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Online CME for Family Practitioners Bernard Sklar MD MS January 2002

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Presentation on theme: "Online CME for Family Practitioners Bernard Sklar MD MS January 2002"— Presentation transcript:

1 Online CME for Family Practitioners Bernard Sklar MD MS January 2002

2 Plan of Talk I am going to show you about 13 web sites which offer CME specifically designed for FPs I have chosen the sites based on ease of access and appropriateness for FPs I have chosen at least one example of the various types of web-based instruction

3 Online CME – An Overview At last count (December 2001), there were about 200 web sites offering CME; there were about 12,000 courses and about 17,500 hours of CME credit available. Well over half of the sites have instruction oriented to primary care physicians.

4 Online CME – Types of Instruction Although many educators believe that Case-Based-Interactive instruction is the best form of CME, whether live or online, I think that different doctors have different learning styles, and that different modes of instruction may suit you at different times.

5 Online CME – Types of Instruction II I classify online CME into10 instruction types: Text-Only Text-and-Graphics Slides-Only (or Slides and Text) Slide-Audio Slide-Video Guideline or Consensus (usually text only) Question-and-Answer Case-Based Interactive Correspondence Games

6 Types of Instruction Defined The types of instruction are pretty obvious by looking at the names, but if you want to see how I have defined them, you can visit defined.htm defined.htm

7 How to find these sites (and others) All the sites shown in this talk (and all the other active online CME sites that I have found) are listed in alphabetical order and described at

8 Text-Only This is the easiest type of site to put up, and not very interesting. It is essentially the same as reading a journal article or a textbook chapter. If the text is long, it is often better to print it and read it offline.

9 Text-Only Medbytes

10 Text-and-Graphics AFP The next step up is text-and-graphics. I like American Family Physician online version for lots of reasons:American Family Physician

11 Almost all FPs are subscribers Reflects the official view of AAFP Two issues per month Online Quiz has questions on most of the articles in each issue Regular use can satisfy requirements for AAFP membership and ABFP recertification AAFP keeps track of the CME hours you earn CME is free to AAFP members

12 American Family PhysicianAmerican Family Physician December 15, 2001

13 American Family Physician You can read online or print html or pdf versions Disadvantages – not interactive; you must read all articles in an issue to get credit You could read print version just as easily (but you have to remember where you put it, and put a stamp on the card)

14 American Family PhysicianAmerican Family Physician Quiz

15 American Family PhysicianAmerican Family Physician Quiz You can check your answers online and get feedback on incorrect answers before submitting for credit Should definitely be a part of your regular CME (unless you prefer the print version)

16 Slide-Only Texas Medical Association Stroke ProjectTexas Medical Association Stroke Project

17 Texas Stroke-Slide 3

18 Texas Stroke – Accompanying Text Stroke is expensive as well as dehumanizing. Economic models and regional costs vary (reflected in the broad range of estimates on the slide). An average lifetime cost of $60,000/stroke is a reasonable figure. However, some strokes leave no functional deficits while others result in total dependency for basic activities of daily living, so an "average" can be misleading. Preventing stroke in using most current, proven therapies is cost-effective and often cost-saving.

19 Slide-Audio Increasingly common Many lectures are recorded live If you visit the Vaccine Safety site, you can hear the sound and watch the slides advanceVaccine Safety You can fast forward, reverse, etc, the slides and the audio just like a VCR

20 Vaccine Safety

21 Slide-Video-Lecture This form of online CME is more pleasant if you have a high-speed connection, because the video can be very small or jerky; and in general, you dont gain that much by watching the speaker walk around or see him forming his words. The video is usually in a very small portion of the screen.

22 World Medical Leaders- Osteoarthritis

23 Baylor College of Medicine's Online CME Courses A very nice set of lectures in cardiology, surgery, diabetes and womens health. Baylor has a good solution to the connection speed issue. According to your connection speed, you can view slides and text only, or add audio, or add video. CME credit is free. The next slide shows a screen shot of a lecture on osteoporosis. If you visit this site, you will hear the speaker, see him, look at his slides and see a scrolling transcript of his words.

24 Avoiding Osteoporotic Fractures

25 Guidelines There are thousands of guidelines for diagnosis and treatment, put out by various official organizations. Only a very few of these have been converted to online CME. Search to find them. Usually the guideline is simply presented, and then you answer a few questions about the guideline in order to earn CME credit. I will show one example, from the University of Michigan.

26 University of Michigan Clinical Guidelines 15 guidelines offering free CME (1 hour each) Some examples: –Asthma in Adults and ChildrenAsthma in Adults and Children –Lipid Screening and Management in AdultsLipid Screening and Management in Adults –Otitis Media in Children and AdultsOtitis Media in Children and Adults –Peptic Ulcer Disease in AdultsPeptic Ulcer Disease in Adults Pdf format; download, print, read and return for quiz and evaluation


28 Three Question-and-Answer Sites If you like to challenge yourself, all of these sites are fun. ABFP In-Training Exam ABFP In-Training Exam Questions Family Medicine Review II eCore - The Core Content Review of Primary CareeCore - The Core Content Review of Primary Care

29 ABFP In- Training Exam Questions The program presents you with multiple choice questions. If you answer the question correctly, you will have the option to view the answer summary and then continue on to the next question. If you answer incorrectly, the answer summary is presented for your reference and then you may continue on to the next question.

30 ABFP In- Training Exam Questions 1000 questions and answers; start and stop whenever you like; 25 units of CME; free to anyone (no membership required) The questions are fun; the answers are short but informative

31 ABFP In-Training Exam Questions A sample question: A 45-year-old white male develops disabling tremulousness, loss of voice, and a marked sense of forceful and rapid heartbeat whenever he must speak to a large group. Which one of the following drugs is likely to be of most value in enabling him to give presentations at sales and stockholders' meetings?

32 ABFP In-Training Exam Questions Answer choices: Buspirone (BuSpar) Amantadine (Symmetrel) Alprazolam (Xanax) Propranolol (Inderal) Desipramine (Norpramin)

33 ABFP In-Training Exam Questions Right answer: Propranolol (Inderal) You chose: Alprazolam (Xanax) This patient has a specific situational anxiety disorder called performance anxiety, characterized by marked and sometimes disabling symptoms of catecholamine excess during specific performance situations, such as public speaking. Beta blockers such as propranolol and atenolol block peripheral anxiety symptoms, i.e., tachycardia and tremulousness, that can escalate subjective anxiety and impair performance. Drugs which are primarily psychotropics or antiparkinsonian agents are much less likely to be of value in this specific anxiety disorder, and may cause undesirable sedation and dry mouth. Ref: Kaplan HI, Sadock BJ (eds): Synopsis of Psychiatry, ed 8. Lippincott Williams & Wilkins, 1998, pp 975-976.

34 Family Medicine Review II This is a "study tool for family physicians preparing for certification and recertification examinations." A question/answer type of instruction featuring 224 questions. Each question presents a clinical situation and a set of multiple choice questions.

35 Family Medicine Review II You may go through all 224 questions and answers without a fee. You have to pay $75 to receive a CME certificate (10 hours)

36 Family Medicine Review II Which of the following statements about varicella immunization is FALSE? a. The vaccine contains live, attenuated virus. b. Immunization provides 70% to 90% protection against chickenpox infection. c. Immunization provides 95% protection against severe disease. d. Herpes zoster occurs after immunization at a slightly higher rate than after chickenpox infection. e. Immunization provides protection against chickenpox infection for at least 7 to 10 years after vaccination.

37 Family Medicine Review II The answer is d. Varicella vaccine does contain live, attenuated virus. After review of the available data on vaccine efficacy, the Advisory Committee on Immunization Practices (ACIP) stated that vaccination provides 70-90% protection against chicken pox infection and 95% protection against severe disease. Immunization appears to provide this protection against varicella-zoster virus infection for at least 7-10 years after vaccination." Herpes zoster can occur following both varicella immunization and infection. However, the rate of occurrence of zoster after immunization is lower.

38 eCore - The Core Content Review of Primary Care This course will: Test your knowledge against 242 questions in Family/General Practice. Provide you with one hour ($10) of AAFP Prescribed credit (equivalent to AMA Category 1 credit) for each 10 questions you answer.(equivalent to AMA Category 1 credit) Answers are much more thorough and detailed than in the first two programs discussed.

39 eCore - The Core Content Review of Primary Care You are asked to perform a preoperative evaluation on a healthy 55-year-old man who is scheduled for an elective inguinal hernia repair. During the examination, he relates that he is allergic to rubber. He reports getting a red scaly dermatitis that lasts for several days around his abdomen after wearing underwear with an elastic waistband. He also gets a similar rash on his hands after wearing rubber gloves. He has never had associated breathing difficulties, lightheadedness, or hives. Which of the following is TRUE? (Select the single best answer.)

40 eCore - The Core Content Review of Primary Care 1.You should recommend that the surgery be done with absolute latex-free operating room precautions. 2.He is at significant risk for latex-associated anaphylaxis. 3.He is most likely allergic to natural latex protein. 4.This patient is having a T-cell-mediated reaction. 5.This patient is also likely to have a reaction to kiwi fruit and bananas.

41 eCore - The Core Content Review of Primary Care This selection is correct! Natural rubber latex (NRL) comes from sap of the rubber tree Hevea brasiliensi and contains a complex mixture of more than 100 organic proteins. In its raw state, latex sap is not commercially useful, and several chemicals called accelerators or vulcanizing agents need to be added during manufacturing to produce functional rubber products. A few rare individuals are allergic to latex proteins. These true "latex- allergic" individuals have a type I, eosinophil-mediated allergic reaction characterized clinically by the relatively immediate appearance of urticaria, angioedema, airway swelling, vascular collapse, shock, and/or anaphylaxis (and 3 more pages of discussion….)

42 Case-based-Interactive The first example, Cleveland Clinic Online Journal of Medicine, is a text instruction with some CBI features. It represents a fairly easy way to put in some interactivity.Cleveland Clinic Online Journal of Medicine

43 Cleveland Clinic Online Journal of Medicine Each module begins with a brief case presentation followed by a set of 7-10 questions. You receive feedback on your answers, then proceed to a didactic discussion of the case. You then have a quiz. You receive feedback on the answer to each quiz question before proceeding to the next. You receive one hour of credit (free) for each module.

44 Cleveland Clinic Online Journal of Medicine An example is: Diabetic gastropathy: A practical approach to a vexing problemDiabetic gastropathy: A practical approach to a vexing problem

45 Brief Case Presentation

46 Pre-Instruction Quiz

47 Feedback on your answers

48 The Didactic Presentation

49 Post-Instruction Quiz

50 Feedback on Quiz

51 is the industry standard on CBI instruction. You can access these cases free through MerckMedicus MerckMedicus Go there, register, then go to CEMedicus, search content by Content Host and choose

52 109 highly interactive cases, aimed at primary physicians. The site helps you to assess your learning needs, and then suggests cases matching those needs in a personalized "Virtual Waiting Room." or you can view a catalog of all 109 cases (listed by chief complaint or major finding, not diagnosis)


54 You progress through the case in the usual way from history to differential diagnosis to labs and tests to diagnosis to treatment plan. Each of these sections offers you multiple choices and then feedback on each of your choices. All along the way, you can follow links to evidence-based discussion of your choices.

55 Skipping to Most Likely Diagnosis

56 Key Points

57 Other CBI Sites A few other CBI sites worth visiting are: ACP/ASIM Clinical Problem-Solving CasesACP/ASIM Clinical Problem-Solving Cases Interactive Grand Rounds from Medsite Virtual Lecture Hall

58 Games Games are really a form of question-and-answer or Case Based Instruction, but done in a fun way. The program is presented in game format; as you answer questions or make choices, your score goes up or down. You may compete against yourself or against other players.

59 Cardio Country Club Click on "Cardio Country Club" to start this game, a set of brief case presentations on hypertension and arrhythmias. Each case is followed by multiple choice questions. Your score climbs with each incorrect answer. You may "play" by yourself or in a group. You may also join a discussion group with one of the authors and other students. Primary care practitioners play an easier game, while cardiologists are urged to play at the "master's" level.

60 A case and a question

61 Finally a correct answer (but too many strokes)

62 Correspondence Courses Only one good example at present University of South Florida Business of Medicine

63 Presents a Mini-MBA in 4 courses: 24-96 credits; about $40 per credit Slide-Audio lectures, assignments, email discussion groups Groups start every month and you have 2 months to complete any one course

64 University of South Florida Business of Medicine Four courses: Marketing and the Management of Service Quality Managing People and Developing Strategies The Business Environment of Health Care Data Driven Management

65 Summary We have looked at about 13 online CME sites for FPs These sites were chosen to illustrate various instruction types of online CME I hope you will want to visit some of these sites and take some of these courses

66 Thanks for Listening Links to all of these sites, and about 185 others, as well as descriptions, can be found at Contact me at Bernard Sklar MD MS

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