Evolution of Online CME: Trends & Insights | Bernard M. Sklar, M.D.

1. Online CME – An Update • Review of December 2002 • 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 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.

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 and December 2002.

7. Annotated List of Online CME Sites

8. Database Created from List Based on examining each site, I created an Access database of the 229* sites offering CME in December 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.

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. Size of Sites – December 2000

15. Size of Sites – December 2001

16. Size of Sites – June 2002

17. Size of Sites – December 2002

18. The Largest Sites December 2000

19. The Largest Sites December 2001

20. The Largest Sites June 2002

21. The Largest Sites December 2002

22. Fee Structure by Site Dec 2000

23. Fee Structure by Site Dec 2001

24. Fee Structure by Site June 2002

25. Fee Structure by Site December 2002

26. Hourly Fee Structure Dec 2000

27. Hourly Fee Structure Dec 2001

28. Hourly Fee Structure June 2002

29. Hourly Fee Structure December 2002

30. Financial Support Dec 2000

31. Financial Support Dec 2001

32. Financial Support June 2002

33. Financial Support December 2002

34. Specialty – Primary Care December 2000

35. Specialty – Primary Care Dec 2001

36. Specialty – Primary Care June 2002

37. Specialty – Primary Care December 2002

38. Subspecialties Dec 2000

39. Subspecialties Dec 2001

40. Subspecialties June 2002

41. Subspecialties December 2002

42. 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

43. 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

44. 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

45. Five “Different” Sites I • CE Medicus has no CME of its own, but offers access without fee to about 550 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. 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. • 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

46. Five “Different” Sites II • University of Wisconsin Professional Courses offer credit for courses on non-medical subjects which could be expected to improve your practice or your life. • Stanford SKOLAR offers credit for performing Internet literature searches on topics of your own interest

47. 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.

48. 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 Email Reminders June 2002

49. Email Reminders December 2002 About 24 sites send out regular email reminders about additions to their lists of activities on request by users: Audio Digest, Boston University, cmecorner, cmecourses, CMEcybersessions, Cyberounds, Doctor’s Guide, eMedHome.com, eMedicine, GAMA Longevity, Medsite, Journal of Clinical Psychiatry, Medinfosource, Medscape, Meniscus, MMWR, mypatient.com, Natal U, pedsref, psychLINK, Serono, University of Wisconsin, Virtual Lecture Hall, World Medical Leaders

50. 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 • Journal with Multiple Topics