. every six months since.
From March through December 2006, I From March through December 2006, I visited and updated the review of each site visited and updated the review of each site on the list.on the list.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Database Created from ListDatabase Created from List
The database contains information about The database contains information about the 300 sites offering CME in early the 300 sites offering CME in early December 2006. This information includes December 2006. This information includes the number of activities, number of hours the number of activities, number of hours of instruction, types of instruction, target of instruction, types of instruction, target audiences, cost to users, the name of the audiences, cost to users, the name of the accrediting organization and sources of accrediting organization and sources of financial support.financial support.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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
December 2001December 2001 197197 1202612026 1752317523
June 2002June 2002 209209 1095210952 1826618266
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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
December 2002December 2002 229229 1148511485 1910519105
July 2003July 2003 253253 1134611346 2029920299
January 2004January 2004 271271 1239512395 2170021700
June 2005June 2005 283283 1496314963 2507525075
December 2006December 2006 300300 1574415744 2628726287
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Explanation of calculations on next Explanation of calculations on next several slidesseveral slides
Although the number of sites is now Although the number of sites is now estimated at 300, the number used for the estimated at 300, the number used for the following calculations is 286following calculations is 286This method counts only those sites which This method counts only those sites which offer original content and not those sites offer original content and not those sites which only link to or which only link to or re-package content re-package content offered elsewhereoffered elsewhere (Nothing wrong with (Nothing wrong with doing that, but I don’t want to count the doing that, but I don’t want to count the same activity twice)same activity twice)
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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
December 2006December 2006 4040 2088420884 1414 7979
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Size of Sites – December 2006Size of Sites – December 2006
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 4040 2088420884 1414 7979
50-9950-99 3333 21632163 1212 88
25-4925-49 4646 16431643 1616 66
10-2410-24 8080 12011201 2828 55
5-95-9 3939 273273 1414 11
< 5< 5 4848 123123 1717 11
TotalTotal 286286 2628726287 100100 100100
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
The Largest Sites Dec 2006 - IThe Largest Sites Dec 2006 - IName of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours
eMedicine CMEeMedicine CME 63916391 95869586
ChallengerChallenger 4040 28002800
CMEWebCMEWeb 856856 12841284
ArcMesa Educators 9797 350350
JournalBytes (All Specialties)JournalBytes (All Specialties) 108108 346346
McGill Cont Medical EducationMcGill Cont Medical Education 346346 346346
Oncologist (The)Oncologist (The) 318318 318318
Clinical Directors NetworkClinical Directors Network 300300 300300
FreeCMEFreeCME 179179 300300
Rad Soc North America 300 300
TheAnswerPage 5 300
NetCE 32 250
CardioVillage 10 231
PriMed Online 173 220
Ohio State University 205 205
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
The Largest Sites Dec 2006 - 2The Largest Sites Dec 2006 - 2Name of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours
CME Institute (Psychiatry)CME Institute (Psychiatry) 200200 200200
Johns Hopkins Adv Study coursesJohns Hopkins Adv Study courses 100100 166166
CMELectures.orgCMELectures.org 110110 165165
Pediatrix UniversityPediatrix University 110110 165165
Audio DigestAudio Digest 7373 146146
Amer Soc Clin Path Check SampleAmer Soc Clin Path Check Sample 145145 145145
NEJM Weekly CME ProgramNEJM Weekly CME Program 140140 140140
BioCritiqueBioCritique 271271 135135
JAMA & ArchivesJAMA & Archives 130130 130130
MedRisk OnlineMedRisk Online 2727 127127
University of WisconsinUniversity of Wisconsin 6262 126126
ACP Medicine Online VersionACP Medicine Online Version 11 120120
Amer Acad Ped Self AssessmentAmer Acad Ped Self Assessment 33 120120
Epocrates Mobile CMEEpocrates Mobile CME 120120 120120
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
The Largest Sites Dec 2006 - 3The Largest Sites Dec 2006 - 3Name of SiteName of Site No. of ActivitiesNo. of Activities No. of HoursNo. of Hours
Johns Hopkins Adv Study JournalJohns Hopkins Adv Study Journal 3636 117117
American Psychiatric AssociationAmerican Psychiatric Association 1717 116116
Amer Acad Peds Other CoursesAmer Acad Peds Other Courses 1414 114114
Children’s Minnesota Grand RoundsChildren’s Minnesota Grand Rounds 110110 110110
Washington Univ St LouisWashington Univ St Louis 106106 110110
Anesoft Medical SimulationAnesoft Medical Simulation 66 106106
EMed Home Concert programEMed Home Concert program 33 105105
DiabetesConnect.orgDiabetesConnect.org 9999 103103
The heart.orgThe heart.org 100100 100100
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Fee Structure – Free SitesFee Structure – Free Sites
There has been a leveling off in the There has been a leveling off in the number of sites offering free CME – from number of sites offering free CME – from 177 sites (70%) to 168 sites (59%) in 177 sites (70%) to 168 sites (59%) in December 2006.December 2006.
There has been a similar leveling off in the There has been a similar leveling off in the number of free credit-hours – from 5075 number of free credit-hours – from 5075 hours (20%) in June 2005 to 5740 (21%) hours (20%) in June 2005 to 5740 (21%) in December 2006.in December 2006.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Fee Structure – Pay for Credit SitesFee Structure – Pay for Credit Sites
There has been very little change in the There has been very little change in the median fee for a credit hour. The bulk of median fee for a credit hour. The bulk of the fee instruction (70-80%) continues to the fee instruction (70-80%) continues to cost $5 to $15 per credit hourcost $5 to $15 per credit hour
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Fee Structure by Site Dec 2006Fee Structure by Site Dec 2006Dominant or Average FeeDominant or Average Fee Number of SitesNumber of Sites % of Sites% of Sites
FreeFree 168168 5959
<$5 per hour<$5 per hour 1515 55
$5 per hour$5 per hour 88 33
$6-9 per hour$6-9 per hour 1414 55
$10 per hour$10 per hour 1616 66
$11-14 per hour$11-14 per hour 44 11
$15 per hour$15 per hour 2828 1010
$16-19 per hour$16-19 per hour 33 11
$20 per hour$20 per hour 1010 33
$21-24 per hour$21-24 per hour 44 11
$25 per hour$25 per hour 66 22
>$25 per hour>$25 per hour 1010 33
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Hourly Fee Structure Dec 2006Hourly Fee Structure Dec 2006Dominant or Average FeeDominant or Average Fee No of HoursNo of Hours % of Hours% of Hours
FreeFree 57405740 2222
<$5 per hour<$5 per hour 12031203 55
$5 per hour$5 per hour 1004210042 3838
$6-9 per hour$6-9 per hour 24482448 99
$10 per hour$10 per hour 904904 33
$11-14 per hour$11-14 per hour 7878 11
$15 per hour$15 per hour 43844384 1717
$16-19 per hour$16-19 per hour 304304 11
$20 per hour$20 per hour 407407 22
$21-24 per hour$21-24 per hour 272272 11
$25 per hour$25 per hour 199199 11
>$25 per hour>$25 per hour 230230 11
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Financial Support Summary: Financial Support Summary: There has been very little change in There has been very little change in
relative percentages of financial relative percentages of financial support since December, 2001.support since December, 2001.
As the number of free sites increases, As the number of free sites increases, the number of fee sites decreasesthe number of fee sites decreases
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Financial Support Dec 2006Financial Support Dec 2006
Source of SupportSource of Support No. of SitesNo. of Sites % of Sites% of Sites
Commercial CompaniesCommercial Companies 152152 5151
University/Medical SchoolUniversity/Medical School 9898 3333
GovernmentGovernment 3333 1111
Medical/Specialty AssociationMedical/Specialty Association 6666 2222
FoundationFoundation 1313 44
User Fees/Partial or CompleteUser Fees/Partial or Complete 118 118 (approximate)(approximate)
4141
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Primary Care and Specialty SitesPrimary Care and Specialty Sites
Family Practice and Internal Medicine Family Practice and Internal Medicine content continues to dominate the content continues to dominate the Primary Care sites (about 40% of sites).Primary Care sites (about 40% of sites).
Cardiology, Psychiatry, Infectious Cardiology, Psychiatry, Infectious Disease/HIV, and Oncology content Disease/HIV, and Oncology content appear most frequently (about 20% of appear most frequently (about 20% of sites for each specialty).sites for each specialty).Many sites offer instruction for more than one specialty groupMany sites offer instruction for more than one specialty group
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Specialty – Primary Care Dec 2006Specialty – Primary Care Dec 2006
No. of SitesNo. of Sites % of Sites% of Sites
Primary Care SitesPrimary Care Sites
including:including:
Family PracticeFamily Practice 108108 3636
Internal MedicineInternal Medicine 9797 3232
PediatricsPediatrics 3737 1212
Obstetrics/GynecologyObstetrics/Gynecology 2828 99
Multiple Specialties (>6)Multiple Specialties (>6) 3535 1212
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Subspecialties Dec 2006Subspecialties Dec 2006
Subspecialty sitesSubspecialty sites Number of SitesNumber of Sites % of Sites% of Sites
including:including:
CardiologyCardiology 2727 99
Infectious Disease/HIVInfectious Disease/HIV 2424 88
PsychiatryPsychiatry 2020 77
OncologyOncology 2020 77
RadiologyRadiology 2020 77
EndocrineEndocrine 1616 55
SurgerySurgery 1313 44
NeurologyNeurology 1212 44
Pulmonary-Critical CarePulmonary-Critical Care 1010 33
GeriatricsGeriatrics 88 33
UrologyUrology 88 33
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Sites by Specialty-Dec 2006- OtherSites by Specialty-Dec 2006- Other
36 sites (12%) offer subjects of interest 36 sites (12%) offer subjects of interest to many specialists: ethics, legal, to many specialists: ethics, legal, practice management, risk practice management, risk management, tobacco cessation, management, tobacco cessation, addiction, alcoholism, genetics, basic addiction, alcoholism, genetics, basic sciencescience
Many other specialties are included at 5 Many other specialties are included at 5 or fewer sitesor fewer sites
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Five “Different” Sites Dec 2006- IFive “Different” Sites Dec 2006- ICE Medicus CE Medicus has no CME of its own, but offers has no CME of its own, but offers access without fee to about 6100 activities (about access without fee to about 6100 activities (about 9000 hours) produced by 20 content providers. 9000 hours) produced by 20 content providers. Instruction is free.Instruction is free.Doctor’s Guide Doctor’s Guide also has no CME of its own, but also has no CME of its own, but offers descriptions of over 2000 activities (free offers descriptions of over 2000 activities (free and fee) with links to those coursesand fee) with links to those coursesDigiscriptDigiscript contains many hundreds of audio and contains many hundreds of audio and video slide lectures recorded at medical video slide lectures recorded at medical meetings. The yearly charge is $400. Somemeetings. The yearly charge is $400. Some activities offer CME and others do not. The site is activities offer CME and others do not. The site is searchable by medical topic and by sponsoring searchable by medical topic and by sponsoring organization. You may have to pay an additional organization. You may have to pay an additional fee for CME credit by any given sponsor.fee for CME credit by any given sponsor.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Five “Different” Sites June 2005 IIFive “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 Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Email Reminders Dec 2006Email Reminders Dec 2006
It is becoming increasingly common It is becoming increasingly common for the larger sites to send email for the larger sites to send email reminders on request of the users reminders on request of the users about their new courses. At least 55 about their new courses. At least 55 sites are doing this regularlysites are doing this regularly
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Types of InstructionTypes of Instruction
There has been little recent change in the There has been little recent change in the proportion of instruction types. (But see my proportion of instruction types. (But see my comments about podcasts and point-of-comments about podcasts and point-of-service models below.) service models below.) Text (with or without graphics) remains the Text (with or without graphics) remains the dominant mode, followed by slide-audio or dominant mode, followed by slide-audio or slide-video lectures, case-based interactive slide-video lectures, case-based interactive and question-and-answer instruction.and question-and-answer instruction.For definitions of these and other types of For definitions of these and other types of online instruction, seeonline instruction, see Types of Online CME Instruction DefinedTypes of Online CME Instruction Defined
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Types of Instruction Dec 2006-ITypes of Instruction Dec 2006-I
Instruction TypeInstruction Type Number of SitesNumber of Sites % of Sites% of Sites
Text onlyText only 8686 2929
Text-and-graphicsText-and-graphics 6565 2222
Slide-audioSlide-audio 6767 2222
Slide-videoSlide-video 5656 1919
GuidelinesGuidelines 55 22
Question-and-answerQuestion-and-answer 1010 33
Case-Based-InteractiveCase-Based-Interactive 5757 1919
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Types of Instruction Dec 2006-IITypes of Instruction Dec 2006-II
Instruction TypeInstruction Type Number of Number of SitesSites
% of Sites% of Sites
CorrespondenceCorrespondence 44 11
GamesGames 44 11
JournalJournal 1818 66
Journal with multiple subjectsJournal with multiple subjects 1212 44
Board Review/Self-AssessmentBoard Review/Self-Assessment 55 22
Streaming VideoStreaming Video 1414 55
Self-Directed Search (POS)Self-Directed Search (POS) 33 11
Text-AudioText-Audio 55 22
Pod castPod cast 55 22
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
More about Question & Answer InstructionMore about Question & Answer Instruction
Only 10 sites (3%) feature Q&A, BUT the number of hours is relatively large (3545)Challenger - 2800 hoursTheAnswerPage – 300 hoursAm Acad Pediatrics Self-Assessment – 120 hoursEMedHome Concert – 105 hoursAm Acad Orthopedic Self-Assessment – 75 hoursOrthopedics Hyperguide – 50 hoursEcore Family Practice – 40 hoursMedical Letter – 26 hoursMedical Education Opportunities – 20 hoursInteractive Testing in Psychiatry – 7 hours
Total about 3545 hours (13 % of all CME hours)
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Sites I Could Not ViewSites I Could Not View
There are a number of proprietary sites, e.g., staff model HMOs, There are a number of proprietary sites, e.g., staff model HMOs, like Kaiser-Permanente, where access to instruction is limited like Kaiser-Permanente, where access to instruction is limited to staff members of that organization. Those sites are not to staff members of that organization. Those sites are not reviewed in this report.reviewed in this report.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
PodcastsPodcasts
I only counted five sites offering podcasts, I only counted five sites offering podcasts, but I may have missed some sites that but I may have missed some sites that added podcasts after my visitadded podcasts after my visit
I believe that podcasting will catch on I believe that podcasting will catch on quickly because the technology is easy to quickly because the technology is easy to apply and because most younger doctors apply and because most younger doctors and many older ones have I-Pods or other and many older ones have I-Pods or other portable playersportable players
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Point of Care/Self Study Point of Care/Self Study
I counted only three sites offering “Point of I counted only three sites offering “Point of Care” CME, but I believe some have been Care” CME, but I believe some have been added since my count.added since my count.
I know that some providers (Skolar, I know that some providers (Skolar, MerckMedicus) have given up the effortMerckMedicus) have given up the effort
Time will tell; it’s a great idea, but may be Time will tell; it’s a great idea, but may be too awkward to use in practicetoo awkward to use in practice
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Sites that have closedSites that have closed
About 44 sites offering about 800 credit About 44 sites offering about 800 credit hours disappeared between July 2005 hours disappeared between July 2005 and November 2006and November 2006
In about half the cases, this was planned In about half the cases, this was planned because credit expiredbecause credit expired
In the other half, the site disappeared, In the other half, the site disappeared, sometimes with an explanation and sometimes with an explanation and sometimes withoutsometimes without
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
CME Participation by Location Based on CME Participation by Location Based on ACCME Figures for 2005ACCME Figures for 2005
Live meetings and conferences accounted for 52% Live meetings and conferences accounted for 52% of “physician-registrants”of “physician-registrants”
Home study CME (“enduring materials”) and Home study CME (“enduring materials”) and journals accounted for 30% of physician-registrantsjournals accounted for 30% of physician-registrants
Online CME accounted for about 18% of physician-Online CME accounted for about 18% of physician-registrantsregistrants
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Physician Usage of Online CMEPhysician Usage of Online CME
Physician usage of online CME is increasing, and Physician usage of online CME is increasing, and now accounts for about 18% of all CME now accounts for about 18% 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 (14%)2004: 895,120 physician-registrants (14%)2005: 1,368,335 physician-registrants (18%)2005: 1,368,335 physician-registrants (18%)
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Changes and Trends IChanges and Trends I
There is a gradual upward trend in the numbers There is a gradual upward trend in the numbers of sites, courses and hours (about 5% increase of sites, courses and hours (about 5% increase over the past 18 months)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 found; about 44 sites offering about 800 hours found; about 44 sites offering about 800 hours have discontinued operationhave discontinued operationThere has been a small increase in the number of There has been a small increase in the number of free CME hours (5740 vs. 5074) over the 18 free CME hours (5740 vs. 5074) over the 18 months. There has been little change in the months. There has been little change in the specialty groups targeted, types of instruction or specialty groups targeted, types of instruction or the sources of financial support.the sources of financial support.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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 to 1,368,335 (18%) in 2005.899,390 (14%) in 2004 to 1,368,335 (18%) in 2005.
The number of physicians registering for online The number of physicians registering for online CME has tripled in the past three years.CME has tripled in the past three years.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Why is Online CME use Still So Low? IWhy is Online CME use Still So Low? I
Pretty soon I hope to eliminate the ”Why is Online Pretty soon I hope to eliminate the ”Why is Online CME Use so low?” portion of this report.CME Use so low?” portion of this report.My points about the “low” use of Online CME are My points about the “low” use of Online CME are still pertinent, BUT much less so than just a few still pertinent, BUT much less so than just a few years ago:years ago:Some physicians are still uneasy with computers Some physicians are still uneasy with computers and the Internet and the Internet Some physicians are unaware of online CME or don’t Some physicians are unaware of online CME or don’t know how to find itknow 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
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Why is Online CME Use Why is Online CME Use Still Still So Low? IISo Low? II
These observations remain true, BUT, again, These observations remain true, BUT, again, to a lesser extent tan in past years:to a lesser extent tan in past years:A series of “gates” for the user to pass A series of “gates” for the user to pass throughthroughNavigation: 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 Each site has a different procedure and passwordpassword
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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” sitePrice (lower is better; free is best)Price (lower is better; free is best)Preference for Type of InstructionPreference for Type of InstructionEmail reminders (the more frequent the better)Email reminders (the more frequent the better)The CME is part of a larger medical site which offers The CME is part of a larger medical site which offers additional services for doctors (“one-stop-additional services for doctors (“one-stop-shopping”)shopping”)Help with CME reportingHelp with CME reportingRecommendation by colleagues, medical groupRecommendation by colleagues, medical groupSpecial arrangements with physician groupSpecial arrangements with physician group
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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 18%, the (I believe that, with usage now at 18%, the answer is YES)answer is YES)
What do they like and dislike?What do they like and dislike?
(According to most studies, lectures are (According to most studies, lectures are still the preferred mode of instruction) still the preferred mode of instruction)
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
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
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Other Problems to SolveOther Problems to Solve
Another problem will be to prove that a given CME Another problem will be to prove that a given CME activity actually improves physician performance.activity actually improves physician performance.
For now, CME providers and evaluating groups will For now, CME providers and evaluating groups will need to settle for some lesser measure, such as the need to settle for some lesser measure, such as the difference in scores between pre-tests and post-difference in scores between pre-tests and post-tests, or statements by “experts” that the course will tests, or statements by “experts” that the course will correct the deficiency.correct the deficiency.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Opportunities for ResearchOpportunities for Research
More sophisticated (and expensive) methods of More sophisticated (and expensive) methods of evaluation exist, such as reviewing physician charts evaluation exist, such as reviewing physician charts or interviewing patientsor interviewing patients
This is a great opportunity for research. This is a great opportunity for research.
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Conclusions IConclusions I
The number of online CME activities and credits is The number of online CME activities and credits is growing rapidly. Online CME is becoming nicer to growing rapidly. Online CME is becoming nicer to look at, with more graphics, lots more audio and look at, with more graphics, lots more audio and video, and a bit more interactive programmingvideo, and a bit more interactive programming
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Conclusions IIConclusions II
The percentage of CME hours earned online has risen The percentage of CME hours earned online has risen to about 18%to about 18%
Barriers to usage are coming downBarriers to usage are coming down
There is very little proof that any kind of standalone There is very little proof that any kind of standalone CME, whether live, home study or online, and regardless CME, whether live, home study or online, and regardless of mode of instruction, is useful in changing physician of mode of instruction, is useful in changing physician practicepractice
Results of most studies indicate that a coordinated set of Results of most studies indicate that a coordinated set of educational interventions will be needed to accomplish educational interventions will be needed to accomplish behavior changebehavior change
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Conclusions IIIConclusions III
The future lies in the integration of medical practice, The future lies in the integration of medical practice, quality assessment and user-specific CMEquality assessment and user-specific CME
The challenges and opportunities are greatThe challenges and opportunities are great
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Important URLsImportant URLs
Master’s thesis: Master’s thesis: www.cmelist.com/mastersthesis/www.cmelist.com/mastersthesis/
My home page: My home page: www.cmelist.comwww.cmelist.com
Online CME list: Online CME list: www.cmelist.com/list.htmwww.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 2005ACCME Annual Report 2005
Bernard Sklar, MD: Online Continuing Bernard Sklar, MD: Online Continuing Medical Education December 2006Medical Education December 2006
Questions or Comments?Questions or Comments?
Send email to Send email to [email protected]@netcantina.com
Top Related