Online Continuing Medical Education Program Research Articles

Empowering Continuing Medical Education (CME) in India: leveraging Kern’s instructional design model

IntroductionContinuing Medical Education (CME) is vital for healthcare professionals to remain current with advancements and maintain their competence. In India, CME remains in its early stages, lacking a systematic approach. There is a pressing need for a comprehensive framework that addresses needs assessment, program development, accreditation, and credit allocation. Specifically, there is a gap in delivering targeted CME that meets the needs of different medical professionals at appropriate times. The aim of this study is to employ Kern’s six steps of curriculum design to plan and evaluate a faculty development program focused on Entrustable Professional Activities (EPAs) for MD (Doctor of Medicine) Biochemistry professionals.MethodsThis study utilized Kern’s six-step approach to design a training program on Entrustable Professional Activities (EPAs) tailored for MD Biochemistry professionals. Approval was obtained from the Institutional Human Ethics Committee. Following problem identification, a targeted needs assessment was conducted through expert consultations. The goal of the program was established, focusing on the development and delivery of an interactive online CME program. The program was developed, implemented and evaluated using surveys and feedback questionnaires.ResultsA comprehensive literature review revealed a notable gap in EPA-related works for MD Biochemistry program. Expert consultations highlighted significant training needs and barriers, such as limited resources and professional commitments. Consequently, the program’s primary objective was to raise awareness and sensitize participants to EPA development. A 4-h online CME was designed, featuring expert-led sessions and collaborative group activities. The program attracted 152 participants and utilized interactive elements, such as polls and chats, to foster engagement. Group activities allowed participants to apply concepts in EPA validation. Pre- and post-program surveys demonstrated significant improvements in participants’ knowledge and confidence. Feedback highlighted the practical relevance of the content and the interactive, hands-on nature of the sessions.ConclusionKern’s six-step approach provided a structured and effective framework for developing the CME program, addressing identified needs and barriers, and enhancing faculty development in MD Biochemistry. This study underscores the importance of a systematic approach in CME to improve program effectiveness.Trial registrationNot applicable.

Impact of a Nutrition and Diabetes Continuing Education Program on Primary Care Provider's Knowledge, Attitude, and Clinical Practice.

Diet/nutrition is the first-line non-pharmacological therapy in the treatment of diabetes. Diet/nutrition counseling is infrequently provided by primary care providers (PCPs), who have limited nutrition education in both medical and advanced practice provider curricula. This quality improvement project aimed to improve knowledge and attitude, and frequency of diet/nutrition counseling by PCPs among patients with uncontrolled diabetes (glycosylated hemoglobin A1c ≥8%), by providing an online continuing medical education (CME) program on diabetes diet/nutrition. At a community health center in New England, PCPs attended a live 50-minute online CME program that was developed internally, which taught PCPs current diet/nutrition guidelines and recommendations related to diabetes. Knowledge was assessed prior to and two weeks following the program, utilizing a 10-question tool, the Nutrition Management of Diabetes Assessment (NMDA). Similarly, attitude was evaluated using two subscales of the Nutrition in Patient Care Survey (NIPS): Nutrition in routine care and Physician efficacy. Chart audits of patients with uncontrolled diabetes were evaluated to assess PCPs documentation of diet/nutrition counseling four weeks prior to and six weeks following the CME program. In September 2023, PCPs (n = 29) completed the CME program. There was an improvement in knowledge in the NMDA amongst PCPs (36% difference, p < 0.001). Attitude scores from two subscales of the NIPS were evaluated and both showed improvement, however only physician efficacy was significant (15% difference, p < 0.01). There was a positive difference in the trend of diet/nutrition counseling after the education program (p < 0.05). An online CME program improved diabetes diet/nutrition knowledge and attitude of PCPs and improved counseling practices for patients living with uncontrolled diabetes. The education program provided PCPs current standards of care guidelines/recommendations, which they can utilize when counseling patients with diabetes. PCPs would benefit from dedicated continuing education programs regarding diet/nutrition therapy for chronic illnesses.

Significant improvement of physicians' knowledge and clinical practice: an opportune, effective, and convenient continuing medical education program on functional dyspepsia.

This cohort study aimed to explore the effect of a one-day online continuing medical education (CME) on the improvement of physicians' knowledge and clinical practice on functional dyspepsia (FD). Physicians were invited to participate in this CME via medical education applications. FD training videos made in advance were sent to participants via a weblink. Before and after training, participants were required to finish the FD knowledge test and provide case information of FD patients. McNemar test, Wilcoxon rank-sum test, Freidman test, Chi-square test, quantile regression, and generalized estimating equations (GEE) were used to perform statistical analysis. There were 397 of 430 (92.33%) physicians finished this CME program. The total score of the FD knowledge test after training was significantly higher compared with before training [488.3 (468.3-510.0) vs. 391.7 (341.7-450.0), p < 0.001]. Particularly, physicians from primary hospitals show more increase in total scores than physicians from secondary and tertiary hospitals. According to the GEE model, receiving this online training was an independent predictor of physicians' choice of upper gastrointestinal endoscopy in patients with FD [OR 1.73, 95%CI (1.09-2.73), p = 0.020], especially in PDS. Also, it was an independent predictor of physicians' choice of acid-suppressive drugs in patients with FD [OR 1.30, 95%CI (1.03-1.63), p = 0.026], especially in EPS and PDS overlapping EPS. This one-day online CME program effectively and conveniently improved physicians' knowledge and clinical practice, providing new ideas for future CME and facilitating precise clinical management of FD patients with different subtypes especially in primary hospitals.

Satisfaction and attitudes towards online continuous medical education and its impact on clinical practice among physiotherapists

BackgroundThe traditional face-to-face of medical education is gradually being replaced with online education. However, the rate of adoption of online continuing medical education (OCME) as a learning method among practicing clinical physiotherapists (PTs) is unclear. The objectives of this study were to measure the satisfaction with, attitudes towards, and impact of OCME among practicing clinical PTs in Saudi Arabia (SA) and to examine the factors that affect the findings for satisfaction, attitude, and impact towards OCME.MethodsThis cross-sectional survey was conducted between October 2021 and January 2022. PTs employed at various medical facilities and specialties in Saudi Arabia completed an online survey to assess satisfaction with, attitudes towards, and impact of OCME.ResultsOf the 127 participants, 48 were female (37.8%), 44.1% were aged between 24 and 30 years. Overall, 57.5% of the respondents were satisfied with OCME compared with conventional face-to-face education, and 45.7% agreed and 18.1% strongly agreed that OCME was more flexible. Further, 52.8% of the respondents thought that OCME programs could supplement traditional face-to-face education. The majority of the participants (63.8%) agreed that participating in OCME programs increased their knowledge, and 55.1% and 51.2% agreed that attending these programs improved patient outcomes and increased their confidence in patient management, respectively. However, only 38.6% agreed that participating in OCME programs enhanced their clinical expertise. The mean satisfaction, attitude, and impact scores differed significantly according to age group, marital status, number of years of practice, and specialty (p < 0.0001). Multiple regression analysis showed that older age was independently associated with better satisfaction and more positive attitudes and impact. Further, having a specialization also seemed to improve the impact of OCME.ConclusionThe PTs were satisfied with and had positive attitudes towards OCME, and also found that it had a positive impact on their clinical practice. Thus, existing OCME programs are a good option for expanding the number of PTs proficient in clinical care.

Continuing Medical Education Increases Knowledge, Competence, and Confidence Related to the Use of Non-Oral Acute Migraine Therapies Among Neurologists (P13-2.003)

Continuing Medical Education Increases Knowledge, Competence, and Confidence Related to the Use of Non-Oral Acute Migraine Therapies Among Neurologists (P13-2.003)

Knowledge of physicians regarding the management of Type two Diabetes in a primary care setting: the impact of online continuous medical education

BackgroundTo explore the impact of an online continuing medical education (CME) program on physicians’ knowledge about the management of type two diabetes.MethodsAn online CME program was designed and uploaded in the CME platform, Department of Education, Ministry of health, Iran. A 28-item questionnaire was used for the assessment. In the beginning, a case scenario was introduced. Then, participants were asked to follow and answer to a pretest assessment. Details of the educational content were provided afterward. Finally, the participants took part in the same post-test exam 4 weeks later. The Wilcoxon matched-pairs signed-ranks test was used to compare the measurements. In addition, the Mann-Whitney test was applied to compare knowledge indices between the general practitioners (GPs) and internists.ResultsFive hundred twenty-six primary care physicians participated in this study. There was a significant positive effect regarding diagnosis confirmation (10.3% difference, P = 0.0001). Moreover, a smaller effect was observed in relation to the importance of glycosylated hemoglobin (HbA1c) at diagnosis (5.2% difference, P = 0.0006). The effect was positive in relation to the self-reported HbA1c testing frequency: more than 90% of the participants answered correctly in the post-test exam (7.6% difference, P = 0.0001). Considering improved knowledge in the treatment of diabetes, there was a very significant difference in response to questions targeting advice on a healthy diet, and physical activity; 27.7% (P = 0.000), and 18.7% (P = 0.000), respectively. In addition, the program had a positive impact on various aspects of treatment with oral glucose-lowering drugs (OGLDs). Moreover, the intervention difference was 25, and 34.4% for the questions targeting the appropriate type of insulin, and insulin initiation regimen after OGLD failure. Subgroup analyses revealed that the intervention increased the rate of correct responses among the GPs in various domains of knowledge in diagnosis and treatment. The initial differences between the GPs and internists no longer remained significant after the intervention.ConclusionKnowledge of Iranian primary health care professionals in diabetes management has significant shortcomings. This is concerning because they are at the front line of patient care. We demonstrate the effectiveness of online CME on improving GPs knowledge in the management of type 2 diabetes.

APA to Offer Two Online CME Programs in Lieu of Annual Meeting

Back to table of contents Next article APA & MeetingsFull AccessAPA to Offer Two Online CME Programs in Lieu of Annual MeetingSearch for more papers by this authorPublished Online:26 Mar 2020https://doi.org/10.1176/appi.pn.2020.4a24AbstractEven though they are virtual, the education and continuing medical education (CME) credits they offer will be as real as if participants had been in the room.APA is offering two new educational programs this spring to help members earn the CME credits they need for licensure and certification and to sharpen their clinical skills.The first program, called the APA Spring Highlights, will feature headline speakers, subject experts, and thought leaders, some of whom were slated to appear at APA’s Annual Meeting in Philadelphia. The Annual Meeting, which had been scheduled from April 25 to 29, will not take place due to public health concerns around the COVID-19 pandemic.APA’s Spring Highlights is a two-day online event that will be held on Saturday and Sunday, April 25 and 26, from noon to 5 p.m. The program will begin on Saturday with an Opening Session that includes addresses by APA President Bruce Schwartz, M.D., APA President-elect Jeffrey Geller, M.D., M.P.A., and APA CEO and Medical Director Saul Levin, M.D., M.P.A.That session will be followed by scientific sessions over two days offering 9 hours of CME content featuring experts in major areas of psychiatric diagnosis and treatment. Some of the sessions will focus on supporting clinicians during the current COVID-19 crisis with information about its impact on mental health treatment. APA’s Business Meeting will end the program on Sunday at 4:30 p.m.APA’s Spring Highlights is free to APA members. At press time, the price for nonmembers had not been determined. A forthcoming all-member communication and Psychiatric News Alert will provide details about registration.Additionally, APA is simultaneously developing the 2020 APA On Demand program. APA Annual Meeting On Demand historically has consisted of scientific sessions from the Annual Meeting with presenter slides synchronized with presenter audio. This year, in the absence of an Annual Meeting, APA On Demand will feature presentations that will be recorded remotely over the internet from speakers’ institutions or homes. The presentations will cover emerging clinical topics, cutting-edge science, and new therapies and offers 75 hours of CME credit. It will include presentations and speakers originally planned for in-person delivery at the Annual Meeting.Presentations will continue to be recorded over the coming months and added to the online library on a rolling basis within 24 hours of being recorded. Once all presentations are recorded, a USB will be shipped to those who selected this add-on option upon purchase. More information is posted here.At press time, APA On Demand was scheduled to be released this spring, with registration fees similar to those of the Annual Meeting.“Although the Highlights and APA On Demand cannot replace or substitute the Annual Meeting, we hope that these programs will offer the kind of essential education our members and mental health professionals have come to expect from APA,” said APA Director of Education and Deputy Medical Director Tristan Gorrindo, M.D. “I urge everyone seeking the very best in psychiatric expertise to take advantage of these learning opportunities.”“A large number of our physician members are restricted by their respective institutions from traveling to conferences and meetings to help stop the spread of COVID-19 and provide patient care, making it impossible for lecturers and registrants to attend a spring medical conference,” Levin said. “The latest information from the Centers for Disease Control and Prevention and Pennsylvania health authorities supported our judgment that travel restrictions, meeting restrictions, and social distancing are the required, safe, and responsible actions. Public health must come first.” ■ ISSUES NewArchived

E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers.

Patients are asking health care providers about e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME). A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social). From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/student/other; 41% were international. The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units. A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias. Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches.

Effective learning environments - the process of creating and maintaining an online continuing education tool.

Continuing medical education (CME) is an indispensable part of maintaining physicians’ competency. Since attending conferences requires clinical absenteeism and is not universally available, online learning has become popular. The purpose of this study is to conduct a retrospective analysis examining the creation process of an anesthesia website for adherence to the published guidelines and, in turn, provide an illustration of developing accredited online CME. Using Kern’s guide to curriculum development, our website analysis confirmed each of the six steps was met. As well, the technical design features are consistent with the published literature on efficient online educational courses. Analysis of the database from 3937 modules and 1628 site evaluations reveals the site is being used extensively and is effective as demonstrated by the participants’ examination results, content evaluations and reports of improvements in patient management. Utilizing technology to enable distant learning has become a priority for many educators. When creating accredited online CME programs, course developers should understand the educational principles and technical design characteristics that foster effective online programs. This study provides an illustration of incorporating these features. It also demonstrates significant participation in online CME by anesthesiologists and highlights the need for more accredited programs.

An internet based approach to improve general practitioners’ knowledge and practices: The development and pilot testing of the “ABC's of vitamin D” program

BackgroundOnline continuing medical education (CME) offers a number of advantages for physicians including flexibility with regards to location and timing of use. In order to effect physician practices and improve patient outcomes, it is important that the development of online CME is theory and evidence-based. ObjectivesThis paper aims to describe the development of an online CME program for practising general practitioners (GPs) on vitamin D and sun health called “The ABC's of Vitamin D for GPs” using elements of design principles for physician-education web sites as a framework. The paper will also report the program's usability and acceptability pilot test results. MethodsThe ABC's of Vitamin D program was developed following nine principles: needs assessment; evidence-based content development; multimodal program and modularisation; clinical cases; tailoring and interactivity; audit and feedback; credibility of the web site host; patient education materials; ease of use and navigation. Among the 20 GPs invited, acceptability and useability was tested with 12 GPs (60%) who agreed to participate and were interviewed following use of the program. The study was conducted between 2011 and 2013. ResultsAn online CME program consisting of eight modules was constructed. Of the 12 participating GPs, most (n=11) reported that the program was clear and easy to understand, logical, easy to navigate, and took a reasonable amount of time (estimated between 1 and 3h) to complete. Eleven of 12 participants said they would use the program as an accredited CME activity and all participants indicated that the program was ‘very or somewhat’ likely to lead to changes in the advice patients are given. ConclusionThis study found that a theory and evidence based approach for the development of an online CME program for GPs was acceptable to users. Further research is needed to examine whether the online CME program is effective at changing GP practices and improving patient outcomes.

Effectiveness of monetary incentives to recruit family physicians as study subjects: a randomized controlled trial.

BackgroundRecruiting family physicians to participate as subjects of clinical studies is challenging. Monetary incentives are often used to increase enrolment, but few studies have measured the impact of doing so. As part of a trial seeking to compare two formats of interactive activities within an online continuing medical education (CME) program, we compared family physicians’ recruitment rates with and without a monetary incentive. Recruitment took place by email.MethodsFamily physicians listed in the directory of the College of Physicians of the Province of Quebec (Canada) were emailed a one-page letter inviting them to participate in a randomized trial designed to evaluate a three-hour online CME program on rheumatology. Half of physicians were randomly allocated to receive a version of the letter that offered them $300 to participate (incentive group); the other half was not offered compensation (no-incentive group).ResultsA total of 1314 (91%) physicians had a valid email address as listed in the directory. The response rate was 7.5% (54/724) in the incentive group and 2.6% (19/724) in the no-incentive group (absolute difference [AD] 4.8%, 95% confidence interval [95% CI] = 2.6 – 7.2%; risk ratio [RR] 2.8, 95% CI = 1.7 - 4.7). Recruitment rates were 3.5% (25/724) in the incentive group and 0.6% (4/724) in the no-incentive group (AD 2.9%, 95% CI = 1.5 - 4.5%; RR 6.3, 95% CI = 2.2 - 17.9).ConclusionsMonetary incentives significantly increased recruitment, which nonetheless remained low. To reach recruitment targets, researchers are advised to plan for an extensive list of email contacts and to minimize restrictive eligibility criteria.

Evaluating Online Continuing Medical Education Seminars: Evidence for Improving Clinical Practices

The purpose of this study was to evaluate the potential for online continuing medical education (CME) seminars to improve quality of care. Primary care physicians (113) participated in a randomized controlled trial to evaluate an online CME series. Physicians were randomized to view either a seminar about type 2 diabetes or a seminar about systolic heart failure. Following the seminar, physicians were presented with 4 clinical vignettes and asked to describe what tests, treatments, counseling, or referrals they would recommend. Physicians who viewed the seminars were significantly more likely to recommend guideline-consistent care to patients in the vignettes. For example, physicians who viewed the diabetes seminar were significantly more likely to order an eye exam for diabetes patients (63%) compared with physicians in the control group (27%). For some guidelines there were no group differences. These results provide early evidence of the effectiveness of online CME programs to improve physician clinical practice.

Lifelong Learning: Skills and Online Resources

Advances in information technology enable the practicing psychiatrist's quest to keep up-to-date with new discoveries in psychiatry, as well as to meet recertification requirements. However, physicians' computer skills do not always keep up with technology, nor do they take advantage of online search and continuing education services. This article describes the rationale for using electronic databases and training, as well as basic computer skills, computer equipment, and important online resources for psychiatrists to meet their continuing education and recertification needs quickly, easily, and conveniently. A literature review was performed using PUBMED and Google to find articles related to recertification, physician's technology adoption and computer skills, evidence-based medicine, and basic approaches to lifelong learning using computers and the Internet, and resources for lifelong learning. Psychiatrists are required to master a discrete set of information for board certification, and to maintain that knowledge for recertification. Surveys have shown that although most physicians use computers, the majority use them for personal or business purposes, and not for accessing Continuing Medical Education (CME) programs (1). The Council on Graduate Medical Education requires the acquisition of medical informatics skills for the Undergraduate Medical Education for the 21st Century (UME-21) curriculum project (2). There is a growing body of literature outlining basic computer skills and competencies for physicians to access online textbooks, databases, journals, and CME programs. Psychiatrists can benefit from learning how to use computers and the Internet to keep current with the advances in the field. Skills now being taught in medical school and residency are equally important for practicing psychiatrists to learn and master.

Interactive on-line continuing medical education: Physicians' perceptions and experiences

Although research in continuing medical education (CME) demonstrates positive outcomes of on-line CME programs, the effectiveness of and learners' satisfaction with interpersonal interaction in on-line CME are lower Defined as faculty-learner or learner-learner interpersonal interaction, this study explores physicians' perceptions of and experiences in interactive on-line CME and factors influencing these. Focus groups and interviews were undertaken by three Canadian universities. Using purposive sampling, we recruited physicians based on their experiences with interactive on-line CME. Content analysis was applied first, followed by a comparative analysis to confirm themes and findings. Physicians based their perceptions of interactive on-line CME by comparing it with what they know best, face-to-face CME. Although perceptions about access and technical competency remained important, two other themes emerged. The first was the capacity of on-line CME to meet individual learning preferences, which, in turn, was influenced by the quality of the program, the degree of self-pacing or self-direction, opportunity for reflection, and educational design. The second was the quality and quantity of interpersonal interaction, which was shaped by perceptions of social comfort, the educational value of interactions, and the role of the facilitator. Prior experience with on-line CME moderated perceptions. The extent that on-line CME programs reflected characteristics of high-quality CME and individual learning preferences appeared to shape perceptions about it. It is important to incorporate the characteristics of effective CME into the design and implementation of interactive on-line programs, considering diverse learning preferences, providing faculty development for on-line facilitators, and grounding this work in learning theory.

Women physicians are early adopters of on-line continuing medical education.

On-line continuing medical education (CME) provides advantages to physicians and to medical educators. Although practicing physicians increasingly use on-line CME to meet their educational needs, the overall use of on-line CME remains limited. There are few data to describe the physicians who use this new educational medium; yet, they clearly are the innovators and early adopters who will facilitate the growth of this educational technology. It would be useful to instructional designers and CME developers to better understand the characteristics of this influential group. We studied the actual use of several different on-line CME programs within three different groups of physicians. The on-line programs were developed as part of research studies funded by the National Institutes of Health, with no relationship to commercial interests. They were presented to physicians using mass mailouts (two physician groups) or personal contact and were accompanied by incentives to reduce resistance to the new technology. We compared the characteristics of physicians who chose to use these on-line programs with demographic data from larger populations representing the groups from which these users originated. We found that physicians who used these on-line CME programs were younger than average and, importantly, more likely to be female than expected. This finding was consistent across different types of physician populations and different types of CME programs. Based on data reflecting actual use of on-line CME, younger physicians appear to be adopting on-line CME more rapidly than others, and women physicians appear to be adopting on-line CME at a faster rate than their male counterparts. This latter finding conflicts with the impression provided by some survey-based studies that male physicians are more likely than female physicians to use on-line CME. The data suggest that the growth of on-line CME is most likely occurring in diffusion networks dominated by relatively new medical school graduates and, possibly, women physicians. These results provide valuable insight to those who seek to develop and market on-line CME and those who seek to reach women physicians with CME programs.

Collaborative Online Learning

Continuing medical education (CME) has not taken advantage of the ability to communicate and collaborate online. Collaborative learning is an important learning principle, yet online CME programs are generally completed in a one-on-one relationship between the computer and the learner. This limits opportunities for reflective learning, and does not access the rich learning available from interacting with peers. We believe online CME will benefit from interaction between learners and from opportunities for reflection. We implemented a prototype online course designed to improve the skills of general practitioners (GPs) in the care of patients with type 2 diabetes. The course design reflects adult learning principles but, uniquely, applies them to online learning. Currently, 20 GPs from England are enrolled, including one based in Bosnia, and one GP from New Zealand. The course uses BlackBoard(TM) software. Participants log in twice weekly for seven weeks to study one of seven interactive modules on diabetes from evidence-based sources. Modules provide for branched learning via links to additional resources. Subsequently, GPs engage in two online discussions, which are at the learner's convenience rather than requiring adherence to a set schedule. One discussion group is for reflection on the modules, with an assignment to discuss how the material is being applied clinically. Participants also respond to colleagues' postings each week. In a second discussion group, learners apply concepts from the modules to the collaborative management of a problem-based case of a patient with newly diagnosed diabetes. The patient is presented via an online medical chart and streaming videos. She returns each week of the course to mimic 18 months of care. Faculty facilitate the discussion groups and provide feedback. We are in the last week of the class and the participant feedback has been overwhelmingly positive. Many note how well the course design and timing match their learning styles and schedule constraints. A powerful feature has been our ability to identify additional educational needs, and quickly add corresponding content online. So far, participants have provided 340 postings, which include evidence of course effectiveness and documentation of application of course objectives and disease management strategies to change actual practice patterns. GPs report changing: screening practices for diabetic renal disease; prescribing of diabetic medications; screening protocols for diabetes; and organizing practice management systems to better track diabetic care. After diagnosing and managing a new diabetic patient during the course, one participant wrote: "It was fantastic to feel that I am offering an up-to-date evidence-based approach in something that I am deskilled in." This course is unique in online CME. It is international in scope, collaborative, asynchronous in delivery, flexible, responsive to learner needs in real time, and has yielded evidence of its effectiveness in changing the actual clinical practices of participants. It will next enroll GPs in Singapore and additional UK-based GPs. Additional CME courses will be developed using this method.

Can internet-based continuing medical education improve physicians’ skin cancer knowledge and skills?

We sought to determine whether an Internet-based continuing medical education (CME) program could improve physician confidence, knowledge, and clinical skills in managing pigmented skin lesions. The CME program provided an interactive, customized learning experience and incorporated well-established guidelines for recognizing malignant melanoma. During a 6-week evaluation period, 354 physicians completed the online program as well as a pretest and an identical posttest. Use of the CME program was associated with significant improvements in physician confidence, correct answers to a 10-question knowledge test (52% vs 85% correct), and correct answers to a 15-question clinical skills test (81% vs 90% correct). We found that the overall improvement in clinical skills was due to a marked increase in specificity and a small decrease in sensitivity for evaluating pigmented lesions. User satisfaction was extremely high. This popular and easily distributed online CME program increased physicians’ confidence and knowledge of skin cancer. Remaining challenges include improving the program to increase physician sensitivity for evaluating pigmented lesions while preserving the enhanced specificity.

Can Internet-Based Continuing Medical Education Improve Physicians' Skin Cancer Knowledge and Skills?

We sought to determine whether an Internet-based continuing medical education (CME) program could improve physician confidence, knowledge, and clinical skills in managing pigmented skin lesions. The CME program provided an interactive, customized learning experience and incorporated well-established guidelines for recognizing malignant melanoma. During a 6-week evaluation period, 354 physicians completed the on-line program as well as a pretest and an identical posttest. Use of the CME program was associated with significant improvements in physician confidence, correct answers to a 10-question knowledge test (52% vs 85% correct), and correct answers to a 15-question clinical skills test (81% vs 90% correct). We found that the overall improvement in clinical skills was due to a marked increase in specificity and a small decrease in sensitivity for evaluating pigmented lesions. User satisfaction was extremely high. This popular and easily distributed online CME program increased physicians' confidence and knowledge of skin cancer. Remaining challenges include improving the program to increase physician sensitivity for evaluating pigmented lesions while preserving the enhanced specificity.

Realizing the Promise: Delivering Pulmonary Continuing Medical Education Over the Internet

Continuing medical education (CME) is meant to bridge the gap between new scientific observations and clinical practice. However, traditional CME has not been effective at altering the behaviors of physicians. One reason for this failure of traditional CME programs may be their inflexibility. In traditional CME, the clinician does not choose the topic, the pace of the program, or the place of learning, and the CME material cannot be easily delivered to the point of care where the clinician needs the information. Computers and computer networks have the potential to accomplish these goals. CME has begun to appear on the Internet; however, there have been few evaluations of its usefulness, acceptance, and effectiveness. Over the last 18 months, we have developed three on-line pulmonary CME programs, and we have delivered them on the Virtual Hospital, the University of Iowa's digital health sciences library on the Internet. We report our initial experience with this CME material. We measured the frequency with which the Internet-delivered CME is accessed by monitoring page accessions and by using a log file analysis program (Analog 1.2.3; University of Cambridge Statistical Laboratory; Cambridge, UK). In addition, we collected all completed CME examinations and evaluation forms submitted by registered users. We have found that the frequency with which the Internet-delivered CME is accessed has continued to increase with time (2.3-fold increase over 18 months), that evaluations of technical and content issues are strongly favorable, and that some clinicians have been willing to pay to receive CME through the medium of the Internet. We feel that with adequate peer review and quality control, physicians will use the Internet-delivered CME. However, several obstacles to wide use remain. These obstacles include issues regarding training in using the Internet for physicians, reluctance of physicians to participate in on-line commerce, and the current unavailability of CME to be delivered in small-grained quantities to the point of care. As these issues are addressed, we feel that on-line CME will represent an increasingly important CME medium for clinicians.