CMAJ 1997;156:1623
© 1997 Canadian Medical Association
Online CME
How often have you attended a conference at which you had to make many choices among simultaneous sessions, couldn't see the slides, couldn't always hear the speaker or, worst of all, drifted off because of fatigue and missed most of the talk? You received your continuing-education credits, but did you get your money's worth or the learning you wanted?
Now imagine a conference at which you can take in every talk and have a record of every word, can scrutinize the slides and ask as many questions as you like, and do all of this at your convenience, without leaving your home or office.
On the Net, such conferences already exist in many disciplines, and it may not be long before they're an accepted option for professional development, allowing busy doctors to address their learning needs and overcome professional isolation at their keyboards. Both major Web-based conferences and smaller online events that focus on case-based learning in a specific clinical area may become popular means of keeping up to date and consulting widely with colleagues. Experiments with smaller events are happening already, often with as simple a vehicle as a mailing-list discussion group ("listserv"), in which cases can be posted and discussed.
Internet technology for "distance learning" has progressed well beyond simple email, though. At a number of American Web sites, physicians can take continuing-education quizzes, sometimes with graphics such as radiologic images, and receive instant feedback about their answers. They can also follow hypertext links to a brief explanation of why an answer is wrong and further links to detailed reference information, perhaps from an online textbook. At the end of the quiz, the physician's score can be submitted to the accrediting institution, and sometimes physicians can compare their scores with those of their anonymous peers.
But the learning needn't be a solitary pursuit, because a group environment can exist online. The learner can interact with experts, who will respond to emailed queries, and with colleagues taking the same educational module or discussing the same case. Real-time, scheduled interaction can simulate the discussion in a meeting room, but in the future the face-to-face experience of interactive digital video may dominate.
For longer learning experiences, such as courses lasting months, Web-based instruction is usually just 1 element of a delivery system that may begin with a face-to-face session or a telephone call, incorporate "chalk and talk" from time to time, and be supplemented by email and discussion groups. In concept it's an evolution of the correspondence course, but it allows much more interaction and is not linear; hypertext, for example, facilitates learning according to needs and interests, with the instructor assuming the role of facilitator rather than lecturer and the student having more control over time and pace of learning.
Computer-mediated professional development will not be for everyone. The proportion of physicians who would choose an online seminar over a "souper-conference" (a session that includes a nice meal) because they actually enjoy using their computers is probably quite small. However, physicians in rural areas, those with little time for formal professional development and with limited budgets may find online courses a godsend. Moreover, the opportunity to consult more broadly and more quickly about challenging clinical cases and issues may be the deciding factor for many.
Technology is offering choices in how physicians conduct their communication, record-keeping, research and business affairs. It can also help them keep up to date with clinical medicine and so promote quality care, in a way that's easier, faster and cheaper. Those who are conducting online-CME experiments in Canada expect to demonstrate that the same educational principles can be applied and equivalent outcomes achieved as in a face-to-face meeting.
However, developing online courses and seminars is certainly not easier, faster and cheaper than developing face-to-face sessions: instructors must spend large amounts of time, energy and imagination restructuring material for a different medium, redefine their role and deal with new challenges, such as fostering a sense of community in an environment with no visual cues. They must provide more personal attention, at odd hours, to individual students, and cope with technologic glitches.
We encourage Canadian physicians to try an online course delivered through an American site; a selection is presented in CMA Online in the "Education and Conferences" section of the WebMed Links page (www.cma.ca/other_r.htm) [links to French sites are found at www.cma.ca/other_f.htm].
WebMed Links is our compilation of medicine-related sites that physicians may find useful. Suggestions for additions to the page would be welcome, and comments about computer-mediated professional-development opportunities and concerns would be helpful as we plan online services for CMA members. The CMA's director of professional development, Stephen Prudhomme (prudhs@cma.ca), would be pleased to hear from you.
-- Ann Bolster, associate director, new media, CMA
Highlights from CMA Online
Visit our new and redesigned CMA Publications Catalogue (www.cma.ca/catalog); French (www.cma.ca/catalog/index_f.htm). With its new, graphically enhanced "point-and-click" menus, the catalogue is appealing and user friendly. You can place your order directly with the electronic order form. Watch for updates of new releases and special offers, which are also publicized on our "What's new" page (www.cma.ca/whatsnew.htm); French (whatsn_f.htm).
Cool site
www.interchg.ubc.ca/jauca/
The Therapeutics Initiative Web site provides practical, unbiased, evidence-based information on drugs and drug therapy. The initiative, dedicated to changing physicians' prescribing habits and improving health care, was founded in 1994 by the Department of Pharmacology and Therapeutics at the University of British Columbia. The site provides information about the project, listings of educational activities that it offers and issues of Therapeutics Letter, which publishes concise reviews on new and existing drugs based on a critical evaluation whose rigorous process is detailed on the site. The drug assessment working group that performs the evaluations makes recommendations on new drugs to Pharmacare, the provincial drug-benefit program, and collaborates with groups doing similar reviews, such as the Cochrane Collaboration. Epidemiologic evaluation of the impact on prescribing, on health and on health care utilization of each program of the Therapeutics Initiative is under way or being planned. The initiative includes an international email network focused on evidence-based pharmacotherapy that is coordinated by Dr. Carl Whiteside (cbwh@unixg.ubc.ca).
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