The Effectiveness
of Need Time CME to
Demand in regards to access of CME for Physicians
David N. Bailey, MBA
Director, Continuing Medical Education
Marshall University School of Medicine
Huntington, WV
John Kues, PhD
Assistant Dean for CME
University of Cincinnati/Family Medicine
Cincinnati, OH
Abstract: Physicians face increasing pressure regarding obtaining CME for decision making and educational purposes. On the one hand the explosion of new information requires increasing time be taken for CME, but on the other hand the physicians face the pressure of seeing increasing numbers of patients in order to meet managed care obligations. Thus a need exists to make CME available efficiently yet with substance. The aim of this study is to compare two modes of delivering CME and identify physicians’ perception regarding the merits of each. Results from the survey indicate that traditional forms of CME are relied upon more than computer based forms to make patient care decisions.
Key words: Continuing medical education (CME), interactive patient.
Continuing medical education (CME) forms (as online CME, formal programs, grand rounds, consulting with peers, audiotapes, journals and texts, videotapes, teleconference and telemedicine) enable health care providers an opportunity to obtain information regarding outcomes, drug interactions, patient histories, FDA regulations, nursing home care guidelines. In order to provide the best possible health care for patients, physicians must rely upon a combination of resources to make sound decisions with the added pressure of managed care obligations along with increasing patient loads.
The future role of CME is steeped in the current practice of moving medicine toward outcomes oriented practice and many institutions are looking at benchmarking exercises to identify "best practices" for physicians and institutions. CME has an important roles to play in this loop through designing educational materials and activities that help change physician behavior will be critical to the survival of all health care institutions. Electronic communications technologies have created an environment where we can deliver "point of need" education (CME on Demand). The need to make immediate patient care decisions by physicians will require more dependence on electronic support systems that can be accessed immediately. At present traditional forms of CME are relied upon to support patient care decisions.
Too much of our technology today is separate because of the limitations of the current analog system. Digital technology requires systems-thinking. The digital difference centers on seamless interconnection. All of the appliance that we use will be bundled into one small intelligent appliance that can be easily carried. Imagine a combined phone, computer, TV and video camcorder. The way to convert our physicians to using electronic appliances is through education, social consensus, and positive experiences.
One specific study was found that addressed the need for CME on Demand as related to patient care and physician education. The study indicated that while reading is the most frequently selected method overall, physicians are more likely to select formal CME or consults, when the problem requires more technical expertise or communication ability to solve. Region and year of graduation added only slightly to the model. Gender, certification, and size of town did not add to the predictive model. The articles referenced related to expected change in traditional CME and tools for delivery.
Methods and Analysis
Data Collection
The aim of this study was to compare physician’s perception of merits of CME on demand in relation to traditional, seminar-based CME. The study was designed to assess physicians’ perception of Marshall’s Interactive Patient program, other computer based programs and internet resources. The study was accomplished through a survey of a traditional group of 400 physicians from WV, OH and KY and an innovative group of 100 users of Marshall Interactive Patient program. The surveys were mailed in 1998 during the months of April/May (validation), June (Phase 1), August (Phase 11). A total of 400 surveys were mailed and 88 completed by the traditional group and a total of 100 surveys were electronically sent and 16 completed by the innovative group. An additional 100 surveys were mailed to the innovative group when the initial electronic mailing did not produce responses.
Subjects
The traditional group in this study included physicians from the tri-state area of West Virginia, Ohio and Kentucky. The innovative group included health care providers from the USA, Canada, and Australia. 25% Female, 75% Male, with a medical school graduation year range from 1933 to 1995.
Data Analysis
Data was entered on Microsoft Access with analysis by SPSS.
Frequency distributions were run for each of the 22 questions on the survey for both groups. The low response from the innovative group prompted a combination of traditional and innovative group surveys for frequency distribution results only. 88 surveys or 22% returned for the traditional group (88/400) and 16 surveys or 16% for the innovative group (16/100).
Results
Frequencies Summarized
Responding to the survey were 32 Academic physicians, 51 private practice physicians and 21 others. Year of graduation from medical school ranged from 1933-1995. The responding group represented 20 solo practices, 2 group-single specialty, 21 multi-disciplinary groups and 21 others. Half days a week seeing patients ranged from 1 to 14 half days. Total CME Category 1 hours completed in one year ranged from 6 to 200 hours. Top CME sources utilized (97) formal CME programs, (51) grand rounds, (66) reading journals and texts. Additional information required by rank order of = emergency/trauma (25), personal education(25), consultation(17), and scheduled appointments(5). Question/time of response by rank order = emergency patient care (.5/hr) (60), scheduled patient visits (.5/hr) (29), consultation (24/hr) (45), personal education (24/hr) (63). The number one source for information for emergency patient care (consult w/peers), scheduled patient care (medical books), consultation request (consult w/peers), personal education (cme program or medical journal). Online CME reference source for credit, (15) MUSOM-interactive patient, (6) other web sites, (42) none. Computer experience, (47) beginners, (35) intermediates, (17) experienced. Computer systems utilized, (11) laptops, (74) desk tops, (11) shared networks, (2) others. Time spent on the computer per day (1 hr), per week (2 hrs). Access to computer sources, outpatient clinic (19), library (17), office (27), home (20). CME reference source most useful, online cme (26), formal cme programs (25), journals & texts (23). AM hours used to access online reference sources rank, 8a, 9a, 10a. PM hours used to access online reference sources rank, 8p,9p, 10p. Informational data bases used by rank, (51) Medline, (44) CD Rom , (18) MUSOM-interactive patient, (15) AAFP, (12) AMA. Use of computer/on-line resources by rank, (44) education, (17) patient care decisions, (7) consultations.
No significant difference was identified in the survey results for the traditional group and innovative group.
Conclusions and Implications
Based on the study’s initial research question, the direction of this study is changing towards identifying the specific CME resource choices utilized by health care providers in making patient care decisions or decisions regarding education. A comparison of demographic information for the health care provider and choice of CME resource will provide the basis for further analysis of the survey information received.
The implications of this study is to increase the awareness of CME sponsors/providers towards developing programs that reflect the needs of physicians in urban and rural settings. CME on Demand is in essence having the right resource, at the right time for the current problem, delivered by an appliance that is easy to manipulate in a stressful situation.