Physicians lack skills for computer CME
By Carolyn Rogers
Its not surprising that interest in the development of computer-based continuing medical education (CME) programs is growing. New computer technologies offers CME participants convenience, reduced costs, continually updated information, reduced time away from the workplace and a self-directed format that allows learning to occur at the individuals pace.
What is surprising is thatdespite the benefits and increasing availability of computer-based instructionpassive modes of learning still dominate current CME efforts. A recent survey of nearly 1,000 physicians, however, finds that a primary reason for the slow acceptance of computer-based CME may simply be a lack of computer skills.
"While self-directed delivery modes for continuing medical education are known to be the most effective approaches for improving physician performance, instructor-directed programs are still the most popular methods used for CME," says Edward Mamary, assistant professor, department of health science, San Jose State University.
In order to assess current CME practices and preferences, and to identify barriers to the use of new technology, Mamaryalong with and Patricia Charles, director of evaluation and program development, at the University of Nevada School of Medicineconducted a survey of all licensed physicians in the state of Nevada. The self-administered survey took place over a three-month period in early 1999.
Questions for this unpublished study included the use of both self-directed and instructor-directed CME delivery modes. Self-directed methods, in which the learner takes the active role in accomplishing educational objectives, are comprised of journal review, audio and videocassettes, as well as CD-ROM media and the Internet. Instructor-directed methods, in which an instructor takes the lead in delivering program content, include on-location conferences, interactive (compressed) video, satellite broadcasts, and teleconference systems.
Of the 2,844 surveys that were sent to Nevadas physicians, 949 were returned for a response rate of 33 percent. Although a higher return rate would have been preferable, Mammary says, the response was "more than satisfactory for a sample of physicians."
Respondents were asked to select their top three preferences from a list of nine types of CME delivery modes. The physicians ranked in-person conference as the top preference, followed by print-based self-study; and CD-ROM. Interactive audioconference (telephone conference calls) was the least preferred method.
The study also assessed the level of physician access to computer-based technologies. More than 80 percent of the physicians had home computers and three-quarters of them could access the World Wide Web through the Internet. The majority of respondents have access to other computer-based technologies including e-mail (73 percent) office computer (66 percent) and CD-ROM (63 percent). A substantial majority of physicians (75 percent) indicated interest in receiving instruction on the use of Internet and CD-ROM methods for acquiring CME.
"Clearly, the physicians surveyed in this study have easy access to computers," Mamary says, "so the reasons for the limited use of computers cannot be explained entirely by access."
So what are the barriers to the use of computer-based CME delivery methods?
"While a preference for in-person instruction was the most frequently reported reason for not using the computer for CME," Mamary says, "not knowing how to use the Internet or a CD-ROM was the second most frequently reported reason for their non-use."
Further evidence supporting the lack of computer skills is provided by a finding in a similar study conducted by Mamary and Charles that surveyed physicians, nurse practitioners and physicians assistants in Nevada. More than 75 percent of those respondents indicated they would be interested in receiving instruction on the use of the Internet and CD-ROM methods for CE/CME.
"The barriers to using advanced technology for CME are not insurmountable," Mamary says.
Indeed, the study did not find rejection of computer-based technologies. Although computer assisted self-directed methods of CME instruction were among the lowest in actual usage, respondents ranked the CD-ROM third out of nine for possible future preference.
"Training to increase the computer competence of physicians should be provided," Mamary says. "The need to provide such training will undoubtedly lessen as new people enter the profession, already proficient in these technologically advanced methods for CME."
CME program planners can take advantage of the popularity of on-site programs by integrating the two concepts. The traditional on-site conferences can be used to promote new technologies and provide training, Mamary says.
"For example, an on-site conference could be complemented by a take-home CD-ROM, or program planners could incorporate sessions on accessing web-based CME. As more physicians gain access to computers and gain proficiency in their use, both CD-ROM and Internet CME programs will enjoy greater acceptance. Indeed, this is occurring now as an ever-increasing number of web-based programs become available."
As online and CD-ROM CME offerings become more prominent, physicians will undoubtedly become more aware of their potential savings of time and money. And competent computer-based skills will help prepare them for the profound changes likely to occur in the way in which health care will be delivered in the 21st century.