Online CME – An Update

1. Online CME – An Update • Review of July 2003 • Bernard M. Sklar, M.D., M.S. • www.cmelist.com/list.htm • bersklar@netcantina.com

2. Plan of Presentation • Results of Recent and Past Surveys • Types of Instruction • Physician Use of CME and Online CME • Obstacles to Physician Use

3. Master’s Thesis • This review is based on the July 2003 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.

4. 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

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

6. Extensive Updates • I have been maintaining the list for about six years • The list was updated for my master’s thesis in February 2000, again in August and December 2000, in December 2001, in June 2002, December 2002 and in July 2003.

7. Annotated List of Online CME Sites

8. Database Created from List Based on examining each site, I have updated an Access database of the 253* sites offering CME in July 2003. 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.

9. Results of Study I • The number of sites and activities continues to increase • April 1997 – 13 sites • December 1997 – 18 sites • August 1998 – 61 sites • May 1999 – 69 sites • December 1999 – 87 sites

10. 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.

11. Results of Study III • December 2001 • 197 sites • 12026 activities • 17523 hours

12. Results of Study IV • June 2002 • 209 sites • 10952 activities • 18266 hours

13. Results of Study V • December 2002 • 229* sites (200 sites for certain counting purposes) • 11485 activities • 19105 hours

14. Results of Study VI • July 2003 • 253* sites (210 sites for certain counting purposes) • 11346 activities • 20299 hours

15. Size of Sites – December 2001

16. Size of Sites – June 2002

17. Size of Sites – December 2002

18. Size of Sites – July 2003

19. The Largest Sites December 2001

20. The Largest Sites June 2002

21. The Largest Sites December 2002

22. The Largest Sites July 2003 Page 1

23. The Largest Sites July 2003 Page 2

24. Fee Structure by Site Dec 2001

25. Fee Structure by Site June 2002

26. Fee Structure by Site December 2002

27. Fee Structure by Site July 2003

28. Hourly Fee Structure Dec 2001

29. Hourly Fee Structure June 2002

30. Hourly Fee Structure December 2002

31. Hourly Fee Structure July 2003

32. Financial Support Dec 2001

33. Financial Support June 2002

34. Financial Support December 2002

35. Financial Support July 2003

36. Specialty – Primary Care Dec 2001

37. Specialty – Primary Care June 2002

38. Specialty – Primary Care December 2002

39. Specialty – Primary Care July 2003

40. Subspecialties Dec 2001

41. Subspecialties June 2002

42. Subspecialties December 2002

43. Subspecialties July 2003

44. 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

45. 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

46. Sites by Specialty-December 2002- Other • 36 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

47. Sites by Specialty-July 2003- Other • 35 sites (14%) 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

48. Seven “Different” Sites I • CE Medicus has no CME of its own, but offers access without fee to about 9000 activities produced by six content providers. Instruction is free. • Doctor’s Guide also has no CME of its own, but offers descriptions of over 900 activities (free and fee) with links to those courses • Digiscript contains many hundreds of audio and video slide lectures recorded at medical meetings. The yearly charge is $400. Someactivities offer CME and others 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. • University of Wisconsin Professional Courses offer credit for courses on non-medical subjects which could be expected to improve your practice or your life.

49. Seven “Different” Sites 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.

50. Sites I Could Not View • There are 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.