The past several decades have brought about a number of changes in medical education resulting from the introduction of newer technology into the educational process. The newest arrival to the changes brought about by technology is the use of the Internet in medical education. 

Beginning in 1995, there have been a growing number of attempts to use the Internet to deliver continuing medical education (CME) to physicians. Although many educators and developers of online predict a rosy future for online CME, Internet CME has been used by only a tiny fraction of American physicians. 

Because of the potential widespread use of the Internet as a vehicle for delivering CME, it was decided to undertake a descriptive analysis of the current status of CME. 

In the Review of Literature, the emergence of online CME as a convergence of several trends is put forth; these trends include developments in the theory and practice of distance education, new theories of how practicing physicians learn and developments in continuing medical education; several previous studies of online CME are discussed; similarities and differences between non-online CME and online CME are outlined; theories of effective online instruction are reviewed; multimedia, simulation and interactivity in online CME is discussed as is the newer tendency towards combinations of modalities in CME; the review of literature is concluded with a discussion of attempts to measure and enforce the quality of medical information presented on the Internet. 

In Method, the compilation of a list of most current online CME sites is described; the construction of a database created from the information in that list is explained; the construction of a prototype database and search engine that will allow physicians to search for online CME by course is delineated; a review of previous versions of the online CME list and comparison with the present list is given; and a physician-usage survey is presented.

In Results, a sample entry from the list of online CME sites is shown; the growth in the number of online CME sites is illustrated; the results of the analysis of the online CME site database is presented; and the physician-usage survey results are given.

In Discussion, the rapid growth of online CME sites and courses is reviewed; the growing gap between large sites and small sites is discussed; the slow growth in the numbers of users is presented; ideas are suggested to explain the discrepancy between the number of visitors to online CME sites and the number of credits awarded; and a brief discussion of the use of educational theory in online CME.

In Conclusion, the growth and consolidation of online CME is discussed; a set of predictions is put forth. These predictions include the greater use of principles of instructional technology and the "team approach" in the production of online CME courses; changes in the ways CME is monitored and paid for; requirements that CME be shown to be effective; and combination of online CME with other instructional modalities. Some weaknesses in the present report are outlined. Finally, directions for future research are suggested.