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A descriptive study design was used to address these research questions: (1) How many online CME sites exist, and how many courses and credit hours of CME do they offer? (2) For which medical specialties is online CME available, and in what numbers and proportions? (3) What are the dominant types of instruction found in online CME? (4) What proportion of sites is affiliated with medical schools or universities? (5) How much does online CME cost? (6) Where do the sites find financial support? (7) How do sites vary in size? (8) How do the sites promote and advertise their offerings? (9) How many physicians are visiting online CME sites, participating in courses and obtaining CME credit from those courses? Creation of the online CME list
Beginning
in August 1997, and at approximately three-month intervals until
February 2000, the Internet was searched for sites offering CME
accredited by the ACCME. The search string used at each of the search
portals was "+online +continuing +medical +education." During
each quarterly search, the first 200 links from each portal site were
followed as well as other promising links from those links. In the first
two and half years, these major portals were searched: Altavista,
Yahoo, Netscape,
Lycos and Excite. Qualifying sites were added to the list
named “Annotated List of Continuing Medical Education Sites” and
posted on the Internet at http://www.medicalcomputingtoday.com. With each quarterly search newly found sites were added to the list. The last search of the five portals named above was carried out in December 1999. In February 2000, an additional search of the first two hundred links from two new search portals, Google and NorthernLight, was carried out. Also, when site owners or developers asked to be added to the list, those sites were visited and evaluated and added to the list when they met the criteria for inclusion. Sites were selected for inclusion where the entire instructional process (except, in a few instances, accreditation and payment) could be conducted online. Sites were not included if they offered only promotion of other forms of CME, such as meetings, conferences, home study text, audio, video and CD-ROMs. In addition to searching for new sites every three months, each site on the list was revisited to be sure that it was still active; those sites which could not be found, where CME credit had expired, or where navigation through the site was judged to be too confusing to be followed, were deleted from the list. Once a qualifying site was located, the following descriptive data was collected: Name
and Internet address (URL) of the Site. In December 1999, the list was moved to a temporary location at http://www.netcantina.com/bernardsklar/cmelist.html (link no longer active) and shortly afterwards to its present home at http://www.cmelist.com/list.htm. With subsequent quarterly reviews, additional notations have been made about when each site was last visited and when the instructional material was last updated. Direct links to many of the individual instructional courses have been added. The sites were described but not rated for the adequacy of instruction or the attractiveness of the presentation. Creation of the Site Database
Using the data gathered from the cumulative searches described above and additional information described below, a database (Microsoft Access 2000) was developed and populated, designed to capture the salient features of each website offering online CME. The following data items are included in the Site Database: ID Number. Yes/No Answers to these data items: Yes/No Answers to these data items concerning type of instruction. Yes/No Answers to these data items: Multiple possible Yes/No answers to data items about medical
specialty. Allergy/Immunology,
Anesthesia, Basic Science/Research, Cardiology, Colon & Rectal
Surgery, Critical Care, Dermatology, Emergency Medicine, Endocrinology,
Family Practice, Gastroenterology, General Interest, Geriatrics,
Hematology, Infectious Disease. Internal Medicine, Medical Genetics,
Medical Informatics, Nephrology, Neurological Surgery, Neurology,
Nuclear Medicine, Obstetrics/Gynecology, Oncology, Ophthalmology,
Orthopedic Surgery, Otolaryngology, Pain Management, Pathology,
Pediatrics, Physical Medicine & Rehabilitation, Plastic Surgery,
Preventive Medicine, Psychiatry, Pulmonology, Radiology, Rheumatology,
Sports Medicine, Surgery, Thoracic Surgery, Urology. The names of the specialties are taken from the lists of specialties maintained by the American Board of Medical Specialties and the American Board of Internal Medicine List of Subspecialties (list not found on December 5, 2006). A
complete description of the site database is found in Appendix
A. A
copy of the site database (CME_Site_Attributes.mdb) is available by
request. Definitions of Types of Instruction
The types of online CME instruction were defined as belonging in seven categories: Text-only, text plus graphics, audio-slide lectures, audio-video-slide lectures, guideline-based, question-answer and interactive. Definitions of these types of instructions are shown in Table 5. Most instructions fit into only one category. However, guideline-based, question-answer and interactive instructions utilized text or graphics (and, in some cases, audio or video) to present their instruction. Where the major thrust of the instruction was to present guidelines using any of those modalities, the instruction was classified under "guidelines." Where instruction was primarily question-answer using any of those modalities, it was called "question-answer." Where instruction was interactive using any of those modalities, it was said to be "interactive." Where there were several dominant types of instruction at a site, the site was listed as belonging to two different groups of instructional types. Analysis of the Site Database The Site Database was queried to find answers to the research questions listed above. The results of the queries were transformed to Microsoft Excel spreadsheets in order to do calculations (sums and percentages). The Excel spreadsheets were then transformed to HTML tables (Microsoft FrontPage 2000) for the Internet version of this report and to Microsoft Word Tables for the paper version of the report. The Excel spreadsheets are available for inspection on request. Creation of the Course Database Prototype A demonstration web-searchable database (Microsoft Access 2000) of Internet CME organized by course was created. The following data items are included in the Course Database: ID Number. Fee
(US$) per Credit Hour (values in ranges 0, 1-4, 5, 6-9, 10, 11-14, 15,
16-19, 20, 21-24, 25, and 26+ entered with a drop-down box). Where there
were several fee structures for members or non-members, the non-member
fee was chosen. Where there were several fee structures according to
whether the user paid for one course at a time or a fixed fee for a set
of courses, the latter was chosen. Does the site accept financial support from
pharmaceutical or other commercial sponsors? Yes/No Answers to data items about medical specialty (up to eight specialties accepted). The list of specialties is the same as for the Site Database. Yes/No Answers to data items about medical conditions or procedures (up to six medical conditions or procedures may be chosen). The names of these medical conditions or procedures and their associated numerical codes are taken from the UMLS Knowledge Source Server list of unique identifiers. The names and unique identifiers are accessed from an abridged dropdown list of medical conditions or procedures derived from the UMLS Knowledge Source Server list. Yes/No Answers to data items about Types of Instruction. The choices include Text-Only, Text-and-Graphics, Slide-Audio-Lecture, Video-Lecture, Guideline-Based, Question-and-Answer and Interactive. Up to 3 choices were made. Yes/No Answers to data items about specialty board
accreditation: A course description
(text input). Where available, the course description or list of
objectives given by the author(s) was inserted. Where not available, a
brief description was created based on an examination of the course
material. Finally there is a space for comments to be made by the
reviewer. A
more complete description of the Course Database is found in Appendix
B.
A copy of the course database (CME_Site_Attributes.mdb) is available by
request. The
prototype search engine is no longer available online (December 5,
2006).
An illustration of the user request interface is shown in Appendix C.
Searches by the website user yield this information: Name of Site and
Course, Course Description, Date Posted or Revised, Sponsor, Credit
Hours and Fee/Hour. The
result of a sample search is shown in Appendix D. At this time, this
database is populated with only 45 courses, so most searches will yield
empty results. Additional data items collected in the database will be
made available to researchers on request. Comparison of
Previous Versions of the Online CME List with the Present List In an attempt to quantify the growth of online CME, previous versions of the Online CME list were reviewed. The number of sites offering online CME beginning in September 1997 is compared to the number of sites found in the present version of the list. The
Physician Usage Survey In December 1999, an email was sent to each online CME site offering ten or more credit hours asking for information about physician usage at their site. Email contact addresses were obtained from the contact information given at the site. The first email request is shown in Appendix C. About one month later a second email was sent to those contacts that had not responded to the first note. A copy of the second note is shown in Appendix D. |