CME Credits as Indicators of Improved Physician Competence: An Online Survey

1. CME Credits as Indicators of Improved Physician Competence: An Online Survey

2. Judith Ribble, PhD Dir, CME, Medscape/WebMD; no other financial interests Jribble@webmd.net; www.medscape.com Bernard Sklar, MD, MS Consultant, Online CME; Consultant for Schering-Plough Bsklar@netcantina.com; www.cmelist.com

3. Presented at the Alliance for Continuing Medical Education Annual Meeting January 31, 2003 Dallas, Texas

4. Purpose of Study • Determine how physicians who have completed online CME activities perceive the value of earning and documenting CME credits [“the CME credit system”] • Contribute quantitative and qualitative data from a pilot study to the CME field

5. Objectives After attending this session, you should be able to: • Assess howphysicianswho have completed online CME perceive the value of CME credits • Cite metrics that reflect the survey findings • Describe a method of conducting surveys online.

6. Literature Review

7. Slotnick et al., 1994 • Physician Preferences in CME Including Insights into Education versus Promotion • The study “examined the factors that physicians consider in deciding to attend CME” • “Availability of CME credit was markedly associated with selection of CME activities” (the most important single criterion) Source: JCEHP Volume 14, pp. 173-86

8. Slotnick et al., 1994 (continued) • Possible explanation of importance of CME credits: In addition to meeting requirements, “CME-awarding activities are often sponsored by organizations (such as specialty societies) for whom ensuring availability of credit is important”

9. Slotnick et al., 1995 • “Rethinking Continuing Medical Education” • In-depth interviews of 26 physicians • The availability of credit found to be a very important factor in attending activities, but the explanations for that importance were not consistent Source: JCEHP Volume 15, pp. 8-22

10. Harris et al., 2001 • Can Internet-based CME improve physicians' skin cancer knowledge and skills? • Use of the program was associated with significant improvements in physician confidence, knowledge and clinical skills Source: J Gen Intern Med 2001; 16:50-56

11. Heath KJ, Jones JG, 1998 • Experiences and attitudes of consultant and nontraining grade anaesthetists to continuing medical education (CME). • Most anaesthetists were motivated to achieve the required number of credits • Continuing medical education was felt to be effective Source: Anaesthesia 1998 May;53(5):461-7 (UK)

12. du Boulay, 1997 • Continuing medical education for pathologists: Royal College of Pathologists' Wessex pilot scheme • CME is important; positive attitudes • They want a wide variety of locally based CME activities • They value local activities that link theory with practice. Source: J Clin Pathol 1997 Dec;50(12):1022-6

13. Hagus CK, 2000 • Health care professionals' attitudes toward licensure, national certification, and continuing education requirements: results of a Texas survey • The majority of the respondents supported the need for licensure and certification and perceived that they benefited personally (from CME/CE). Source: J Allied Health 2000 Spring;29(1):18-24

14. B.R. Rowe et al., 1995 • Continuing medical education: A comparison of Northeastern and Southern Ontario physicians. • “Although Ontario physicians felt CME should form part of practice assessment, there was ambivalence regarding its use for relicensure.…” Source: B. Minore and C. Hartvikson, eds., Redressing the Imbalance: Health Human Resources in Rural and Northern Communities

15. Personal Communications Listserve postings and personal emails from B. Sklar (quoted with permission): “Are you aware of studies where physicians were questioned about their attitudes toward earning CME credits?”

16. Steve Weinman Exerpta Medica Excerpta Medica asked their members: "If you were to receive two identical pieces of medical educational literature and one is CME certified and the other is not, which would you choose to read?" • 89% indicated they would preferentially choose the CME certified literature. • 0% indicated they would preferentially choose the non- CME certified literature. • 11% indicated that it did not matter to them.

17. Dennis Wentz American Medical Association (AMA) • Asked: “Is the current CME credit system an albatross?” • Answered: “No. Based on my distillation of comments from the CME subcommittee of the AMA Council on Medical Education, the CMSS document on Repositioning of CME, and from talking to lots of practicing physicians from around the country … “No - documentation of CME credits is going to continue to be required and is still very much wanted by doctors“

18. Mary Logan American Medical Directors Association [AMDA] • “One of the most frequently asked questions about our programs is whether or not there is CME - and the number of credits available. On-site, comments from attendees suggest that they do come for the credit hours as well as for the value of the education itself. • “Because our members also belong to AAFP and AOA we frequently seek the respective association credit hours …that are specifically sought by our attendees.”

19. Beth Hunter Amer. Society of Reproductive Medicine (ASRM) • “Many of our members read our journal, including the ones marked for CME credit (test), but do not take the test. Many simply don't need the credit as the number of credits per state varies. In Alabama, for example, we have very few (12/yr) compared to other states .” • “Most of our members receive all or most of their needed credits for the year at our Annual Meeting, which provides around 30-35. ”

20. Sarajane Garten Society of General Internal Medicine (SGIM) • “Less than 20% of attendees at our annual and regional meetings ever apply for CME credit. • This could be because: • Our members are primarily academic physicians, not clinicians • They earn more CME credits than they can ever use • They perceive of CME as clinical learning only, and while we offer some clinical content at all of our activities, our CME program is not primarily clinical in nature. • In other words, they get their CME (clinical) from the ACP meeting or grand rounds. They come to SGIM activities for non-clinical information (curriculum development), and don't identify that as CME.”

21. Anonymous Correspondent • “This is not an issue I have ever reallyconsidered because CME, like death and taxes, is an unavoidable element of medical practice.”

22. Survey Methods • Online survey • Instrument by SurveyMonkey.com • Links posted on Medscape • Home Pages and MedPulse links • Jan 23-30, 2003 • Opt-in link opened online survey: • “Please take a minute to complete a short survey”

24. Survey Population • Self-selected online participants 185 • Registered as physicians on Medscape • Respondents who reported earning CME credits online 123

25. Results

28. Question 1 The CME credit system is an effective method of motivating physicians to keep up-to-date with medical advances. Strongly Disagree Neutral Agree Strongly Mean Disagree Agree Score 4% (5) 5% (6) 7% (8) 47%(58) 37%(46) 4.09 (123) 84%

29. Question 2 Earning CME credits encourages physicians to maintain clinical competency. Strongly Disagree Neutral Agree Strongly Mean DisagreeAgree Score 4%(5) 2%(3) 11%(13) 48%(58) 35% (43) 4.07 (123) 83%

30. Question 3 The CME credit system is perceived by most physicians as useful in motivating physicians to maintain clinical competency. Strongly Disagree Neutral Agree Strongly Mean Disagree Agree Score 4% (5) 7% (8) 20% (25) 39% (48) 30% (36) 3.84 69%

31. Question 4 Physicians who earn at least 50 CME credits per year are likely to be more competent than physicians who do not earn any credits. Strongly Disagree Neutral Agree Strongly Mean Disagree Agree Score 3% (4) 12% (15) 20% (25) 44% (54) 20% (25) 3.66 (123) 64%

32. Question 5 The current CME credit system should be replaced by a more rigorous national monitoring system. Strongly Disagree Neutral Agree Strongly Mean Disagree Agree Score 32% (39) 37% (46) 19% (23) 9% (11) 3% (4) 2.15 (123) 69%

33. OPEN-ENDED COMMENTSComment, # 1 “I think CME is great…. It aids in teaching you the latest in your specialty, plus you learn what you are not current on and may concentrate on that.”

34. Comment, # 2 “ I am always reading and learning. There is not always attached CME. I find myself leaning toward reading things with attached CME to meet requirements. You get no credit otherwise for your endeavors and time is limited.”

35. Comment, # 3 “It is important that obtaining CME credit NOT place an undue drain on the time and pocketbook of a physician. Online CME is an excellent method of accomplishing this.”

36. Comment, # 4 “The current CME credit system has some loopholes that need attention. In principle, the system is sound and should NOT be replaced, just tightened up in order to maintain its integrity and authority and hence its credibility.”

37. Comment, # 5 “ I disagree with the concept of living in a police state. Those of us interested in furthering our medical knowledge will continue to read and study without being "beat up" by a system that requires specific subjects be added to our CME curricula, whether they be pertinent to field of interest or not. CME in the past was a sharing of information, not a business in itself.”

38. Comment, # 6 “The present CME system is an incredible boondoggle. It is dominated by commercial interests and credits are given where none are deserved. No commercial company should be allowed to certify credits. Only medical schools and a relatively few tertiary referral centers and carefully screened teaching hospitals should be certified for (CME).”

39. Limitations of Online Study • Pilot study • Random sampling not available • Opt-in survey; rotated [not constant] • Active physician status not verified • CME is traditionally an honor system • Medscape registrants only • Trends reported • Summary data • Not analyzed for statistical significance

40. Strengths of Study • Captured feedback from physicians themselves • Quantifiable data; not anecdotal opinions • Good interactivity: • 32 open-ended comments (17%) • 83 requested results (45%) • Low cost; not labor-intensive • Rapid results; dynamic tallies online

41. Summary of Results

42. Conclusions • Most respondents agreed that the present CME credit system is an effective/useful method of : • motivating physicians to keep up-to-date • encouraging physicians to maintainclinical competency

43. Conclusions • Most respondents agreed that physicians who earn at least 50 CME credits/yr are more likely to be competent than physicians who do not earn any credits.

44. Conclusions • Most respondents disagreed that the current CME credit system should bereplaced by a more rigorous national monitoring system.

45. Slides Will Be Available Online www.cmelist.com/slideshows For further information: Bernard Sklar, MD, MS bersklar@netcantina.com; www.cmelist.com Judith Ribble, PhD jribble@webmd.com; www.medscape.com