By Bonnie Booth
Steven Hughes, MD, vividly remembers the first time he used a computer for educational purposes. It was 1984 and he was an intern at the naval hospital in Bethesda, Md. The National Library of Medicine's MEDLINE had just gone "on line" and he used it as a research resource.
At the time, the search process was so complicated that library personnel had to do the actual searching. A year later it became possible for anyone with a modem to access MEDLINE. Dr. Hughes decided to purchase a computer so he could search MEDLINE from home.
"I figured I was going to force myself to learn how to use it," said Dr. Hughes. "The access to information was so incredible."
Now, thanks to the Internet, Dr. Hughes uses his portable computer to access information on almost any topic. And he is far from alone. According to the American Medical Association's 1997 Physician Opinion on Health Care Issues, more than half of the physicians who have access to a computer log on to the Internet or World Wide Web at least once a week. And truly Internet savvy physicians are logging on much more often to find additional information on new drugs, consult with other physicians through mailing lists and news groups and garner continuing medical education credits.
It's actually pretty easy to do.
"When I really started to look on the Internet for sites, one of the first sites I went to was the Academy site (www.aaos.org)," said Dr. Hughes, a Maryland spine surgeon. "Then I got some search engines, put in two words-orthopaedic and orthopedic- searched on them and started sorting through the sites."
Dr. Hughes' search netted him a wide variety of sites related to orthopaedics. Since he knew he was looking for teaching resources, research resources and sites his patients could use to find more information, he started sifting through the sites and categorizing the ones he thought would be helpful.
Sometimes the number of "hits" a search produces can be overwhelming, but there are ways to cut down that number.
"Most search engines have a 'Help section' and the 'Help section' really does help," said Dr. Richard Strain Jr., an orthopaedist who practices in Davie, Fla.
Both Dr. Hughes and Dr. Strain also use the Internet to communicate with other orthopaedic surgeons, be it through an informal network of colleagues or through the mail lists found on sites such as www.orthogate.com-an orthopaedic Internet consortium.
Dr. Strain became a participant in Orthogate's mail list soon after he decided to step up his use of the Internet.
"It was a group of orthopaedic surgeons who traded cases back and forth over the Internet," said Dr. Strain. "It has really become international now. I see just as many postings from people in the eastern hemisphere as the western hemisphere. These mail lists are a good place for orthopaedic surgeons to start. It's a rich source of collegial consultation."
The Internet's potential as a learning tool is in its ability to foster greater communication between physicians, said Ira Kirschenbaum, MD, a member of the Academy's Electronic Media Education Committee and editor of several web sites.
"I believe the number one reason (for using the Internet) is surgeon-to-surgeon communication," said Dr. Kirschenbaum. "The great power is the ability for people in very remote geographic sites from each other to communicate in one sort of medium.
"Diseases and medical problems are often found to be quite common when you are in the world community," he continued. "For example, let's say I have a case and I think it's pretty rare, I post it to a mail list of 2,000. I may get 30 responses from people around the world who've had a similar case, while locally I will get none."
While few would debate the Internet's value in enhancing physician communication, using the world wide web as a resource for continuing medical education can be a bit trickier.
The Academy offers one CME course, "Reducing Professional Liability Risk," through it's home page. It also offers three on-line orthopaedic special interest exams that can be completed for CME credit. Many other organizations (including the Academy) that offer accredited CME, offer some courses through their web sites. But they are not the only web-based CME providers in cyberspace.
"CME (on the web) can be anything from well-written, well-designed, documented sites to things that are promotional in nature to sheer marketing of company products," said Bruce Bellande, executive director of the Alliance for Continuing Medical Education. "Education can be used as a way to get a physician to a site and then there are ways that are quite creative to introduce marketing."
Bellande said one of the first things physicians should check when assessing the credibility of CME offered through a web site is who is providing or sponsoring that site.
Secondly, he said, check to see whether the educational opportunity is accredited by a reputable, preferably, national CME body. He said if it's certified for Category 1, American Medical Association Physician's Recognition Award credit, very stringent standards have been met and there must be appropriate disclosure from faculty as well as any disclosure of commercial support.