Online CME Research Articles

Occupational Asthma

MOC as well as CME credit can now be obtained, free for a limited time, by reviewing this Difficult Cases presentation. Please note the following instructions. 1.Review the target audience, learning objectives, and author disclosures. 2.Complete the pre-test online at the JACI: In Practice homepage at www.jaci-inpractice.org (click on the Online CME heading). 3.Follow the online instructions to review the full online version of the presentation. 4.Complete the post-test. At this time, you will have earned 1.0 AMA PRA Category 1 CME Credit™. 5.Approximately 4 weeks later you will receive an online assessment regarding your application of this article to your practice. Once you have completed this assessment, you will be eligible to receive 2 MOC Part II Self-Assessment credits from the American Board of Allergy and Immunology. CME Exam: Occupational AsthmaThe Journal of Allergy and Clinical Immunology: In PracticeVol. 4Issue 4Preview Full-Text PDF

Preparing for a paradigm shift in the treatment of ovarian cancer: Effect of online CME on oncologists' knowledge and competence

Preparing for a paradigm shift in the treatment of ovarian cancer: Effect of online CME on oncologists' knowledge and competence

Abstract #238: Improving Impact of Guidelines on T2d: Effect of Online CME and Need for Further Education

Abstract #238: Improving Impact of Guidelines on T2d: Effect of Online CME and Need for Further Education

APA Approves Development of Registry, Takes Other Major Actions

APA Approves Development of Registry, Takes Other Major Actions

Abstract 126: Cardiac Stress Testing: Optimizing Outcomes Through Dual Physician-Patient Education

Background: Even though cardiovascular (CV) tests, which are used to assess coronary arterial disease (CAD) are included in medical guidelines, cardiologists have limited ability to adequately perform appropriate testing modalities. In parallel, many patients have concerns or anxiety related to CV testing, and are not proactively educated on how to prepare for their procedure. Goals: To determine if an online parallel physician-patient education interventions could improve performance of cardiologists related to CV stress testing, and patient knowledge about the procedure. Methods: An online CME activity was developed as a 25-minute roundtable discussion with 3 leading experts on criteria for appropriate use of stress testing and preparing physicians to communicate the risks and benefits of testing modalities to their patients. The activity included a transcript of the discussion and a downloadable slide deck to reinforce key recommendations. Participant responses to questions were collected after the education (post-assessment) and compared with each user’s baseline data (pre-assessment) using a 2-tailed paired T-test to provide P values for assessing the impact of education. The CME activity also included a link to a patient/caregiver education module, developed in parallel to educate patients and their caregivers about cardiac stress testing. Patient/caregiver responses post-education compared to pre-education were also assessed to measure improvement in knowledge. Results: A total of 312 of cardiologists who participated in the CME activity and answered all pre- and post-assessment questions were included in the analysis. In addition, 3458 patients preparing for a stress test, 640 family members, 116 caregivers, and 3299 other participants interested in the topic of CV testing who completed the patient/caregiver education module and the pre- and post-education questions were included in the assessment. Post-education, significant improvements were observed (Table). Conclusion: This study demonstrated that both knowledge/competence of cardiologists on evidence-based practices as well as the understanding of patient/caregivers on CV testing can be improved using a dual approach to education.

Abstract #260: Targeting Sglt2 Inhibition in T2D Management: Effect of Online Cme and Continued Educational Gaps

Abstract #260: Targeting Sglt2 Inhibition in T2D Management: Effect of Online Cme and Continued Educational Gaps

Strengthening the health system capacity to monitor demographic and population health metrics through surveillance nested on existing government community health structures: A pilot from a rural area of Kenya

Structure/Method/Design: The development of the textbook began with the editor recruiting an editorial board of diverse experts, who then assisted in determining textbook content and identifying pertinent clinicians as chapter authors. Leadership from the Consortium of Universities for Global Health and the former GHEC provided critical input on selecting editorial board members, chapter contributors, and textbook content. Chapter content was developed through an intense and iterative process between chapter authors and the editorial board, including several stages of drafting, reviewing, editing, and revising. We also partnered closely with illustrators from Wiley-Blackwell to produce a text rich in illustrations and photographs. Outcomes & Evaluation: Essential Clinical Global Health includes contributions from nearly 100 global health experts, with content organized into 37 chapters and 6 sections: Introduction; Newborn and Child Health; Adolescent, Reproductive, and Maternal Health; Infectious Diseases; Non-Communicable Diseases; and Other Global Health Topics. Chapters cover the clinical diagnosis, management, and prevention of the leading causes of morbidity and mortality in lowand middle-income countries, along with special chapters on resource-limited health systems and other contextual topics, for example, “Working clinically in resourcelimited settings,” “Preparing for travel and staying safe abroad,” “Neglected tropical diseases,” “Laboratory skills,” “Nursing care,” “Pharmacy,” “Global health technologies,” “Illness in returning travelers,” and “Developing a career in global health.” Each chapter features key learning objectives, evidence-based clinical guidelines, practical clinical skills, realworld experiences from trainees and clinicians in the field, and core readings. The textbook’s accompanying electronic supplement contains additional resources, videos, and self-assessment questions and answers as well as an electronic version of the complete textbook e valuable for reference abroad on a laptop, tablet, or mobile device. Going Forward: As this collaborative textbook is published the beginning of 2015, our goal is to make it widely accessible to individual global health students, trainees, and clinicians, as well as to all institutions with global health programs. We welcome feedback from the global health community on how to improve future editions of Essential Clinical Global Health. We are also working with WileyBlackwell to develop online CME offerings based upon the textbook. Funding: None Abstract #: 01ETC068

Intervention effects from a social marketing campaign to promote HPV vaccination in preteen boys

ObjectivesAdoption of human papillomavirus (HPV) vaccination in the US has been slow. In 2011, HPV vaccination of boys was recommended by CDC for routine use at ages 11–12. We conducted and evaluated a social marketing intervention with parents and providers to stimulate HPV vaccination among preteen boys. MethodsWe targeted parents and providers of 9–13 year old boys in a 13 county NC region. The 3-month intervention included distribution of HPV vaccination posters and brochures to all county health departments plus 194 enrolled providers; two radio PSAs; and an online CME training. A Cox proportional hazards model was fit using NC immunization registry data to examine whether vaccination rates in 9–13 year old boys increased during the intervention period in targeted counties compared to control counties (n=15) with similar demographics. To compare with other adolescent vaccines, similar models were fit for HPV vaccination in girls and meningococcal and Tdap vaccination of boys in the same age range. Moderating effects of age, race, and Vaccines for Children (VFC) eligibility on the intervention were considered. ResultsThe Cox model showed an intervention effect (β=0.29, HR=1.34, p=.0024), indicating that during the intervention the probability of vaccination increased by 34% in the intervention counties relative to the control counties. Comparisons with HPV vaccination in girls and Tdap and meningococcal vaccination in boys suggest a unique boost for HPV vaccination in boys during the intervention. Model covariates of age, race and VFC eligibility were all significantly associated with vaccination rates (p<.0001 for all). HPV vaccination rates were highest in the 11–12 year old boys. Overall, three of every four clinic visits for Tdap and meningococcal vaccines for preteen boys were missed opportunities to administer HPV vaccination simultaneously. ConclusionsSocial marketing techniques can encourage parents and health care providers to vaccinate preteen boys against HPV.

Medical Communication Companies and Industry Grants

Medical communication companies (MCCs) are among the most significant health care stakeholders, supported mainly by drug and device companies. How MCCs share or protect physicians' personal data requires greater transparency. To explore the financial relationships between MCCs and drug and device companies, to describe the characteristics of the large MCCs, and to explore whether they accurately represent themselves to physicians. We combined data from the 2010 grant registries of 14 pharmaceutical and device companies; grouped recipients into categories such as MCCs, academic medical centers, disease-targeted advocacy organizations, and professional associations; and created a master list of 19,272 grants. Determine the distribution of funds from drug and device companies to various entities and assess the characteristics of large MCCs. Of the 6493 recipients of more than $657 million grant awards from drug and device companies, 18 of 363 MCCs received 26%, academic medical centers received 21%, and disease-targeted organizations received 15%. For-profit MCCs received 77% of funds (208 of 363). Among the top 5% of MCCs, 14 of 18 were for-profit. All 18 offered continuing medical education: 14 offered live and 17 offered online CME courses. All required physicians to provide personal data. Ten stated that they shared information with unnamed third parties. Eight stated they did not share information, but almost all added exceptions. None required explicit physician consent to their sharing policies. Medical communication companies receive substantial support from drug and device companies. Physicians who interact with MCCs should be aware that all require personal data from the physician and some share these data with unnamed third parties.

Distance-based training in two community health centers to address tobacco smoke exposure of children

BackgroundThe CEASE (Clinical Effort Against Secondhand Smoke Exposure) intervention was developed to help pediatricians routinely and effectively address the harms of family smoking behaviors. Based on paper versions of CEASE, we partnered with the American Academy of Pediatrics’ online education department and developed a completely distance-based training, including an online CME training, handouts and education materials for families, and phone and email support.MethodsThe pediatric offices of two low income health clinics with primarily Medicaid populations were selected for the study. Pre and post intervention data by survey of the parents was collected in both practices (Practice 1 n = 470; Practice 2 n = 177). The primary outcome for this study was a comparison of rates of clinician’s asking and advising parents about smoking and smoke-free home and cars.ResultsExit surveys of parents revealed statistically significant increases in rates of clinicians asking about parental smoking (22% vs. 41%), smoke-free rules (25% vs. 44%), and asking about other smoking household members (26% vs. 48%).ConclusionsThrough a completely distance based intervention, we were able to train pediatricians who see low income children to ask parents about smoking, smoke-free home and car rules, and whether other household members smoke. Implementing a system to routinely ask about family tobacco use and smoke-free home and car rules is a first step to effectively addressing tobacco in a pediatric office setting. By knowing which family members use tobacco, pediatricians can take the next steps to help families become completely tobacco-free.Trial registrationClinical trials number: NCT01087177

Common Fractures and Dislocations of the Hand

After reading this article, the participant should be able to: 1. Describe the concept of early protected movement with Kirschner-wired finger fractures to the hand therapist. 2. Choose the most appropriate method of fracture fixation to achieve the goal of a full range of motion. 3. Describe the methods of treatment available for the most common fractures and dislocations of the hand. The main goal of treatment of hand and finger fractures and dislocations is to attain a full range of wrist and nonscissoring finger motion after the treatment is accomplished. This CME article consists of literature review, illustrations, movies, and an online CME examination to bring the participant recent available information on the topic. The authors reviewed literature regarding the most current treatment strategies for common hand and finger fractures and dislocations. Films were created to illustrate operative and rehabilitation methods used to treat these problems. A series of multiple-choice questions, answers, discussions, and references were written and are provided online so that the participant can receive the full benefit of this review. Many treatment options are available, from buddy and Coban taping to closed reduction with immobilization; percutaneous pins or screws; and open reduction with pins, screws, or plates. Knowledge of all available options is important because all can be used to achieve the goal of treatment in the shortest time possible. The commonly used methods of treatment are reviewed and illustrated. Management of common hand and finger fractures and dislocations includes the need to focus on achieving a full range of motion after treatment. A balance of fracture reduction with minimal dissection and early protected movement will achieve the goal.

Rationale for Reducing the Spread of Human Papillomavirus in Adolescents: Strategies to Improve Outcomes (CME Multimedia Activity)

As detailed in this online CME activity (http://cmeaccess.com/cme/JAH_HPV_program/index.asp?link_id=2), human papillomavirus (HPV) infection is the cause of cervical cancer and neoplasias in women, and genital warts in men and women. In addition, 35%-85% of vaginal, vulvar, anal, penile, and oropharyngeal cancers are attributable to HPV. An estimated 80% of females and 50% of males in the United States will become infected at some point in their lives; however, the incidence of this highly prevalent infection peaks in adolescents and young adults. Owing to the importance of vaccination before this elevated risk of exposure, the Centers for Disease Control and Prevention recommends HPV vaccination for girls aged 11-12 years with either the bivalent or quadrivalent vaccine. Recently, the quadrivalent vaccine, which also protects against genital warts and anal neoplasias and cancer, was approved for use in boys as well. Although the coverage rate has increased steadily in the 5 years since the vaccine's introduction, it remains below 50%. To overcome barriers to vaccination, including lack of awareness about adolescents' HPV risk and challenges associated with preventive care in this age group in general, healthcare providers must be able to educate parents/patients about HPV and the vaccine, as well as maximize opportunities to vaccinate adolescents at every office visit.

Managing Chronic Pain with Nonopioid Analgesics: A Multidisciplinary Consult

As detailed in this online CME activity (www.cmeaccess.com/AJM/ChronicPain04), determining pain mechanism is an important aspect guiding treatment selection for chronic musculoskeletal pain states. Although broad classifications provide a framework, any combination of mechanisms may be present in a chronic pain patient, and there is growing evidence that pain states generally considered nociceptive may also involve elements of augmented central nervous system pain processing. Nonopioid analgesics, including serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and alpha-2-delta ligand anticonvulsants, are the treatments of choice for fibromyalgia and other central neuropathic pain states. Additionally, studies have now shown that certain SNRIs can be effective in treating "classic" nociceptive pain states, such as osteoarthritis, and also are effective for low back pain. In addition to considering biological mechanisms, chronic pain management also involves recognizing and evaluating the contribution of psychological and sociocultural factors that can influence pain chronicity and patient prognosis. A multimodal/multidisciplinary approach incorporating pharmacologic and nonpharmacologic therapy into a program that includes more than 1 discipline is important to improve outcomes in patients with chronic pain.

Defining quality criteria for online continuing medical education modules using modified nominal group technique *

The rapid increase in the use of the Internet for continuing education by physicians suggests the need to define quality criteria for accredited online modules. Continuing medical education (CME) directors from Canadian medical schools and academic researchers participated in a consensus process, Modified Nominal Group Technique, to develop agreement on the most important quality criteria to guide module development. Rankings were compared to responses to a survey of a subset of Canadian Medical Association (CMA) members. A list of 17 items was developed, of which 10 were deemed by experts to be important and 7 were considered secondary. A quality module would: be needs-based; presented in a clinical format; utilize evidence-based information; permit interaction with content and experts; facilitate and attempt to document practice change; be accessible for later review; and include a robust course evaluation. There was less agreement among CMA members on criteria ranking, with consensus on ranking reached on only 12 of 17 items. In contrast to experts, members agreed that the need to assess performance change as a result of an educational experience was not important. This project identified 10 quality criteria for accredited online CME modules that representatives of Canadian organizations involved in continuing education believe should be taken into account when developing learning products. The lack of practitioner support for documentation of change in clinical behavior may suggest that they favor traditional attendance- or completion-based CME; this finding requires further research.

Multicenter Medical Malpractice Risk Reduction Study for Medical Students, Trainees &amp; Practicing Physicians Using Short Burst [Ssb] E-Mailed Seminars

Purpose: The purpose of this multicenter study was to evaluate the use of medical malpractice risk reduction seminars in the form of short bursts of e-mailed seminars [SBS]. Methods: SBS to teach medical malpractice reduction strategies [1] were designed for hospital trainees and practicing physicians at several institutions and private practices centers in the Northeast, Southeast & West coasts of the U.S. SBS was e-mailed to coordinators in gastroenterology, internal medicine, psychiatry & other specialties who targeted their audience of students, trainees and practicing physicians. The target audience, performed the sequence of pre test, seminar, post test, and returned the testing on an anonymous basis to the coordinators. One answer on the post-test required a short written response to a medical malpractice case study. Pre and post-tests were graded by the change of post-test answer scores compared to pre test total scores. Results: Post-test scores showed significant improvements & documented the benefits of an e-mailed medical malpractice/risk reduction seminar. SBS was well accepted by medical students, gastrointestinal trainees and practicing physicians. Residents [2] and department chiefs learned how to teach medical malpractice reduction techniques which provides a potential pool of new teachers. Actual medical malpractice cases were useful as documented by responses given to a case study. Conclusion: SBS: 1. Offers more convenience, reduces time away from patient care, schedules learning around busy schedules, and can be an ongoing resource to refresh seminar knowledge retention when filed in each participant's e-mail folder. 2. Can be provided in a consistent fashion and specifically tailored to certain levels of training for each specialty. 3. May be delivered in each specialty either as online CME or in a classroom setting by medical schools, teaching hospitals, & medical professional liability insurance companies. 4. Teaches how to teach medical malpractice/risk reduction. 5. More easily connects physicians with risk management specialists with short turn around time to customize contemporaneously in changing risk areas of hospitals and/or different clinical specialties. 6. A medical malpractice case history increases seminar lesson retention. [1] Hookman P. “Medical Malpractice Expert Witnessing: Introductory Guide for Physicians and Medical Professionals” (Hardcover) 592 pages Publisher: CRC; Boca Raton, Fl. ISBN-10: 1420058959; Price $239.95 [2] Aiyer M. et al. “Change in Residents Perceptions of Teaching: Following a One Day Residents as Teachers” [RasT] Workshop, Southern Medical Journal 2008 101[5]:485

Educating Generalist Physicians about Chronic Pain: Live Experts and Online Education Can Provide Durable Benefits

Determine whether lectures by national experts and a publicly available online program with similar educational objectives can improve knowledge, attitudes, and beliefs (KAB) important to chronic pain management. A pretest-posttest randomized design with two active educational interventions in two different physician groups and a third physician group that received live education on a different topic to control for outside influences, including retesting effects, on our evaluation. A total of 136 community-based primary care physicians met eligibility criteria. All physicians attended the educational program to which they were assigned. Ninety-five physicians (70%) provided complete data for evaluation. Physician responses to a standardized 50-item pain management KAB survey before, immediately after, and 3 months following the interventions. The study groups and the 41 physicians not providing outcomes information were similar with respect to age, sex, race, percent engaged in primary care, and number of patients seen per week. Physician survey scores improved immediately following both pain education programs (live: 138.0-->150.6, P < 0.001; online: 143.6-->150.4, P = 0.007), but did not change appreciably in the control group (139.2-->142.5, P > 0.05). Findings persisted at 3 months. Satisfaction measures were high (4.00-4.72 on 1-5 scale) and not significantly different (P = 0.072-0.893) between groups. When used under similar conditions, national speakers and a publicly available online CME program were associated with improved pain management KAB in physicians. The benefits lasted for 3 months. These findings support the continued use of these pain education strategies.

Do You Love a Great Bargain? APA Membership Fits the Bill

Do You Love a Great Bargain? APA Membership Fits the Bill

The transition from face-to-face to online CME facilitation

This study examines the experiences of nine medical teachers who transitioned from face-to-face teaching to facilitating a course in an online environment. The authors examined the reasons why the teachers agreed to facilitate an online course, the challenges they encountered and their practical solutions, and the advantages and disadvantages they perceived to this teaching environment. Thirty-minute phone interviews were conducted. An iterative process was used to develop the themes and sub-themes for coding. Teachers reported being attracted to the novelty of the new instructional format and saw online learning as an opportunity to reach different learners. They described two facets to the transition associated with the technical and facilitation aspects of online facilitation. They had to adapt their usual teaching materials and determine how they could make the ‘classroom’ user friendly. They had to determine ways to encourage interaction and facilitate learning. Lack of participation was frustrating for most. This study has implications for those intending to develop online courses. Teacher selection is important as teachers must invest time in course development and teaching and encourage participation. Teacher support is critical for course design, site navigation and mentoring to ensure teachers facilitate online discussion.Practice points•Online interactive continuing medical education is a new format for physician-teachers.•Facilitators are drawn to online CME by the novelty of teaching with this new medium and the opportunity to reach new learners.•Facilitators faced two challenges in their transition from face-to-face teaching: the technical aspects associated with the medium and the skills of facilitating in a different environment.•Organizations beginning to develop interactive online learning programs need to pay attention to the selection of teachers who are prepared to invest the time and energy into learning and thinking about the technology and their facilitation skills.•Facilitators recognize and appreciate instructional design support for course construction, navigation tips and facilitation guidance.

Facilitating interpersonal interaction and learning online: Linking theory and practice

An earlier study of physicians' perceptions of interactive online learning showed that these were shaped both by program design and quality and the quality and quantity of interpersonal interaction. We explore instructor roles in enhancing online learning through interpersonal interaction and the learning theories that inform these. This was a qualitative study using focus groups and interviews. Using purposive sampling, 50 physicians were recruited based on their experience with interactive online CME and face-to-face CME. Qualitative thematic and interpretive analysis was used. Two facilitation roles appeared key: creating a comfortable learning environment and enhancing the educational value of electronic discussions. Comfort developed gradually, and specific interventions like facilitating introductions and sharing experiences in a friendly, informative manner were helpful. As in facilitating effective small-group learning, instructors' thoughtful use of techniques that facilitated constructive interaction based on learner's needs and practice demands contributed to the educational value of interpersonal interactions. Facilitators require enhanced skills to engage learners in meaningful interaction and to overcome the transactional distance of online learning. The use of learning theories, including behavioral, cognitive, social, humanistic, and constructivist, can strengthen the educational design and facilitation of online programs. Preparation for online facilitation should include instruction in the roles and techniques required and the theories that inform them.

The Emergency Contraception Online Learning Module

Kaiser Permanente (KP) has been on the forefront of educating providers and members about emergency contraception (EC) since 1996, even before a dedicated product was available. EC is up to 89% effective and is exceedingly safe for all women at risk for an unintended pregnancy. Despite awareness efforts, EC has remained underutilized. Recognizing this fact, recommendations were made by a California-wide EC Task Force to increase prophylactic prescribing by all providers who care for women of childbearing age, especially those who are exposed to teratogenic medications and chronic conditions that negatively impact pregnancy. KP Northern California Regional Women's Health—in cooperation with Multimedia, Pharmacy and Analytical Services (PAS)—and Physician Education—developed the Emergency Contraception [Online] Learning Module. The module is approved for one CME and consists of an 18-minute video: Emergency Contraception, Not Just an Ob/Gyn Issue and a 19-slide PowerPoint presentation entitled: Emergency Contraception, You Can Make a Difference, a pretest, a posttest, and a brief evaluation of the teaching tool. The EC Learning module can be accessed by going through the Northern California Women's Health KP Intranet site: http://insidekp.kp.org/california/womenshealth. The EC Learning Module can be accessed by going through the Northern California Women's Health KP Intranet site: http://insidekp.kp.org/california/womenshealth. On the front page is a link to the hosting site: PAS (Figure 1). The focus of the module is on the evidence that supports prophylactic prescribing of EC by all primary and specialty care providers who care for women and also discusses safety, efficacy, and prescribing issues. Several case studies are included. Figure 1 Emergency Contraception link on KP Northern California Women's Health Intranet site. Women's Health has received mostly positive feedback about the EC Learning Module through online evaluations and e-mail communications. As of August 2004, more than 250 providers have participated in this online CME program. Out of the 250 responding to the evaluation, 63% were “very satisfied,” and an additional 32% reported “satisfied.” When asked if they would be likely to view another online Women's Health video module, 93% reported they would and 90% reported they would be likely to use the materials presented this way as a reference. Providers from all KP Regions have accessed the EC Learning Module, the greatest percentage have come from both Northern and Southern California. So many providers and pharmacists from Southern California have accessed the site too that SCPMG Physician Education chose to accredit the program. Two hundred pharmacists from KP Orange County plan to use the module to satisfy state requirements for direct prescribing via collaborative treatment agreements with the Ob/Gyn physicians. This strategy will result in faster screening and dispensing of EC for Orange County KP members. PAS streamlined the CME certification system to allow for providers and pharmacists to download their own CME certificate. CME records are also maintained with respective regional physician education departments. We invite you to take a look at the module for important information about EC and how it pertains to your practice. The EC Learning Module has been accredited by Northern California Physician Education until October 29, 2006. Women's Health believes the success of the EC [Online] Learning Module stems from effective marketing and cooperation from all departments that participated in its development. Look for more Women's Health online CME education projects in the future.