August 2001 Bulletin

AAOS shifts into high gear on CME of future

Screen from Online Post-operative ACL Rehabilitation Course

By Howard Mevis

Academy members have spoken, and they say they’re ready for online CME. According to the 2000 Census, 67 percent of orthopaedic surgeons indicate that they would periodically take an online CME course if the programs were created by the Academy and the topics were appropriate to their needs. At the same time, 82 percent of orthopaedic surgeons consider themselves either intermediate (60 percent) or advanced users of the Internet, and 61 percent have accessed AAOS on-line services on the Internet.

Fortunately, the Academy is more than ready to meet the needs and desires of its members when it comes to online education. In response to the current environment—which finds orthopaedic surgeons traveling to fewer courses, spending more study time at home, and looking for more convenient CME—the Academy is creating numerous opportunities for education online. Conveniently, all of the Academy’s online education can be found in one place—the AAOS online "Orthopaedic Campus," which is in the Medical Education section of the AAOS home page

"The Academy has always been on the cutting edge of new educational technology," says Robert W. Bucholz, MD, chair of the educational programming committee. "This is just the next step in the education of future orthopaedists. The next generation of orthopaedic surgeons will be naturally inclined to use electronic sources of education. This is the natural next step in how medical knowledge will be communicated from one person to another."

The Academy’s first online course—Post-operative ACL Rehabilitation—has received enthusiastic reviews for its interactive, engaging style. Two hundred and seventy Academy members have registered for the course thus far, and 92 have completed the program, receiving CME credit. The majority of those who haven’t completed the course say they just haven’t had the time. User comments include: "I enjoyed this mode of study—it lets me do it on my own schedule. The give and take that the module demands keeps one’s attention far better than straight reading."..."Easy to use. I liked the four experts format because it forced me to scrutinize the details of their presentations/opinions"…"This is a godsend."

The ACL course, as well as the other online courses in the pipeline, is based on a popular instructional course lecture (ICL).

"Our initial effort was to take an historically popular educational format—instructional course lectures—and try to apply it in an interactive fashion that people can electronically benefit from at home," Dr. Bucholz explains. "Bill Grana took the lead to develop the initial format that now serves a template for ICL courses online."

Three additional online ICL courses are now in development, with another six to follow. The Academy’s second online course—"Rotator Cuff Diagnosis and Treatment"—is nearing completion and will be posted in the AAOS web site this August. A highlight of the rotator cuff course will be an "expert opinion" module, in which a set of questions is asked of each faculty member. For several questions in the module, the learner is asked to formulate an answer and input it prior to listening to the expert opinions. This engages the learner, who will then compare his or her answers with the experts.

Two other ICL online programs currently in development include "Emerging Viral and Bacterial Infections" and "Ankle Injuries in Athletes."

"There was so much interest in this subject [ankle injuries in athletes] that we thought allowing more people to take the course, learn from it and refer back to it—via an online course—would be a big advantage for the Academy’s membership," says Richard D. Ferkel, MD, course chairman. "We want to continue to use the new technology and to learn from what we did with the first online course."

According to Dr. Ferkel, the ankle course will be similar to the ACL course, but will include more illustrations, more pictures, etc. "It’s going to include a lot of different aspects of ankle injuries in athletes such as ligament injuries, lesions of the talus, Achilles injuries, subtalar injuries and tendon problems," he says.

Among other interactive features, the course will present a series of five case reports. "The doctor will first read the reports, and then be presented with X-rays or MRIs or CAT scans," Dr. Ferkel explains. "A series of questions will follow about the appropriate ways to treat these people. Each answer will have a detailed response from me with detailed references as to what the preferred answer would be."

As you can see, these are not traditional CME courses where you simply listen to a lecture online. Each program will offer an interactive experience, with special features to "spice it up." Typically, the courses consist of three modules—expert opinion, case review and literature review.

Many of the online courses are tied to subjects being developed for Orthopaedic Knowledge Online (OKO)—an online service that will provide instant access to the latest orthopaedic information. This tie-in will allow members to gather various levels of review on an OKO topic, then move on to complete a CME course on the topic for a complete educational experience. OKO is scheduled to launch this October.

"The issue over the next year or two is how these courses will be dovetailed into the OKO effort—the Academy’s major source of online curriculum," Dr. Bucholz says. "I would anticipate that the online courses will be merged into the OKO effort some time over the next few years."

Registration fees for these courses will be $30 to $50. Some of the programs will also include a video that will be sent via regular mail as part of the registration fee.

Online education at the Academy is not limited to OKO or online courses. For example, the electronic media committee posts "Orthopaedic Short Stories" on the AAOS web site. While not for CME credit, the stories have proven to be quite popular. A short story by J. Mark Melhorn, MD, on rotator cuff injuries associated with work activities and workers’ comp has had nearly 6,000 visitors since it was posted in June 1999.

The Orthopaedic Grand Rounds (OGR) series, which used to be available only on CD-ROM, will soon be going online as well. New cases will be added, which members can access one at a time for CME credit. Each interactive OGR program presents patient cases an orthopaedic surgeon might see in a typical day of practice. The patient cases are focused on clinical problem-solving and decision-making skills. OGR patient cases provide substantive case discussion, feedback and supporting elements. OGR also explains why alternative treatment choices are incorrect and provides valuable annotations to complete the learning experience.

"OGR was introduced in 1993 and has been very popular with members," says Jay D. Mabrey, MD, chair of the electronic media committee. "Members can expect the same high quality education in the new online case presentations that they experienced in the CD-ROM format, which is still available."

The women’s health issues committee is preparing an online CME course as well—a free osteoporosis educational module is now in development under a grant from Merck. The program will consist of four main modules focusing on: patient presentation, case presentation, a bone mineral density (BMD) component and a patient-doctor encounter. An osteoporosis lecture by John Kaufman, MD, including slides, will be incorporated, as well as physician and patient handout information." The program will offer two hours of CME category one credit for completion of the program.

The Evaluation committee recently posted a new online self-assessment examination on professional affairs. The examination includes questions on ethics, professional liability, occupational health and other non-medical scientific subjects relating to the practice of orthopaedic surgery. CME credit will be offered in hourly segments, i.e., two hours of ethics, two hours of professional liability and one hour of occupational health. This system is designed for orthopaedists residing in states with specific CME requirements. Texas, for example, requires one hour of ethics CME.

In addition to the new professional affairs examination, the Academy’s orthopaedic special interest examinations are now available online, according to Paul Tornetta, MD, chair of the Evaluation Committee. The examination programs can be found in the self-assessment center on the Orthopaedic Campus.

Clearly, the Academy has placed online education as a high priority. The AAOS has always been a leader in taking advantage of useful education technologies, and the development of OKO and other online CME programs puts orthopaedics far ahead of other specialties. Some might question whether the Academy is a little too far ahead of the curve in releasing their online program curriculum, or if they’re right on target. With an eye to the future, and the results of the 2000 census to back them up, the Academy is betting that the timing is just right.

Howard Mevis is director, AAOS department of electronic media, evaluation and course operations.

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