Online CME for Primary Care Physicians <ul><li>Bernard M. Sklar, M.D., M.S. </li></ul><ul><li>www.cmelist.com </li></ul><u...
Plan of Talk  <ul><li>Results of Survey </li></ul><ul><li>Types of Instruction </li></ul><ul><li>Physician Use of CME and ...
How to Find These Sites <ul><li>All the sites mentioned in this talk (as well as all the other sites I know about) can be ...
www.cmelist.com/list.htm
Description of the List <ul><li>Each entry shows the name and URL of the site, when I last visited, how many credit hours ...
The Number of Online CME Sites I <ul><li>The number of sites and courses is rapidly increasing: </li></ul><ul><li>April 19...
The Number of Online CME Sites II <ul><li>February 2000  </li></ul><ul><ul><li>96 sites,  1874 courses, 3064 credit hours ...
The Largest Sites December 2001 293 80 ArcMesa 300 200 Medscape CME 10000 6500 eMedicine CME 350 1400 WEBMD Just in Time 5...
Fee Structure by Site Dec 2001 5 9 $11-14 per hour % of Sites Number of Sites Dominant or Average Fee 2 4 >$25 per hour 5 ...
Hourly Fee Structure Dec 2001 3 470 $11-14 per hour % of Hours No of Hours Dominant or Average Fee 1 155 >$25 per hour 1 1...
Financial Support Dec 2001 50 99 User Fees/Partial or Complete 3 5 Insurance or Managed Care 9 17 Foundation 24 47 Medical...
Sites by Specialty – Primary Care Dec 2001 13 25 Obstetrics/Gynecology including: 3 6 Multiple Specialties 15 29 Pediatric...
Sites by Specialty – Subspecialties Dec 2001 6 12 Geriatrics 6 14 Infectious Disease 6 12 Radiology % of Sites Number of S...
Sites by Specialty-2001- Other <ul><li>26 sites (13%) offer subjects of interest to many different specialties; for exampl...
Types of Instruction-Definitions <ul><li>Text-Only </li></ul><ul><li>Text-and-Graphics </li></ul><ul><li>Slides-Only (or S...
Types of Instruction – Dec 2001 <ul><li>Text only -- 47 sites; 24% </li></ul><ul><li>Text-and-graphics – 59 sites; 30 % </...
CME Participation by Location Based on ACCME Figures for 2000 <ul><li>Live meetings and conferences account for 78% of “ph...
Physician Usage of Online CME <ul><li>Physician usage of online CME is increasing, but still accounts for less than 4% of ...
Why is Online CME use So Low? I <ul><li>Many physicians still uneasy with computers and Internet </li></ul><ul><li>Many ph...
Why is Online CME Use So Low? II <ul><li>A series of “gates” for the user to pass through </li></ul><ul><li>Navigation; Do...
Why Choose One Online CME Site Over Another? <ul><li>Price </li></ul><ul><li>Preference for Type of Instruction </li></ul>...
Good examples <ul><li>Next I will show a good example of online CME of some of the various instruction types and for some ...
Text-and-Graphics <ul><li>Physician’s Assistant Journal </li></ul><ul><li>Lower Extremity Rotational Disorders in Children...
Lower Extremity Rotational Disorders in Children
Learning Objectives <ul><li>Objectives:  After reading the article, the reader should be able to: 1.  describe the conditi...
Abstract <ul><li>Lower extremity rotational deformities are common among pediatric patients, and clinicians who care for c...
CME Quiz
Slide-and-Text Serono Multiple Sclerosis
Slide-and-Text Serono Multiple Sclerosis <ul><li>Note that you see the author’s slides and the complete transcript of the ...
Slide-Audio Vaccine Safety <ul><li>Increasingly common </li></ul><ul><li>Many lectures are recorded live </li></ul><ul><li...
Vaccine Safety
Slide-Video-Lecture <ul><li>This form of online CME is more pleasant if you have a high-speed connection, because the vide...
World Medical Leaders- Osteoarthritis
Baylor College of Medicine's Online CME Courses <ul><li>A very nice set of lectures in cardiology, surgery, diabetes and w...
Three Question-and-Answer Sites <ul><li>If you like to challenge yourself, all of these sites are fun. </li></ul><ul><li>F...
Familypractice.com ABFP In-Training Exam Questions <ul><li>The program presents you with multiple choice questions. If you...
Familypractice.com ABFP In-Training Exam Questions <ul><li>1000 questions and answers; start and stop whenever you like; 2...
Familypractice.com ABFP In-Training Exam Questions <ul><li>A sample question: </li></ul><ul><li>A 45-year-old white male d...
Familypractice.com ABFP In-Training Exam Questions <ul><li>Answer choices: </li></ul><ul><li>Buspirone (BuSpar) </li></ul>...
Familypractice.com ABFP In-Training Exam Questions <ul><li>Right answer: Propranolol (Inderal) </li></ul><ul><li>You chose...
Guidelines <ul><li>There are thousands of guidelines for diagnosis and treatment, put out by various official organization...
Guideline- APA Alzheimer’s
Case-Based Interactive  Mypatient .com <ul><li>Mypatient.com is possibly the best example of CBI instruction.  </li></ul><...
Mypatient .com <ul><li>109 highly interactive cases, aimed at primary physicians. The site helps you to assess your learni...
Mypatient.com Maxillary Pain
Mypatient .com <ul><li>You progress through the case in the usual way from history to differential diagnosis to labs and t...
Skipping to “Most Likely Diagnosis”
Mypatient.com Key Concepts
Other CBI Sites <ul><li>A few other CBI sites worth visiting are: </li></ul><ul><li>ACP/ASIM  Clinical Problem-Solving Cas...
Some Conclusions I <ul><li>The number of online CME courses and credits is growing rapidly </li></ul><ul><li>Online CME is...
Some Conclusions II <ul><li>The percentage of CME hours earned online is still only about 3.5% </li></ul><ul><li>Barriers ...
Some Conclusions III <ul><li>The future lies in the integration of medical practice, quality assessment and user-specific ...
Summary <ul><li>We have looked at about 8 online CME sites for FPs </li></ul><ul><li>These sites were chosen to illustrate...
Thanks for Listening <ul><li>Links to all of these sites, and about 190 others, as well as descriptions, can be found at  ...
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Online CME for Primary Care Physicians

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  • These numbers come from my own periodic review of the Internet using the search string, “online + continuing + medical +education”
  • Here are the seven largest sites (according to the number of hours).
  • Almost 50% of sites offer free instruction. The bulk of the fee-instruction falls into the $5-15 per hour range.
  • 11% of the instruction hours are free. 85% of the instruction falls into the $5-15 per hour range.
  • Commercial companies (almost entirely pharmaceutical) support 50% of sites. Universities and Medical Schools support 42% of sites. 24% of sites are supported by medical specialty associations. Many sites have multiple sources of support.
  • Primary Care (especially Family Practice and Internal Medicine) are the predominant target audiences.
  • Neurology, Psychiatry and Cardiology are relatively high target audiences.
  • You can find my definitions of these terms at http://www.cmelist.com/Instruction_Types_defined.htm
  • Many sites offer more than one type of instruction, so that the percentages add up to greater than 100%.
  • As best I can tell, a “physician-registrant” is one physician registering for one course. Since a course can be greater than one hour, it does not tell how many hours were earned, but I think the trend is meaningful.
  • As best I can tell, a “physician-registrant” is one physician registering for one course. Since a course can be greater than one hour, it does not tell how many hours were earned, but I think the trend is meaningful.
  • The Discrepancy Between Numbers of Visitors and Numbers of Credits Awarded The growth in the number of credits awarded has not been nearly as great as the growth in the number of courses and credits available. Many sites experience a large number of &amp;quot;hits&amp;quot; or page views in contrast to a very small number of CME credits awarded. There is a series of &amp;quot;gates&amp;quot; affecting the journey from visiting a site to receiving CME credit. A large number of physicians visit sites, take a look around, and if they find nothing of interest or have difficulty navigating the site, they leave. If they stay, the next step at most sites is to register. Registration frightens away some portion of physicians who do not wish to give any information about themselves, especially medical license numbers, social security numbers or credit card information. If the physician decides to register, or if the site allows further viewing without registering, there are some additional gates to pass. These gates depend on whether the courses are free, &amp;quot;pay-as-you-go,&amp;quot; or by annual subscription fee. If the instruction is free, a smaller number of physicians look at individual courses and then leave. A smaller number start to view one or more courses, decide that it does not meet their needs and leave without completing the course. An even smaller number complete the course and leave without completing the post-instruction quiz or questionnaire. And the smallest number complete all of the preceding steps and apply for the CME certificate. If the instruction is &amp;quot;pay-as-you-go,&amp;quot; the path through the gates is the same as above, except that at the last gate, a physician must submit his or her credit card information online. The fear of revealing this information further reduces the number of physicians receiving credit. If the site charges fixed fee for all the credits a physician can earn in a given period (usually one year), the physician has another choice. Should he or she pay in advance for instruction he may not use? Or pay in advance for instruction he may not even look at without paying? Most fixed fee sites allow viewing of a &amp;quot;demo&amp;quot; course to help with this decision, but surprisingly, some do not.  A further complication is that each site has its own registration and payment procedures that must be mastered in order to participate. An active user of online CME sites can end up with several dozen user names and passwords.
  • These are my opinions. I do not have research data on user motivations.
  • Online CME for Primary Care Physicians

    1. 1. Online CME for Primary Care Physicians <ul><li>Bernard M. Sklar, M.D., M.S. </li></ul><ul><li>www.cmelist.com </li></ul><ul><li>[email_address] </li></ul>
    2. 2. Plan of Talk <ul><li>Results of Survey </li></ul><ul><li>Types of Instruction </li></ul><ul><li>Physician Use of CME and Online CME </li></ul><ul><li>Obstacles to Physician Use </li></ul><ul><li>Examples of good sites of some types of instruction and for various specialties </li></ul>
    3. 3. How to Find These Sites <ul><li>All the sites mentioned in this talk (as well as all the other sites I know about) can be found at www.cmelist.com/list.htm </li></ul>
    4. 4. www.cmelist.com/list.htm
    5. 5. Description of the List <ul><li>Each entry shows the name and URL of the site, when I last visited, how many credit hours are available, who awards the credit, the cost per unit, when the educational material was last updated, financial support information and a description of the site and its contents and some links to individual courses at the site. </li></ul>
    6. 6. The Number of Online CME Sites I <ul><li>The number of sites and courses is rapidly increasing: </li></ul><ul><li>April 1997 – 13 sites </li></ul><ul><li>December 1997 – 18 sites </li></ul><ul><li>August 1998 – 61 sites </li></ul><ul><li>May 1999 – 69 sites </li></ul><ul><li>December 1999 – 87 sites </li></ul>
    7. 7. The Number of Online CME Sites II <ul><li>February 2000 </li></ul><ul><ul><li>96 sites, 1874 courses, 3064 credit hours </li></ul></ul><ul><li>August 2000 </li></ul><ul><ul><li>135 sites, 3659 courses, 5659 credit hours </li></ul></ul><ul><li>December 2000 </li></ul><ul><ul><li>150 sites, 3000 courses, 5500 credit hours </li></ul></ul><ul><li>December 2001 </li></ul><ul><ul><li>197 sites </li></ul></ul><ul><ul><li>12026 courses </li></ul></ul><ul><ul><li>17523 hours </li></ul></ul>
    8. 8. The Largest Sites December 2001 293 80 ArcMesa 300 200 Medscape CME 10000 6500 eMedicine CME 350 1400 WEBMD Just in Time 500 300 cmecourses 897 10 Challenger 1400 976 CMEWeb No. of Hours No. of Courses Name of Site
    9. 9. Fee Structure by Site Dec 2001 5 9 $11-14 per hour % of Sites Number of Sites Dominant or Average Fee 2 4 >$25 per hour 5 10 $25 per hour 1 2 $21-24 per hour 3 5 $20 per hour 2 3 $16-19 per hour 10 19 $15 per hour 11 22 $10 per hour 7 13 $6-9 per hour 4 6 $5 per hour 3 6 <$5 per hour 50 98 Free
    10. 10. Hourly Fee Structure Dec 2001 3 470 $11-14 per hour % of Hours No of Hours Dominant or Average Fee 1 155 >$25 per hour 1 114 $25 per hour <1 9 $21-24 per hour <1 87 $20 per hour <1 55 $16-19 per hour 5 845 $15 per hour 8 1447 $10 per hour 10 1712 $6-9 per hour 59 10285 $5 per hour 8 365 <$5 per hour 11 1978 Free
    11. 11. Financial Support Dec 2001 50 99 User Fees/Partial or Complete 3 5 Insurance or Managed Care 9 17 Foundation 24 47 Medical/Specialty Association 6 11 Government 42 83 University/Medical School 50 99 Commercial Companies % of Sites No. of Sites Source of Support
    12. 12. Sites by Specialty – Primary Care Dec 2001 13 25 Obstetrics/Gynecology including: 3 6 Multiple Specialties 15 29 Pediatrics 44 86 Internal Medicine 48 95 Family Practice 58 114 Primary Care Sites % of Sites No. of Sites
    13. 13. Sites by Specialty – Subspecialties Dec 2001 6 12 Geriatrics 6 14 Infectious Disease 6 12 Radiology % of Sites Number of Sites Subspecialty sites 17 26 General Interest 5 6 Surgery 5 9 Pulmonary 5 10 Oncology 10 19 Cardiology 11 21 Psychiatry 7 14 Neurology 71 140 including:
    14. 14. Sites by Specialty-2001- Other <ul><li>26 sites (13%) offer subjects of interest to many different specialties; for example, ethics, legal, practice management, genetics, and basic science </li></ul><ul><li>Many other specialties were included at 5 or fewer sites </li></ul>
    15. 15. Types of Instruction-Definitions <ul><li>Text-Only </li></ul><ul><li>Text-and-Graphics </li></ul><ul><li>Slides-Only (or Slides and Text) </li></ul><ul><li>Slide-Audio </li></ul><ul><li>Slide-Video </li></ul><ul><li>Question-and-Answer </li></ul><ul><li>Case-Based Interactive </li></ul><ul><li>Guideline or Consensus (usually text only) </li></ul><ul><li>Correspondence </li></ul><ul><li>Games </li></ul>
    16. 16. Types of Instruction – Dec 2001 <ul><li>Text only -- 47 sites; 24% </li></ul><ul><li>Text-and-graphics – 59 sites; 30 % </li></ul><ul><li>Slide-audio – 57 sites; 29 % </li></ul><ul><li>Slide-video – 21 sites; 11% </li></ul><ul><li>Guidelines – 5 sites; 3 % </li></ul><ul><li>Question-and-answer – 9 sites; 5 % </li></ul><ul><li>Case-Based-Interactive – 26 sites; 13 % </li></ul><ul><li>Correspondence – 3 sites; 2 % </li></ul><ul><li>Games – 2 sites; 1 % </li></ul><ul><li>Slides-Only – 4 sites; 2 % </li></ul><ul><li>Many sites have more than one type of instruction </li></ul>
    17. 17. CME Participation by Location Based on ACCME Figures for 2000 <ul><li>Live meetings and conferences account for 78% of “physician-registrants” </li></ul><ul><li>Home study CME (“enduring materials”) and journals account for 18% of physician-registrants </li></ul><ul><li>Online CME accounts for only 3.5% of physician-registrants </li></ul>
    18. 18. Physician Usage of Online CME <ul><li>Physician usage of online CME is increasing, but still accounts for less than 4% of all CME </li></ul><ul><li>According to ACCME: </li></ul><ul><li>1997: 13,115 physician-registrants (0.34%) </li></ul><ul><li>1998: 37,879 physician-registrants (1.03%) </li></ul><ul><li>1999: 79,536 physician-registrants (1.79%) </li></ul><ul><li>2000: 191,922 physician-registrants (3.59%) </li></ul>
    19. 19. Why is Online CME use So Low? I <ul><li>Many physicians still uneasy with computers and Internet </li></ul><ul><li>Many physicians unaware of online CME or don’t know how to find it </li></ul><ul><li>Much live CME, especially at the hospital, is convenient, free and offers collegial interaction </li></ul><ul><li>No easy way to search by subject </li></ul>
    20. 20. Why is Online CME Use So Low? II <ul><li>A series of “gates” for the user to pass through </li></ul><ul><li>Navigation; Download and install plug-ins </li></ul><ul><li>Registration hassle </li></ul><ul><li>Fear of giving out license, DEA, credit card </li></ul><ul><li>Paying in advance for content you can’t view </li></ul><ul><li>Get content free, leave without paying </li></ul><ul><li>Each site has a different procedure and password </li></ul>
    21. 21. Why Choose One Online CME Site Over Another? <ul><li>Price </li></ul><ul><li>Preference for Type of Instruction </li></ul><ul><li>Email reminders </li></ul><ul><li>Part of larger medical site </li></ul><ul><li>Help with CME reporting </li></ul><ul><li>Recommendation by colleagues, medical group </li></ul><ul><li>Special arrangements with physician group </li></ul>
    22. 22. Good examples <ul><li>Next I will show a good example of online CME of some of the various instruction types and for some primary care specialties. </li></ul><ul><li>These examples are not necessarily the “best” of each type; they were chosen to be illustrative. </li></ul>
    23. 23. Text-and-Graphics <ul><li>Physician’s Assistant Journal </li></ul><ul><li>Lower Extremity Rotational Disorders in Children </li></ul><ul><li>Main page tells you everything you need to know to decide whether you want to read it: </li></ul><ul><li>Hours of credit, price, expiration date, sponsor… </li></ul>
    24. 24. Lower Extremity Rotational Disorders in Children
    25. 25. Learning Objectives <ul><li>Objectives: After reading the article, the reader should be able to: 1. describe the conditions that cause toeing in and toeing out in children 2. evaluate the conditions that cause toeing in and toeing out in children 3. educate parents about the conditions that cause toeing in and toeing out in children. </li></ul>
    26. 26. Abstract <ul><li>Lower extremity rotational deformities are common among pediatric patients, and clinicians who care for children are likely to encounter them. The 4 torsional deformities that affect the lower extremity—external tibial torsion, external femoral torsion, internal tibial torsion, and internal femoral torsion—present as toeing in or toeing out. The majority of these deformities spontaneously normalize over time without long-term sequelae. However, primary care clinicians need a general understanding of these deformities to accurately differentiate between pathologic and physiologic conditions. </li></ul>
    27. 27. CME Quiz
    28. 28. Slide-and-Text Serono Multiple Sclerosis
    29. 29. Slide-and-Text Serono Multiple Sclerosis <ul><li>Note that you see the author’s slides and the complete transcript of the speaker’s words, but there is no audio </li></ul>
    30. 30. Slide-Audio Vaccine Safety <ul><li>Increasingly common </li></ul><ul><li>Many lectures are recorded live </li></ul><ul><li>If you visit the Vaccine Safety site, you can hear the sound and watch the slides advance </li></ul><ul><li>You can fast forward, reverse, etc, the slides and the audio just like a VCR </li></ul>
    31. 31. Vaccine Safety
    32. 32. Slide-Video-Lecture <ul><li>This form of online CME is more pleasant if you have a high-speed connection, because the video can be very small or jerky; and in general, you don’t gain that much by watching the speaker walk around or see him forming his words. The video is usually in a very small portion of the screen. </li></ul>
    33. 33. World Medical Leaders- Osteoarthritis
    34. 34. Baylor College of Medicine's Online CME Courses <ul><li>A very nice set of lectures in cardiology, surgery, diabetes and women’s health. Baylor has a good solution to the connection speed issue. According to your connection speed, you can view slides and text only, or add audio, or add video. CME credit is free. The next slide shows a screen shot of a lecture on osteoporosis. If you visit this site, you will hear the speaker, see him, look at his slides and see a scrolling transcript of his words. </li></ul>
    35. 35. Three Question-and-Answer Sites <ul><li>If you like to challenge yourself, all of these sites are fun. </li></ul><ul><li>Familypractice.com ABFP In-Training Exam Questions </li></ul><ul><li>Family Medicine Review II </li></ul><ul><li>eCore - The Core Content Review of Primary Care </li></ul><ul><li>I will show only the first-you can visit the other sites later </li></ul>
    36. 36. Familypractice.com ABFP In-Training Exam Questions <ul><li>The program presents you with multiple choice questions. If you answer the question correctly, you will have the option to view the answer summary and then continue on to the next question. If you answer incorrectly, the answer summary is presented for your reference and then you may continue on to the next question. </li></ul>
    37. 37. Familypractice.com ABFP In-Training Exam Questions <ul><li>1000 questions and answers; start and stop whenever you like; 25 units of CME; free to anyone (no membership required) </li></ul><ul><li>The questions are fun; the answers are short but informative </li></ul>
    38. 38. Familypractice.com ABFP In-Training Exam Questions <ul><li>A sample question: </li></ul><ul><li>A 45-year-old white male develops disabling tremulousness, loss of voice, and a marked sense of forceful and rapid heartbeat whenever he must speak to a large group. </li></ul><ul><li>Which one of the following drugs is likely to be of most value in enabling him to give presentations at sales and stockholders' meetings? </li></ul>
    39. 39. Familypractice.com ABFP In-Training Exam Questions <ul><li>Answer choices: </li></ul><ul><li>Buspirone (BuSpar) </li></ul><ul><li>Amantadine (Symmetrel) </li></ul><ul><li>Alprazolam (Xanax) </li></ul><ul><li>Propranolol (Inderal) </li></ul><ul><li>Desipramine (Norpramin) </li></ul>
    40. 40. Familypractice.com ABFP In-Training Exam Questions <ul><li>Right answer: Propranolol (Inderal) </li></ul><ul><li>You chose: Alprazolam (Xanax) </li></ul><ul><li>This patient has a specific situational anxiety disorder called performance anxiety, characterized by marked and sometimes disabling symptoms of catecholamine excess during specific performance situations, such as public speaking. Beta blockers such as propranolol and atenolol block peripheral anxiety symptoms, i.e., tachycardia and tremulousness, that can escalate subjective anxiety and impair performance. </li></ul><ul><li>Drugs which are primarily psychotropics or antiparkinsonian agents are much less likely to be of value in this specific anxiety disorder, and may cause undesirable sedation and dry mouth. Ref:  Kaplan HI, Sadock BJ (eds): Synopsis of Psychiatry , ed 8. Lippincott Williams & Wilkins, 1998, pp 975-976. </li></ul>
    41. 41. Guidelines <ul><li>There are thousands of guidelines for diagnosis and treatment, put out by various official organizations. Only a very few of these have been converted to online CME. Search http://www.cmelist.com/list.htm to find them. Usually the guideline is simply presented, and then you answer a few questions about the guideline in order to earn CME credit. I will show one example, from the American Psychiatric Association. </li></ul>
    42. 42. Guideline- APA Alzheimer’s
    43. 43. Case-Based Interactive Mypatient .com <ul><li>Mypatient.com is possibly the best example of CBI instruction. </li></ul><ul><li>You can access these cases free through MerckMedicus </li></ul><ul><li>Go there, register, then go to CEMedicus, search content by “Content Host” and choose mypatient.com </li></ul>
    44. 44. Mypatient .com <ul><li>109 highly interactive cases, aimed at primary physicians. The site helps you to assess your learning needs, and then suggests cases matching those needs in a personalized &quot;Virtual Waiting Room.&quot; or you can view a catalog of all 109 cases (listed by chief complaint or major finding, not diagnosis) </li></ul>
    45. 45. Mypatient.com Maxillary Pain
    46. 46. Mypatient .com <ul><li>You progress through the case in the usual way from history to differential diagnosis to labs and tests to diagnosis to treatment plan. Each of these sections offers you multiple choices and then feedback on each of your choices. All along the way, you can follow links to evidence-based discussion of your choices. </li></ul>
    47. 47. Skipping to “Most Likely Diagnosis”
    48. 48. Mypatient.com Key Concepts
    49. 49. Other CBI Sites <ul><li>A few other CBI sites worth visiting are: </li></ul><ul><li>ACP/ASIM Clinical Problem-Solving Cases </li></ul><ul><li>Interactive Grand Rounds from Medsite </li></ul><ul><li>Virtual Lecture Hall </li></ul><ul><li>Cleveland Clinic Online Journal of Medicine </li></ul>
    50. 50. Some Conclusions I <ul><li>The number of online CME courses and credits is growing rapidly </li></ul><ul><li>Online CME is becoming nicer to look at, with more graphics, lots more audio and video, a bit more interactive programming </li></ul>
    51. 51. Some Conclusions II <ul><li>The percentage of CME hours earned online is still only about 3.5% </li></ul><ul><li>Barriers to usage are still major </li></ul>
    52. 52. Some Conclusions III <ul><li>The future lies in the integration of medical practice, quality assessment and user-specific CME </li></ul><ul><li>The challenges and opportunities are great </li></ul>
    53. 53. Summary <ul><li>We have looked at about 8 online CME sites for FPs </li></ul><ul><li>These sites were chosen to illustrate various instruction types of online CME </li></ul><ul><li>I hope you will want to visit some of these sites and take some of these courses </li></ul>
    54. 54. Thanks for Listening <ul><li>Links to all of these sites, and about 190 others, as well as descriptions, can be found at www.cmelist.com/list.htm </li></ul><ul><li>Contact me at [email_address] </li></ul><ul><li>Bernard Sklar MD MS </li></ul>

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