Physician Learning Articles:

Is Online Learning For You?
By Virginia E. Hall, M.D
Introduction
In 1999, annual data from the Accreditation Council for Continuing Medical Education had approximately 79,000 physicians participating in Internet education programs. Just one year later, the council’s reported figure was more than doubled, at nearly 182,000.

As products of at least a decade of formal postgraduate education, physicians would seem to be prime candidates for traditional as well as innovative educational experiences. But we are not likely to be immune from the high dropout rates (one study found more than 40 percent) cited by educators in their general studies of online learning. Go to article

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Physician's Learning Strategies
By H. B. Slotnick, PhD, PhD
Abstract
This article examines the two categories of learning strategies that physicians use in clinical practice. The strategies are similar in their overall architectures and differ (1) according to nature of the clinical problem that precipitated the need to learn, and (2) the ways in which learning resources are used. Go to article

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Changes in learning-resource use across physicians' learning episodes
By H.B. Slotnick, Ph.D., Ph.D., T. Robert Harris, Ph.D., Ph.D., David R. Antonenko, M.D., Ph.D.,
Introduction:
This study explores the numbers of learning resources physicians use at each stage in self-directed learning episodes addressing general problems.

Results: The 50% response rate for faculty allowed generalization of findings to the population of these physicians; the rate for non-faculty physicians was too low to allow generalization. Faculty findings showed (1) broader resource use in learning about diseases than diagnosis or therapeutics, (2) comparable numbers of resources used in deciding whether to take on the learning problem and learning the required skills and knowledge, (3) greater numbers of resources selected to evaluate the problem and to learn the required skills and knowledge than to gain experience with the newly learned skills and knowledge, and (4) support for assertions that doctors value learning resources that are accessible, applicable, familiar, and time effective. Go to article

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CME at hand: Information you need, when you need it
By Myrle Croasdale
Introduction:
--Pilot projects are giving physicians CME credit for point-of-care learning with handhelds as a way to apply practice guidelines more effectively.--

Family physician Daniel F. McCarter, MD, has a library of evidence-based medicine, diagnostic calculators and best-practice guidelines at his fingertips via his handheld computer.
When a patient complains of an inflamed leg and shortness of breath and mentions that he's recently taken a plane trip, Dr. McCarter can look up the clinical decision rules for a pulmonary embolism on the handheld instead of reaching for a textbook.
He sees 20 to 25 patients on a typical day and uses his handheld on a regular basis during those interactions... Go to article

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Still loading: There's quite a ways to go for Web-based continuing medical education
By Myrle Croasdale
Introduction
Online CME was going to be the next big thing, but reading journals on the Web is boring, and you need broadband to walk through a virtual lab. Solutions look to wed education and technology in new ways. Go to article

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Women Physicians are early adopters of online Continuing Medical Educaiton
By John M. Harris Jr, MD, MBA, Charyl Novalis-Marine, MBA, and Robin B. Harris, Phd, MPH
Abstract
Introduction: Online continuing medical education (CME) provides advantages to physicians and to medical educators. Although practicing physicians increasingly use online CME to meet their educational needs, the overall use of online CME remains limited. There are few data to describe the physicians who use this new educational medium; yet, they clearly are the innovators and early adopters who will facilitate the growth of this educational technology. It would be useful to instructional designers and CME developers to better understand the characteristics of this influential group.

Methods: We studied the actual use of several different online CME programs within three different groups of physicians. The online programs we developed as part of research studies funded by the National Institute of Health, with no relationship to commercial interests. They were presented to physicians using mass mail outs (two physician groups) or personal contact and were accompanied by incentives to reduce resistance to the new technology. We compared the characteristics of physicians who chose to use these online programs with demographic data from larger populations representing the groups from which there users originated.

Results: We found that physicians who used these online CME programs were younger than average and importantly, more likely to be female than expected. This finding was consistent across different types of physician populations and different types of CME programs.

Discussion: Based on data reflecting actual use of online CME, younger physicians appear to be adopting online CME more rapidly than others, and women physicians appear to be adopting online CME at a faster rate than their male counterparts. This latter finding conflicts with the impression provided by some survey-based studies that male physicians are more likely than female physicians to use online CME. The data suggests that the growth of online CME is most likely occurring in diffusion networks dominated by relatively new medical school graduates and, possibly, women physicians. These results provide valuable insight to those who seek to develop the market online CME and those who seek to reach women physicians with CME programs. Go to article

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Physician Internet medical information seeking and on-line continuing education use patterns.
Casebeer L, Bennett N, Kristofco R, Carillo A, Centor R.
Abstract
Introduction: Although physician Internet use patterns have been studied, little attention has been paid to how current physician learning and change theories relate to physician Internet information seeking and on-line learning behaviors. The purpose of this study was to examine physician medical information-seeking behaviors and their relevance to continuing education (CE) providers who design and develop on-line CE activities.

Methods: A survey concerning Internet use and learning was administered by facsimile transmission to a random sample of 2,200 U.S. office-based physicians of all specialties.

Results: Nearly all physicians have access to the Internet, know how to use it, and access it for medical information; the Internet's professional importance to physicians currently is in the area of professional development and information seeking to provide better care rather than for patient-physician communication. A particular patient problem was the most common reason for seeking information. The credibility of the source, quick and 24-hour access to information, and ease of searching were most important to physicians. Barriers to use included too much information to scan and too little specific information to respond to a defined question.

Discussion: The importance of the Internet to physician professional development is growing rapidly. Access to on-line continuing medical education must be immediate, relevant, credible, and easy to use. A sense of high utility demands content that is focused and well indexed. The roles of the CE provider must be reshaped to include helping physicians seek and construct the kind of knowledge they need to improve patient care. Go to article

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Designing Tailored Web-Based Instruction to Improve Practicing Physicians' Preventive Practices
Linda L Casebeer, PhD; Sheryl M Strasser, PhD; Claire M Spettell, PhD; Terry C Wall, MD, MPH; Norman Weissman, PhD; Midge N Ray, MS; Jeroan J Allison, MD
Abstract
Background: The World Wide Web has led to the rapid growth of medical information and continuing medical educational offerings. Ease of access and availability at any time are advantages of the World Wide Web. Existing physician-education sites have often been designed and developed without systematic application of evidence and cognitive-educational theories; little rigorous evaluation has been conducted to determine which design factors are most effective in facilitating improvements in physician performance and patient-health outcomes that might occur as a result of physician participation in Web-based education. Theory and evidence-based Web design principles include the use of: needs assessment, multimodal strategies, interactivity, clinical cases, tailoring, credible evidence-based content, audit and feedback, and patient-education materials. Ease of use and design to support the lowest common technology denominator are also important.

Objective: Using these principles, design and develop a Web site including multimodal strategies for improving chlamydial-screening rates among primary care physicians. Methods: We used office-practice data in needs assessment and as an audit/feedback tool. In the intervention introduced in 4 phases over 11 months, we provided a series of interactive, tailored, case vignettes with feedback on peer answers. We included a quality-improvement toolbox including clinical practice guidelines and printable patient education materials.

Results: In the formative evaluation of the first 2 chlamydia modules, data regarding the recruitment, enrollment, participation, and reminders have been examined. Preliminary evaluation data from a randomized, controlled trial has tested the effectiveness of this intervention in improving chlamydia screening rates with a significant increase in intervention physicians' chlamydia knowledge, attitude, and skills compared to those of a control group.

Conclusions: The application of theory in the development and evaluation of a Web-based continuing medical education intervention offers valuable insight into World Wide Web technology's influence on physician performance and the quality of medical care. Go to article

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A Mixed Learning Technology Approach for Continuing Medical Education
Vernon Curran, PhD, Fran Kirby, MEd, Michael Allen, MD, Joan Sargeant, MEd
Abstract
Introduction: Distance learning technologies have been used for many years to provide CME to rural physicians. The purpose of this study was to evaluate the utility and acceptability of a mixed learning technology approach for providing distance CME. The approach combined audio teleconferencing instruction with a Web-based learning system enabling the live presentation and archiving of instructional material and media, asynchronous computer conferencing discussions, and access to supplemental online learning resources.

Methodology: The study population was comprised of physicians and nurse practitioners who participated in audio teleconference sessions, but did not access the Web-based learning system (non-users); learners who participated in audio teleconferences and accessed the Web-based system (online users); and faculty. The evaluation focused upon faculty and learners’ experiences and perceptions of the mixed learning technology approach; the level of usage; and the effectiveness of the approach in fostering non-mandatory, computer-mediated discussions.

Results and Discussion: The users of the Web-based learning system were satisfied with its features, ease of use, and the ability to access online CME instructional material. Learners who accessed the system reported a higher level of computer skill and comfort than those who did not, and the majority of these users accessed the system at times other than the live audio teleconference sessions. The greatest use of the system appeared to be for self-directed learning. The success of a mixed learning technology approach is dependent on Internet connectivity and computer access; learners and faculty having time to access and use the Web; comfort with computers; and faculty development in the area of Web-based teaching. Go to article

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Short Report: Satisfaction with on-line CME
Vernon Curran, PHD Fran Kirby, MED Ean Parsons, MD, CCFP Jocelyn Lockyer, PHD
Abstract
Introduction: In recent years, use of the World Wide Web as a means of providing lifelong learning opportunities has increased. The main benefits of on-line continuing medical education (CME) include easy access, convenience, cost-effectiveness, reduced travel, self-paced and self-directed learning, and an interactive multimedia format.1-3 Several on-line CME studies4-6 have reported satisfaction with Internet learning and substantial acquisition of knowledge. An interesting aspect of the on-line CME literature is the diverse nature of the delivery formats that have been described. On-line CME has been delivered by real-time Internet teleconferencing, live and delayed audio and video CME Web broadcasts, and problem-based learning discussion system designs.

In spring 2002, Memorial University of Newfoundland in St John’s led a consortium of Canadian university-based CME departments in the development of RuralMDcme, a CME website that provides accredited on-line CME courses by the College of Family Physicians of Canada. The purpose of this study was to evaluate physicians’ satisfaction with an on-line CME format that used the WebCT learning management system and facilitated interaction using computer-mediated discussion. Go to article

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How Much Do You Know About: Physician Learning Techniques.
By the FCG Institute
Introduction
There are many theorists who have described learning. Bandura’s social cognitive theory (1986) links the individual’s personal factors with environmental/situational factors and behavior. Other theorists such as Schon, Knox, Cross, and others share the view that the individual is self-monitoring, capable of goal-setting and achievement. They conclude that because each individual is unique, internal and external influences will impact the motivation of each individual’s pursuit of self-directed learning. Some of these factors include perception of need, curiosity and professionalism. Environmental factors may include the availability of information, interaction with colleagues, community expectations and integration into practice.

Most physicians want to continue to learn and adapt their practice behavior to use new technologies and therapeutic agents to improved patient care and outcome. In the ideal model, the process begins with a self-determined need for new information or competence. The impetus may be a specific patient problem or an interest in the developments in their particular field of practice. The next step is to seek the new information or technical skill. Physicians will seek to gain this new information either informally or in a more structured setting. Physicians willing to adopt a new practice or use of a therapeutic agent are more likely to change if the change can occur autonomously. If there are no barriers (perceived or real) to implementing a new practice behavior based on the information or technical skill, the physician will adopt and incorporate this change into their practice. However, today’s healthcare environment with many physicians in group practices or employees of healthcare systems may encounter organizational barriers. It is essential to understand the environment in which the physician is practicing to plan and deliver "change-enabling" CME. Go to article

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Physician Learning Abstracts and PubMed links:

eLearning: a review of Internet-based continuing medical education. (PubMed link)
Wutoh R, Boren SA, Balas EA.
Abstract
Introduction: The objective was to review the effect of Internet-based continuing medical education (CME) interventions on physician performance and health care outcomes.

Methods: Data sources included searches of MEDLINE (1966 to January 2004), CINAHL (1982 to December 2003), ACP Journal Club (1991 to July/August 2003), and the Cochrane Database of Systematic Reviews (third quarter, 2003). Studies were included in the analyses if they were randomized controlled trials of Internet-based education in which participants were practicing health care professionals or health professionals in training. CME interventions were categorized according to the nature of the intervention, sample size, and other information about educational content and format.

Results: Sixteen studies met the eligibility criteria. Six studies generated positive changes in participant knowledge over traditional formats; only three studies showed a positive change in practices. The remainder of the studies showed no difference in knowledge levels between Internet-based interventions and traditional formats for CME.

Discussion: The results demonstrate that Internet-based CME programs are just as effective in imparting knowledge as traditional formats of CME. Little is known as to whether these positive changes in knowledge are translated into changes in practice. Subjective reports of change in physician behavior should be confirmed through chart review or other objective measures. Additional studies need to be performed to assess how long these new learned behaviors could be sustained. eLearning will continue to evolve as new innovations and more interactive modes are incorporated into learning. Go to article

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Web-based continuing medical education. (II): Evaluation study of computer-mediated continuing medical education (PubMed link)
Curran VR, Hoekman T, Gulliver W, Landells I, Hatcher L
Abstract
Background: Over the years, various distance learning technologies and methods have been applied to the continuing medical education needs of rural and remote physicians. They have included audio teleconferencing, slow scan imaging, correspondence study, and compressed videoconferencing. The recent emergence and growth of Internet, World Wide Web (Web), and compact disk read-only-memory (CD-ROM) technologies have introduced new opportunities for providing continuing education to the rural medical practitioner. This evaluation study assessed the instructional effectiveness of a hybrid computer-mediated courseware delivery system on dermatologic office procedures.

Methods: A hybrid delivery system merges Web documents, multimedia, computer-mediated communications, and CD-ROMs to enable self-paced instruction and collaborative learning. Using a modified pretest to post-test control group study design, several evaluative criteria (participant reaction, learning achievement, self-reported performance change, and instructional transactions) were assessed by various qualitative and quantitative data collection methods.

Results: This evaluation revealed that a hybrid computer-mediated courseware system was an effective means for increasing knowledge and improving self-reported competency in dermatologic office procedures, and that participants were very satisfied with the self-paced instruction and use of asynchronous computer conferencing for collaborative information sharing among colleagues. Go to article

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Internet continuing education for health care professionals: an integrative review J Contin Educ Health Prof 2004; 24(3):171-180. (PubMed link)
Copley Cobb S
Abstract
Introduction:The objective was to review key articles and research studies on practices, preferences, and evaluation of on-line continuing education used by health care professionals.

Method: Data sources included searches of the MEDLINE, CINAHL, and ERIC databases (January 1990 to June 2004) and manual searches of the Journal of Continuing Education in the Health Professions and the Journal of Continuing Education in Nursing. Articles included reviews and research studies focusing on the use of Internet CE by health care professionals. The articles were categorized according to intervention, subjects, study design, and key findings.

Results: Seventeen articles were eligible and were reviewed. Although in-person CE remains the most frequent and most preferred format, Internet CE is gaining in popularity. Most participants who engage in on-line CE are satisfied with the experience and find it to be an effective learning format. Barriers to on-line CE include technical difficulties and lack of computer knowledge.

Discussion: Although the Internet is an effective and satisfactory educational format, barriers to use of the Internet for CE still exist. Additional studies are needed to measure the impact of Internet CE on practice performance, reduce barriers to on-line CE, and identify appropriate theoretical frameworks for on-line learning. Go to article

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Comparison of oncology nurse and physician use of the Internet for continuing education. (PubMed link)
Copley Cobb S
Abstract
Background: In the past 10 years, there has been a dramatic increase in published literature on the topic of Internet use by healthcare professionals. Learners and organizations providing grants to the continuing education (CE) division of a medical education and publishing company have expressed increasing interest in the area of Internet CE. To quantify and analyze this trend, the company began using surveys to evaluate this growing area of interest.

Method: Since 1998, annual surveys at the annual meetings of the Oncology Nursing Society and the American Society of Clinical Oncology were used to determine trends in educational use of the Internet for CE. FINDINGS: Internet use and frequency of use, including use of the Internet for CE among both nurses and physicians, have been increasing. When asked what would make these professionals more likely to use the Internet for CE, both indicated making the activities low cost or free and easier access.

Conclusion: Nurses and physicians are looking to the Internet for quick access to reliable information, thus challenging CE educators to develop ways to implement Internet CE activities quickly. Ongoing needs assessment of target audiences and evaluation of the effectiveness of Internet CE is essential to optimizing the role of this educational format for healthcare professionals. Go to article

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On-site to on-line: barriers to the use of computers for continuing education. (PubMed link)
Mamary EM, Charles P.
Abstract
Background: Continuing education/continuing medical education (CE/CME) programs that adopt self-directed, computer-based instruction formats via the Internet or CD-ROM can ease the demands placed on clinicians who are required by licensing boards to accumulate CE/CME credits as part of their career-long learning. Despite the benefits and availability of computer-based instruction, on-site programs still dominate current CE/CME delivery modes. In order to increase the use of computer-based CE/CME programs, it is important to identify the barriers that inhibit their use.

Method: A survey was conducted to assess the practices, preferences, and barriers to use of CE/CME delivery methods among physicians, nurse practitioners, and physician assistants in Nevada.

Results: Of 3,213 surveys sent, 1,120 were completed and returned for an overall response rate of 35%. In-person conferences (93%) and print-based methods (66%) were the most frequently reported methods of acquiring CE/CME. The majority of respondents had access to computer-based technologies. Respondents with more years in clinical practice were less likely to have access to or to use computer-based technologies. The top three preferred CE/CME delivery modes, in rank order, were in-person conferences, print-based self-study, and CD-ROM. The least preferred method of receiving CE/CME was interactive audioconference (telephone conference calls). "Not knowing how" was the most frequently reported reason for not using the Internet for computer-based training and the second most frequent reason for not using a CD-ROM.

Implications: Program planners may wish to offer training in new technologies during on-site conferences, provide CD-ROMs as take-home instructional materials, or promote technology awareness in other ways to help clinicians prepare for changes in the electronic delivery of health care and education. Go to article

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