Web-based Continuing Medical Education Research Articles

Physician preferences for Online and In-person continuing medical education: a cross-sectional study

BackgroundThe worldwide market for continuing medical education (CME) was severely affected by the COVID-19 pandemic, which precipitated an increase in web-based CME course attendance. Virtual education methods may be effective for engaging learners and changing behaviors. However, more information is needed about physician preferences for in-person vs. livestreamed CME courses in the postpandemic era. Because of the paucity of data regarding this topic, the current study was designed to evaluate CME participant characteristics, preferences, engagement, and satisfaction with traditional in-person vs. virtual educational methods.MethodsA cross-sectional study was performed of attendees of two large internal medicine CME courses held in 2021. Both CME courses were offered via in-person and livestream options, and were taught by Mayo Clinic content experts. Participants, who consisted of practicing physicians seeking CME, completed a 41-question survey after CME course completion. Statistical comparisons were performed by using Fisher exact tests for all survey items, except for those with ordinal response sets, which were compared with Cochran-Armitage trend tests.ResultsA total of 146 participants completed the survey (response rate, 30.2%). Among the 77 respondents who attended in-person courses, the most frequent reasons indicated were the opportunity to travel (66%) and collaboration/networking with others (25%). Among the 68 respondents who attended the livestream courses, the most frequent reasons indicated included COVID-19–related concerns (65%), convenience (46%), and travel costs (34%). The percentage of respondents who indicated that they would choose the same mode of attendance if given the option again was higher for those who attended in person than for those who attended via livestream (91% vs. 65%, P < .001).ConclusionsThese data suggest that in-person course offerings will continue to be a preferred learning method for some physicians. However, most respondents who attended virtually preferred that method. Therefore, hybrid CME models offering both in-person and virtual options may be most beneficial for meeting the needs of all CME learners.

Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis.

Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities.

Identifying and Addressing Knowledge and Confidence Gaps Regarding the Management of Patients with Sickle Cell Disease Via Engaging Continuing Medical Education

Introduction: While there have been recent advances in therapeutic options for the management of patients with sickle cells disease (SCD), hematology providers remain challenged by how to deliver an individualized approach to care, negatively impacting patient outcomes. To address this practice gap and identify drivers that underlie persisting challenges, an interactive continuing medical education (CME) activity was developed and implemented. Methods: Vindico Medical Education provided an interactive web-based CME activity on CME.Healio.com that was available for credit for one year starting August 31, 2022. The activity included opportunities for interaction with the content to encourage engagement, transfer knowledge, improve confidence, and encourage appropriate practice patterns. Impact of education was measured by comparing paired pre- and post-test responses. Results: As of July 2023, 221 hematology/oncology providers, including 116 MDs and advanced practice providers (APPs) and 105 nurses, who each see an average of 4 patients with SCD per month participated in the education. At baseline, scores on questions related to the latest evidence regarding new SCD therapies were low in both professional cohorts - an average 30% for MD/APPs and 16% for nurses. Moreover, 95% of HCPs in both cohorts lacked confidence in their knowledge of these agents and their appropriate use. This lack of knowledge and confidence translated into practice gaps. Specifically, 48% of those involved in treatment decisions indicated in the pre-test that they had never used a newer option for SCD management, and only 17% reported that they always consider the latest evidence when individualizing treatment for patients. On a post-test, however, the MD/APP and nurse cohorts scored an average of 81% and 84%, respectively, indicative of a robust impact of the education on clinician knowledge. Similarly, there was a 41% absolute increase in clinician confidence in understanding the latest evidence. These gains in knowledge and confidence translated into post-education planned practice improvements, with completers 22% more likely to apply this knowledge to clinical decision-making. Conclusion: Hematology/oncology providers lack knowledge and confidence regarding the latest evidence in SCD treatment. While the use of interactive CME led to robust gains in knowledge and confidence, follow-up case-based education is needed to facilitate the application of knowledge to practice while continuing to improve clinician confidence.

Impact on Knowledge, Competence, and Performance of a Faculty-Led Web-Based Educational Activity for Type 2 Diabetes and Obesity: Questionnaire Study Among Health Care Professionals and Analysis of Anonymized Patient Records.

Strategies for managing type 2 diabetes (T2D) and obesity are evolving with the introduction of targeted therapies, including incretin-based dual agonists and growing knowledge of the importance of multidisciplinary care. Accessible, effective continuing medical education (CME) activities are required to ensure that health care professionals (HCPs) understand and can implement the most recent data to optimize patient outcomes. We aimed to measure changes in knowledge, competence, and self-reported performance and quantitatively evaluate changes in performance using anonymized patient data following participation in a web-based educational activity. The faculty-led CME-accredited activity was based on incretin-based dual agonists and patient education on T2D and obesity. The remaining educational gaps in this field were also identified. A CME-accredited, web-based, multidisciplinary (touchMDT) educational activity titled "The future for glycemic control and weight loss in T2D and obesity: Incretin-based dual-agonists and optimizing patient education" was developed. HCP knowledge, competence, and performance were assessed before and after the activity against Moore's expanded outcomes framework (levels 1-5), using self-reported questionnaires and by analyzing anonymized patient record data. For evaluating knowledge and competence (50 respondents before and 50 learners after the activity), the mean number of correctly answered questions was significantly higher post activity (median 5.0, IQR 4.0-6.0 to 6.0, IQR 5.0-7.0; mean 4.98, SD 1.22 to 5.78, SD 1.13; P<.001). Modest, nonsignificant improvements in self-reported performance (N=50 respondents preactivity; N=50 learners postactivity) from before to after the activity were observed (median 4.0, IQR 3.25-4.0 to 4.0, IQR 4.0-4.0; mean 3.64, SD 0.69 to 3.76, SD 0.48; P=.32). PPatient data analysis indicated that patients were being treated more intensively postactivity: before the activity, the most commonly used treatment regimens were metformin monotherapy (13/50, 26%) and dual therapy with metformin plus injectable glucagon-like peptide-1 (GLP-1) receptor agonist (RA; 11/50, 22%); post activity, this changed to dual therapy with metformin plus injectable GLP-1 RA (12/50, 24%) and triple therapy with metformin plus injectable GLP-1 RA plus sodium-glucose cotransporter-2 inhibitor (SGLT2i; 10/50, 20%). In addition, there was an increased number of referrals to a combination of specialists (physicians referred 27%, 8/30 of patients to ≥2 specialists before the activity and 36%, 10/28 to ≥2 specialists post activity). The remaining educational gaps included understanding the biology and psychology of obesity, efficacy and safety data for incretin-based dual agonists, and the role of the diabetes educator or diabetes care and education specialist in managing T2D and obesity. This short, web-based CME activity on the management of T2D and obesity led to improvements in HCP knowledge, competence, and performance. Several remaining unmet needs were identified, which can be used to inform the content of future educational activities in this disease area.

The Impact of Web-Based Continuing Medical Education Using Patient Simulation on Real-World Treatment Selection in Type 2 Diabetes: Retrospective Case-Control Analysis.

Despite guidelines recommending the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in certain patients with type 2 diabetes (T2D), they are not being prescribed for many of these patients. Web-based continuing medical education (CME) patient simulations have been used to identify clinicians' practice gaps and improve clinical decision-making as measured within a simulation, but the impact of this format on real-world treatment has not been researched. This study aimed to evaluate the effect of a simulation-based CME intervention on real-world use of GLP-1 RAs by endocrinologists and primary care physicians. Two evaluation phases of the CME simulation were conducted: phase I, the CME simulation phase, was a paired, pre-post study of 435 physician learners in the United States; and phase II, the real-world phase, was a retrospective, matched case-control study of 157 of the 435 physicians who had claims data available for the study period. Phase I CME results showed a 29 percentage point increase in correct decisions from pre- to postfeedback (178/435, 40.9% to 304/435, 69.9%; P<.001) in selecting treatment that addresses both glycemic control and cardiovascular event protection. Phase II results showed that 39 of 157 (24.8%) physicians in the intervention group increased use of GLP-1 RAs, compared to 20 of 157 (12.7%) in the comparison group. Being in the intervention group predicted GLP-1 RA use after education (odds ratio 4.49; 95% CI 1.45-13.97; P=.001). A web-based CME simulation focused on secondary prevention of cardiovascular events in a patient with T2D was associated with increased use of evidence-based treatment selection in the real world.

Engaging Continuing Medical Education Reveals Persisting Knowledge and Practice Gaps in FLT3-Positve AML

Introduction: Given the rapid evolution of testing and treatment of FMS-like tyrosine kinase 3 (FLT3)-positive AML, oncology providers are challenged by how to administer the latest evidence-based care. Additionally, while the use of patient-reported outcomes (PROs) can improve patient care, they are underutilized in oncology practice An interactive continuing medical education (CME) activity was provided to assess baseline attitudes and practice patterns while also addressing identified gaps in knowledge and skills regarding the management of patients with FLT3-positive AML. Methods: Vindico Medical Education provided a web-based CME activity available on myCME.com and for credit from December 31, 2021 to December 30, 2022. The activity included opportunities for interaction with the content to encourage engagement, transfer knowledge, improve confidence, and assess current practice patterns. Impact of education was measured by comparing paired pre- and post-test responses. Results: As of July 2022, 216 hematology/oncology providers who each see an average of 8 patients with AML per month participated in the education. These providers scored an average 26% on a pretest for topics related to the evaluation of patients with AML the impact of FLT3 mutations on prognosis and management, and the use of PROs in practice. Post-learning, providers scored 49%, highlighting the impact of the education on knowledge gaps, but also demonstrating persisting gaps. Specifically, post-test scores remained lowest regarding the implications of FLT3 mutations on patient outcomes and treatment strategies for these patients. Notably, while 65% of these providers indicated that they were guessing on the pre-test, the percentage of those who were confident and correct on the post-test rose from 1% to 18%, demonstrating a sharp rise in confidence. However, these persisting knowledge and confidence gaps translated to practice gaps - only 40% currently report performing mutational analysis at relapse for patients with AML. Moreover, only 51% were familiar with FLT3 MRD testing and providers lacked consensus regarding first- and subsequent-line treatment for FLT3-positive patients. Forty-seven percent noted an uncertainty regarding optimal combinations and sequencing as the primary challenge they face when selecting treatment for these patients. While knowledge and confidence scores regarding the use of PROs were high, only 16% always use PROs in practice, with patient non-compliance as the biggest barrier to implementation. Conclusion: Hematology/oncology providers lack knowledge and confidence regarding testing and management of patients with FLT3-positive AML, which translates to practice gaps. While the use of interactive CME led to robust gains in knowledge and confidence, further education is needed to address persisting gaps regarding testing and management of patients with FLT3-positive AML. Moreover, skills-based training and patient resources are needed to facilitate the use of PROs in clinical practice.

The Educational Impact of Web-Based, Faculty-Led Continuing Medical Education Programs in Type 2 Diabetes: A Survey Study to Analyze Changes in Knowledge, Competence, and Performance of Health Care Professionals.

BackgroundThe treatment landscape for type 2 diabetes (T2D) is continually evolving; therefore, ongoing education of health care professionals (HCPs) is essential. There is growing interest in measuring the impact of educational activities, such as through use of the Moore framework; however, data on the benefits of continuing medical education (CME) in the management of T2D remain limited.ObjectiveThis study aimed to evaluate HCP satisfaction; measure improvements in knowledge, competence, and performance following short, case-based, multidisciplinary web-based CME activities; and identify the remaining educational gaps.MethodsTwo faculty-led, CME-accredited, web-based educational activities on T2D and obesity, touchIN CONVERSATION and touch MultiDisciplinary Team, were developed and made available on a free-to-access medical education website. Each activity comprised 3 videos lasting 10 to 15 minutes, which addressed learning objectives developed based on a review of published literature and faculty feedback. Participant satisfaction (Moore level 2) was evaluated using a postactivity questionnaire. For both activities, changes in knowledge and competence (Moore levels 3 and 4) were assessed using questionnaires completed by representative HCPs before or after participation in the activities. A second set of HCPs completed a questionnaire before and after engaging in activities that assessed changes in self-reported performance (Moore level 5).ResultsEach activity was viewed by approximately 6000 participants within 6 months. The participants expressed high levels of satisfaction (>80%) with both activities. Statistically significant improvements from baseline in knowledge and competence were reported following participation in touchIN CONVERSATION (mean score, SD before vs after activity: 4.36, 1.40 vs 5.42, 1.37; P<.001), with the proportion of learners answering at least six of 7 questions correctly, increasing from 22% (11/50) to 60% (30/50). A nonsignificant improvement in knowledge and competence was observed following participation in touch MultiDisciplinary Team (mean score, SD 4.36, 1.24 vs 4.58, 1.07; P=.35); however, baseline knowledge and competence were relatively high, where 80% of the respondents (40/50) answered at least four of 6 questions correctly. A significant improvement in HCP self-reported performance was observed in a combined analysis of both activities (mean score, SD 2.65, 1.32 vs 3.15, 1.26; P=.03), with the proportion of learners selecting the answer representing the best clinical option for all 4 questions increasing from 32% (11/34) to 59% (20/34) after the activity. Several unmet educational needs were self-reported or identified from the analysis of incorrectly answered questions, including setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies.ConclusionsShort, case-based, web-based CME activities designed for HCPs to fit their clinical schedules achieved improvements in knowledge, competence, and self-reported performance in T2D management. Ongoing educational needs identified included setting individualized glycemic targets and the potential benefits of sodium-glucose cotransporter 2 inhibitor therapies.

Utilizing Geriatrics-Focused Web-Based Continuing Education to Reach Practitioners in Rural Practice

Continuing education (CE) provides community healthcare practitioners an opportunity to develop and maintain competence after their initial training is complete. With increasing clinical demands and limited resources for practicing community providers, the need for easily accessible, high-quality continuing education is in growing demand. Also, given the aging of the U.S. population, CE that addresses the complex care needs of older adults is of critical importance. These CE opportunities are particularly needed in rural areas where physicians typically maintain a single-physician private practice and are unable to leave their patients to attend in-person CE. Unfortunately, access to CE with geriatrics-focused content can be challenging in rural communities where opportunities may be limited and access to administrative, financial, and technological resources and/or support are minimal (Hendrickx and Winters 2017). To meet this identified need, the University of Alabama at Birmingham (UAB) Geriatric Education Center (GEC) and UAB Reynolds Program partnered with the UAB Division of Continuing Medical Education (CME) to develop enduring interprofessional geriatrics education modules (i-GEMs), a web-based geriatrics-focused CME curricula to be disseminated through a previously established on-line portal with 1000+ community physician members. The UAB GEC and Reynolds Program recognized the need for geriatrics-focused CE for other health professionals and worked with the Division of CME to expand the portal to include CE opportunities for additional healthcare professionals (examples include nurses, occupational therapists, physician assistants, and social workers). To ensure that participants of UAB GEC and Reynolds Program curriculum were able to locate the developed content, a geriatrics-specific sub-portal was established. With the expansion of the CME portal, the UAB GEC also identified that to create versatile and interprofessional content, a different approach would be required to develop i-GEMs that would applicable to all targeted healthcare professionals. To meet this new need, the UAB GEC incorporated the development of i-GEMs as a scholarly project into their year-long faculty development program to establish a pipeline for ongoing geriatrics-focused IPE modules. This paper describes the development of the interprofessional CE content, the partnership between the UAB GEC and Reynolds Programs with the Division of CME, as well as the utilization of the i-GEMs by practicing healthcare professionals.

Content of web-based continuing medical education about HPV vaccination.

Addressing low HPV vaccination coverage will require U.S. health care providers to improve their recommendation practices and vaccine delivery systems. Because readily available continuing medical education (CME) could be an important tool for supporting providers in this process, we sought to assess the content of web-based CME activities related to HPV vaccination. We conducted a content analysis of web-based CME activities about HPV vaccination available to U.S. primary care providers in May-September 2016. Using search engines, educational clearinghouses, and our professional networks, we identified 15 activities eligible for study inclusion. Through a process of open coding, we identified 45 commonly occurring messages in the CME activities, which we organized into five topic areas: delivering recommendations for HPV vaccination, addressing common parent concerns, implementing office-based strategies to increase HPV vaccination coverage, HPV epidemiology, and guidelines for HPV vaccine administration and safety. Using a standardized abstraction form, two coders then independently assessed which of the 45 messages each CME activity included. CME activities varied in the amount of content they delivered, with inclusion of the 45 messages ranging from 17% to 86%. Across activities, the most commonly included messages were related to guidelines for HPV vaccine administration and safety. For example, all activities (100%) specified that routine administration is recommended for ages 11 and 12. Most activities (73%) also noted that provider recommendations are highly influential. Fewer activities modeled examples of effective recommendations (47%), gave specific approaches to addressing common parent concerns (47%), or included guidance on office-based strategies to increase coverage (40%). Given that many existing CME activities lack substantive content on how to change provider practice, future activities should focus on the practical application of interpersonal and organizational approaches for improving HPV vaccine delivery in the clinical setting.

Use of Massive Online Open Courses as a Potential Resource to Provide Continuing Medical Education in Pakistan.

The Pakistan Medical and Dental Council (PM&DC) has made Continuing Medical Education (CME) mandatory for doctors, from 2015 onwards. Aminimum of 15 credit hours of CME per year for general practitioners and 30 credit hours for specialist doctors have been made mandatory for renewal of the PMDC registration. While doctors can attend conferences to earn this CME credit, the opportunities are minimum and limited to major cities across Pakistan. Webbased CME is an attractive alternative to attending conferences. It can make up for 25% of the yearly PMDC requirement. So far, only two web-based CME providers have been launched in Pakistan, which is a shortage. Could Massive Online Open Courses (MOOCs) be used to fill this shortage? The MOOCs are online courses that are easily accessible to all learners irrespective of geographical boundary and resources, and can be used as a tool to provide CME to physicians. The problem as to how credit from PM&DC can be obtained, will need to be explored further.

Awareness Assessment on Continuing Medical Education in Korean Orthopaedic Society

Purpose: Awareness on continuing medical education (CME) of the Korean Orthopaedic Association (KOA) was investigated in order to augment the weak educational points of the conventional academic CME. Materials and Methods: The web-survey was conducted in the KOA on the awareness of conventional academic or web-based CME. The questionnaire included working conditions, intimacy of informational technology, and strengths and weaknesses of academic and webbased CME. Results: Among 3,427 emails sent, 168 (4.9% of effective response rate) responses were received. Of the responders, 74.4% of the responders could not attend CME frequently because of working time (35.7%) and a distance far from the working place (13.2%). The merits of academic CME included as the opportunity for considerations of other members’ thoughts on some clinical matters (64.3%); however, the weak points were holding several similar conferences (60.1%) and too short time for adequate study (53.0%). They wanted that surgical procedures and tips (49.0%) to be provided in the form of lecture slides (44.6%) or movie clips (37.6%) in web-based CME. 95.5% of the responders showed positive response regarding the need for web-based CME. Conclusion: Results of the survey showed high needs and interests in web-based CME, which could support the weaknesses of the academic CME with less time for education and limited accessibility to CME due to time or space barriers due to their working conditions.

Web-Based Continuing Medical Education in Korean and Foreign Orthopaedic Societies

Web-Based Continuing Medical Education in Korean and Foreign Orthopaedic Societies

Impact of reflective learning on physicians and #8217; attitudes and care

Reflection is thought to play a significant role in health professionals’ implementation of learning from continuing medical education (CME) courses into practice. The use of reflective learning as an integral aspect of CME activities to enhance learning and practice changes has not been studied. Therefore, the specific aim of the study is to examine the impact of a Web-based CME activity that emphasizes reflective learning on the attitudes and professional activities of family physicians. Individuals participating in online CME modules were asked to complete a Transition to Practice (t2p) questionnaire that was designed to encourage the participant to reflect on actual changes made in their practice, barriers faced during implementation, and strategies put in place to maintain the change. Responses to specific questions were coded to identify trends and important themes. Of the 1,599 physicians enrolled in at least one of the online CME modules, 71 (4.4%) of these physicians completed the entire t2p questionnaire and process. More than three-quarters (78.2%) of participants who completed Step 3 of t2p reported changes to their thoughts and attitudes regarding their management of patients with diabetes or at risk of developing diabetes. Reflective learning in CME with the use of Web-based learning modules and the t2p instrument impacted the attitudes and patient care activities of participating physicians.

Development and evaluation of a web-based breast cancer cultural competency course for primary healthcare providers.

BackgroundTo develop and evaluate a continuing medical education (CME) course aimed at improving healthcare provider knowledge about breast cancer health disparities and the importance of cross-cultural communication in provider-patient interactions about breast cancer screening.MethodsAn interactive web-based CME course was developed and contained information about breast cancer disparities, the role of culture in healthcare decision making, and demonstrated a model of cross-cultural communication. A single group pre-/post-test design was used to assess knowledge changes. Data on user satisfaction was also collected.ResultsIn all, 132 participants registered for the CME with 103 completing both assessments. Differences between pre-/post-test show a significant increase in knowledge (70% vs. 94%; p < .001). Ninety-five percent of participants agreed that the web based training was an appropriate tool to train healthcare providers about cultural competency and health disparities.ConclusionThere was an overall high level of satisfaction among all users. Users felt that learning objectives were met and the web-based format was appropriate and easy to use and suggests that web-based CME formats are an appropriate tool to teach cultural competency skills. However, more information is needed to understand how the CME impacted practice behaviors.

Is Physician Engagement With Web-Based CME Associated With Patientsʼ Baseline Hemoglobin A1c Levels? The Rural Diabetes Online Care Study

To investigate the association between physician participants' levels of engagement in a Web-based educational intervention and their patients' baseline diabetes measures. The authors conducted a randomized trial of online CME activities designed to improve diabetes care provided by family, general, and internal medicine physicians in rural areas of 11 southeastern states between September 2006 and July 2008. Using incidence rate ratios derived from negative binomial models, the relationship between physicians' engagement with the study Web site and baseline proportion of their patients having controlled diabetes (hemoglobin A1c < or = 7%) was explored. One hundred thirty-three participants (intervention = 64; control = 69) provided information for 1,637 patients with diabetes. In the intervention group, physicians in practices in the worst quartiles of A1c control were least engaged with the study Web site in nearly all dimensions. Total number of pages viewed decreased as quartile of A1c control worsened (137, 73, 68, 57; P = .007); similarly, for a given 10% increase in proportion of patients with controlled A1c, participants viewed 1.13 times more pages (95% CI: 1.02-1.26, P = .02). In the control group, engagement was neither correlated with A1c control nor different across quartiles of A1c control. Engagement in Web-based interventions is measurable and has important implications for research and education. Because physicians of patients with the greatest need for improvement in A1c control may not use online educational resources as intensely as others, other strategies may be necessary to engage these physicians in professional development activities.

Content Analysis of Continuing Medical Education for Cervical Cancer Screening

Since 2003, newer cervical cancer screening guidelines that include human papillomavirus (HPV) testing with cytology (HPV co-testing) call for extension of screening intervals in women who are cytology normal and HPV negative. Continuing medical education (CME) may help increase knowledge and appropriate adoption of new technologies and guidelines. However, there are concerns that industry support of CME may bias messages favoring newer technologies without emphasizing the updated guidelines, especially less frequent testing recommendations. Our objectives were to assess availability and accuracy of web-based CME activities describing cervical cancer screening guidelines, screening intervals, and HPV testing. We identified 20 web-based CME activities available between 2006 and 2008 and evaluated the content for messages related to HPV and natural history, cervical cancer screening guidelines, management of HPV abnormalities, and counseling tips for patients. In addition to content, we noted funding source, credit offered, and dates available. Most activities (80%) discussed the updated screening guidelines with HPV co-testing for eligible women. Twelve activities (60%) referenced professional organization support of the extended screening interval with the HPV co-test, and three (15%) discussed the justification for extension of intervals for eligible women. Eight activities (40%) were funded by industry, seven of which included accurate, updated screening guidelines about extension of screening intervals. Web-based CME activities generally support updated guidance for HPV co-testing and extended screening intervals but need more information on counseling patients and acceptability of extending screening intervals.

Characteristics that predict physician participation in a Web-based CME activity: the MI-Plus study.

Physician use of the Internet for practice improvement has increased dramatically over the last decade, but research shows that many physicians choose not to participate. The current study investigated the association of specific physician characteristics with enrollment rates and intensity of participation in a specific Internet-delivered educational intervention to improve care to post-myocardial infarction (MI) patients. Primary-care physicians were recruited for participation in a randomized controlled trial designed to compare effectiveness of an intervention Web site versus a control Web site in the management of adult chronic disease. Physicians were informed that the intervention focused on ambulatory post-myocardial infarction patients. Physician characteristics were obtained from a commercial vendor with data merged from the American Medical Association and Alabama State Licensing Board. Enrollment and Web use were tracked electronically. Out of a sample of 1337 eligible physicians, 177 (13.2%) enrolled in the study. Enrollment was higher for physicians with more post-MI patients (> or = 20 vs < 20 patients, 15.3% vs 9.3%, P = .002) and for those practicing in rural compared to urban areas (16.3% vs 12.1%, P = .046). Intensity of use of the Internet courses after initial enrollment was not predicted by physician characteristics in the current sample. Physicians with more post-MI patients and rural practice location were found to predict enrollment in an Internet-delivered continuing medical education (CME) intervention designed to improve care for post-MI patients. These factors predicted program interest but not program use. More research is needed to replicate these findings to investigate variables that determine physician engagement in Internet CME.

Evaluation of Learning Outcomes in Web-Based Continuing Medical Education

There has been significant growth in use of Web-based continuing medical education (CME) by physicians. A number of evaluation and metareview studies have examined the effectiveness of Web-based CME to varying degrees. One of the main limitations of this literature has been the lack of systematic evaluation across different clinical subject matter areas using standardized Web-based CME learning formats. One group of pretest-postest designs were used to evaluate knowledge and self-reported confidence change across multiple Web-based courses using a standardized instructional format but comprising distinct clinical subject matter. Participants also completed a participant satisfaction survey and a self-reported retrospective skill/ability change survey. The majority of courses evaluated demonstrated significant pre to post knowledge and confidence effect size change, as well as significant self-reported retrospective practice change. A Web-based CME instructional format comprising multimedia-enhanced learning tutorials supplemented by asynchronous computer-mediated conferencing for case-based discussions was found to be effective in enhancing knowledge, confidence, and self-reported practice change outcomes across a variety of clinical subject matter areas.

A review of evaluation outcomes of web-based continuing medical education

The Internet and worldwide web have expanded opportunities for the provision of a flexible, convenient and interactive form of continuing medical education (CME). Larger numbers of doctors are accessing and using the Internet to locate and seek medical information. It has been suggested that a significant proportion of this usage is directly related to questions that arise from patient care. A variety of Internet technologies are being used to provide both asynchronous and synchronous forms of web-based CME. Various models for designing and facilitating web-based CME learning have also been reported. The purpose of this study was to examine the nature and characteristics of the web-based CME evaluative outcomes reported in the peer-reviewed literature. A search of Medline was undertaken and the level of evaluative outcomes reported was categorised using Kirkpatrick's model for levels of summative evaluation. The results of this analysis revealed that the majority of evaluative research on web-based CME is based on participant satisfaction data. There was limited research demonstrating performance change in clinical practices and there were no studies reported in the literature that demonstrated that web-based CME was effective in influencing patient or health outcomes. The findings suggest an important need to examine in greater detail the nature and characteristics of those web-based learning technologies, environments and systems which are most effective in enhancing practice change and ultimately impacting patient and health outcomes. This is particularly important as the Internet grows in popularity as a medium for knowledge transfer.

Jefferson Medical College of Thomas Jefferson University.

Jefferson Medical College of Thomas Jefferson University.