Breaking the Mold: CME Moves Beyond Text

Published: Monday, May 12, 2008
Continuing Medical Education (CME) has now been available online in quantities sufficcient to make the Internet the primary or only CME source for some physicians—for more than 10 years. What was an oddity, and then a paradigm shift, has become the status quo. With the growing pains of the online CME experience mostly fi nished, we have arrived at a historical vantage point from which this now-mature phenomenon can be accurately assessed. From this perspective, what is most remarkable about online CME is the fact that, when it comes to the actual nature of the educational materials on offer, nothing has really changed.

Oh, the method of delivery has changed. Th e use of the Internet as a tool to distribute CME activities has made the process of obtaining continuing education much more effi cient and convenient for the physician, and has allowed activities to be supplemented by any number of audiovisual goodies (cf, every issue of MDNG, including this one). But the essential pedagogical strategy employed by most online CME activities is no diff erent from what was used in the days when print journal articles and expensive conferences were the only sources of CME credit. Specifi cally, most CME continues to employ a didactic model, in which an expert provides information, to be passively studied by the participant.

This is most obvious in the case of text-based activities: read this article on congestive heart failure, and then answer a few questions to determine whether or not you’ve internalized the appropriate information. But webcasts and live lectures are essentially didactic, as well. Even those activities that introduce some element of interactivity generally still conform to this basic expert teacher–student model.  Th ere is certainly nothing inherently wrong with a didactic approach, which has dominated education since Plato. However, there are indications that other educational philosophies may generate better results among physician learners. In a September 1, 1999 article published in the Journal of the American Medical Association, Davis, et al. reported that traditional, didactic sessions “do not appear to be eff ective in changing physician performance.” Davis and colleagues went on to observe that CME activities that provide the opportunity to practice skills—that encourage “learning by doing,” as it were—have greater potential impact on patient outcomes.

Of course, in 1999, with connective technology still in its relative infancy, the power to create truly immersive CME was limited. Not so today. Th e technical facility now exists to create an entirely new kind of activity, and physician comfort with the Internet and related technology is now at a level to make such an activity practical and likely to be used.  So, let’s take a look at the CME transformation that will seem as unremarkable in 2018 as online CME seems to us today.

CME in Real Life

One simple innovation that seems likely to become more common in years to come is the provision of CME credit for educational tasks carried out in the course of everyday practice.  Most physicians are learning every day, on the fl y, as they research symptoms, conditions, and treatments. Because this information is obtained in the context of actually using it, it’s more likely to be both memorable to the physician and specifically applicable to his or her practice than a general CME article or webcast. Now that the technological means to document this sort of learning is readily available, attaching CME credit to educational experiences of this kind is only a short step. Writing in The Permanente Journal, Carol Havens, MD, and colleagues envision the following potential scenario:

A physician using a computer to review her schedule sees that she will soon see a patient for skin rash and hyperlipidemia. She clicks on an option labeled “diagnosis” and is taken to a diagnostic algorithm... [and] the latest guideline for treating hyperlipidemia... As she records the diagnosis of hyperlipidemia, the computer automatically shows a list of medications. The physician clicks on her fi rst choice and is taken to the pharmacy site, which describes dosages, interactions, contraindications, and formulary status for the drug selected.

The physician’s computer logs the time and locations for all her Internet searches and provides her with a summary that she then sends electronically to her local CME office for credit. Again, the hypothetical physician described here by Havens and colleagues is more likely to retain the new information she sees during the process, because it is contextually tied to a specific, real-life situation.


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