Physicians are slaves to information, but few seem willing to explore the bounty of medical knowledge that Internet technology can unlock.
A recent survey of 1,900 randomly selected physicians conducted by the American Medical Association revealed that only 20% use the Internet at all, and far fewer use it for continuing medical education. Many authorities in the fledgling online CME arena concur with these findings.
"Most of my colleagues who have been developing online CME have found relatively few physicians applying for credit," says Jack Kues, M.D., assistant dean and associate professor of family medicine at the University of Cincinnati College of Medicine. "They're not spending a lot of time on the Web going through elaborate programs. They don't have the time and, for the most part, they don't have the interest.
"What they are interested in, we think, is going to the Web to get a short, succinct answer to their questions about a new medication, treatment or diagnostic test. They don't seem willing to spend 45 minutes to an hour going through a detailed program."
More than 2,000 institutions and companies are accredited by the Accreditation Council for CME as providers of continuing medical education. These organizations offer more than 100,000 courses each year. An increasing number of courses are being offered online, but it's unclear just how many.
As far as accreditation goes, there is no difference between online and traditional CME requirements. Both are subject to the same rigorous ACCME review, including the council's Standards for Commercial Support of CME, which attempt to minimize conflicts of interest between course content and corporate sponsors.
Generally, the cost of online courses tends to be low, sometimes even free, except for small registration or processing fees. But as is the case in traditional classes, there is quite a bit of variation.
The sponsor of a course typically determines its cost. Academic institutions that rely on self-funding usually charge between $15 and $25 per hour of instruction for traditional CME, whereas those with corporate sponsors can charge much less. The same cost variations hold true for online courses.
Sometimes sponsors require a registration fee as well as a nominal fee for each instructional module.
The University of Iowa, for example, has a $50 registration fee for a traditional program and a $16 charge for each module. Online powerhouse Medscape offers unlimited access to approximately 200 CME credit hours for an annual fee of $50. Another Web site, MDConsult, offers more than 300 CME modules for a $19.95 monthly subscription fee and a $16 processing fee for each course.
Physicians can check out different sites to see who is offering the courses of most interest to them and then go for the best deal (see chart on page 55).
Course charges notwithstanding, online CME yields clear savings in terms of travel and accommodation, not to mention time.
"The Internet is ubiquitous," says Jeffrey Drezner, M.D., Medscape's executive vice president. "By providing CME as part of a much larger, comprehensive medical resource, medical education is easily available and fits into the clinician's harried schedule."
Although some busy physicians balk at the idea of sacrificing an hour of time to Internet learning, others believe time pressures are precisely what make Internet CME courses most appealing.
Liz Gabay, M.D., a Bellingham, Wash.-based internist, rarely has a solid hour to take an Internet CME course. After leaving the clinic and picking up her children from school, she might be able to squeeze in about 15 minutes of online CME while cooking dinner and return to it after the kids are in bed.
"The good thing about CME online is . . . you can read for a time, find the place where you left off and start again," Gabay says. "Course materials are always available for reference and are often updated so you can continue to look at them for reference. And much of it is free."
If convenience and cost considerations do not motivate physicians to explore Internet education, patients will. More patients are showing up for office visits with up-to-the-minute information about their condition gleaned from Internet browsing. To keep pace, physicians have no choice but to use the same resources.
For rural physicians, whose 24-hour schedules make it impossible to get away, Internet education offers a lifeline to distant colleagues. "If you look at how physicians answer questions about their patients, they ask a colleague," says Michael Peterson, M.D., associate professor of medicine at the University of Iowa and head of the university's virtual hospital. "Rural physicians don't have the same ability to interchange with colleagues (as urban physicians do). This kind of medium would extend that."
Yet like other educators, Peterson agrees that as a group, physicians have not been particularly receptive to Internet education. "I don't know if it's a learning curve or an access problem, or if they don't know these kind of things are there yet and trying to find them is too daunting," he says. "Once we can make physicians aware that the resources are there and can help them, they will use it."
Medscape goes so far as to offer physicians on-site training on how to use the Internet through its Medscape Academy. But most physicians who use computers for billing and word-processing purposes either never make their way to the Internet or only stumble onto it over time, without formal training.
One converted Internet-phobe is Paul Glunz, M.D., a 69-year-old pathologist who several years ago retired from his practice in rural Wisconsin following a car accident. Initially using the computer for word-processing applications, Glunz says he "never gave a thought to the fantastic potential I have since exploited." Now an Internet enthusiast, Glunz says he accesses a number of online CME providers.
"Don't be afraid; don't be intimidated," he advises those who are reluctant to explore this bountiful medium. "Seek consultation, buy a good computer . . . and get on with it. I am sure there are many CME links that would serve the needs of individual physicians if they would take the time to search for them."
For doctors who want to contribute to course content, Milliman & Robertson is looking for input about online CME. The international consulting firm comprises actuaries and healthcare consultants and is well-known for medical practice guidelines. "(Our) goal is to develop curricula that are in direct response to the immediate educational needs of practicing and executive-level physicians," says Julie Bainbridge, CME manager for Milliman & Robertson's Health Management University, an Internet-based CME institution. By logging in at www2.milliman-hmg.com/hmu/cmesurvey.html, physicians can provide input and also receive a free voucher for an upcoming CME course.
Internet CME training may be convenient and accessible, but it frequently is not interactive. Doctors often can't ask colleagues about course content or raise questions about a particular patient.
"Collegial exchange has traditionally been the most valuable and effective method of physicians learning -- from each other," says Robert Bollinger, who is a trustee for the Society for Academic CME. The society is a professional organization for academic institutions that offer CME, and CME director at Wayne State University School of Medicine. "When you're sitting at a computer workstation all by yourself, you don't have that opportunity."
Cost, not technology, is restricting such one-on-one Internet interactions.
"As soon as you put a person into the medium, it costs money," says Peterson of the University of Iowa. For strapped academic institutions and professional associations, money is frequently hard to come by. Many, like the American College of Physician Executives in Tampa, Fla., and the Foundation of the Pennsylvania Medical Society, use e-mail for discussion among CME course participants. Privately held businesses, which face fewer fiscal constraints, are developing online physician assistance and live chats to allow for collegial dialogue; others are offering live CME courses.
An additional drawback is that too frequently, CME courses are transferred to the Web without consideration of Internet users' fundamental expectations: speed and ease. Internet users have grown accustomed to rapid-fire access to targeted information with search tools available at virtually every site, and sometimes CME courses neglect to factor in those features. Other offerings err in the opposite extreme: Educators fall in love with the technology and employ bells and whistles that frustrate users with limited computer capabilities.
One final drawback to Internet CME training: Doctors miss out on the lunches, dinners and cocktail parties often available at traditional programs.
But for physicians who don't mind leftovers -- and are willing to invest some upfront time identifying suitable sites to achieve long-term payoffs -- Internet training can open a virtual universe of information right in their own living rooms.
Here's a sampling of the growing number of online CME options
Accreditation Council for Continuing Medical Education
The ACCME provides voluntary accreditation to CME programs that meet the standards adopted by seven sponsoring organizations. The organization's home page offers information to physicians about educational opportunities and ACCME activities.
Offers tests worth 1.5 hours of Category 1 credit from the American Medical Association. Each test costs $15; a bulk rate of $100 is available for 15 hours of credit.
Among different payment plans, a $19.95 monthly membership fee or a yearly fee of $199.95 provides access to more than 300 modules. Each test is worth 1.5 credits and carries an additional $16 processing fee.
Provides information about conferences in specific areas and access to more than 200 article topics. Offers both free and fee-based programs.
Milliman & Robertson Health Care Management University
This site is in the early stages of development. It will offer healthcare management courses online for physician executives to earn Category 1 credit.
Genevieve Belfiglio is a Cranbury, N.J.-based writer and editor with a special interest in healthcare topics.