Study Shows Online Continuing Medical Education Highly Effective in Adoption of Evidenced Based Medicine

A recent study showed that continuing medical education (CME) delivered via the internet was highly effective in educating physicians to make evidence-based decisions for their patients.  The study by Linda Casebeer, PhD titled Evidence-based choices of physicians: a comparative analysis of physicians participating in Internet CME and non-participants published in BioMedCentral (BMC), reviewed how the amount of medical education offered through the Internet continues to increase, providing unprecedented access for physicians nationwide and looking at a subset of those courses helped physicians practice evidenced based medicine.


Study Analysis


To determine the effectiveness of 114 Internet CME activities, which included case-based, multimedia, and interactive text, case vignette-based surveys were administered to U.S.-practicing physicians immediately following participation, and to a representative control group of non-participants. Survey responses were then analyzed based on evidence presented in the content of CME activities. An effect size for each activity was calculated using Cohen’s d to determine the amount of difference between the two groups in the likelihood of making evidence-based clinical decisions.


Using this methodology, the study found that in a sample of 17,142 U.S. physicians, of the more than 350,000 physicians who participated in 114 activities, the average effect size was 0.82 (the number that shows if education has an overall effect, for those who attended the programs vs. those who didn’t).   


These findings indicated an increased likelihood of 48% that physicians participating in online activities were making better clinical choices based on evidence.   This is similar to the effect size that David Cook found in his Meta Analysis paper published in JAMA Internet Based Learning in the Health Professions which reviewed 201 programs.


As a result, the study concluded that physicians who participated in online CME activities continue to be more likely to make evidence-based clinical choices than non-participants in response to clinical case vignettes.


CME and the Internet


The number of hours of Internet-based enduring materials provided by Accreditation Council for CME (ACCME)-accredited providers increased dramatically from 16,802 hours in 2002 to 57,944 hours in 2008. This three-fold increase was accompanied by an even larger increase in the number of participants choosing Internet-based enduring materials; the number of physician participants increased from 305,410 individuals in 2002 to 4,365,014, nearly a ten-fold increase.


What these numbers demonstrate is that physicians are taking advantage of the tremendous opportunities CME activities provide for medical practitioners to keep up with new information affecting the delivery of medical care. While ongoing participation is required by most physician state licensing boards and the licensing boards for other types of healthcare providers, such as physician assistants and nurse practitioners, both groups have the freedom to choose what types of programs they attend and in what mediums.


To allow health care providers the freedom to choose which types and kinds of programs to attend, CME providers sponsor a variety of activities, such as courses, regularly scheduled series, or enduring materials, defined as instructional materials that can be accessed at a time chosen by the participant. Consequently, given the increasing number of CME activities offered on the Internet, and the even larger growth of participation in these activities, BMC set out to assess the effectiveness of Internet-based CME is crucial. Another factor leading to their study was that recent reviews of studies comparing results from online and traditional CME materials have concluded that Internet-based CME was as effective as the traditional CME delivery formats.




The authors of the study noted that a possible limitation was that the questions were administered immediately after participation in the CME activity, and therefore these analyses did not assess whether the improvements in physician performance or patient health outcomes were maintained over time. But as one similar study demonstrated, CME activities did improve physician performance and patient outcomes over time.


Another possible limitation the authors pointed out was the need to include non-physician healthcare providers because of the rapid growth in the number of non-physician participants in Internet-based CME activities, especially given the predicted shortage of physicians.


Despite these minimal limitations, the study was strong because of the large number of physician participants and the varied Internet CME formats assessed.




Ultimately, this study is significant because it demonstrated that physicians who participated in varied formats of selected Internet CME activities were more likely, following participation, to make evidence-based clinical choices in response to case vignettes than non-participants. These data support the assertion that Internet CME activities are effective and offer a searchable, credible, available on-demand, high-impact source of CME for physicians.


Since the future of healthcare is moving in the direction of evidence-based care, coupled with comparative-effectiveness research, this study demonstrates that Internet CME can provide a tremendous service for physicians to stay up to date on these kinds of data, and put them into practice effectively, which will improve the outcomes of patients. More collaboration between CME providers, government, academia, and industry is needed to continue making effective Internet and traditional CME that focuses on evidence-based medicine and clinical practice to continue this positive trend.

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