Linda Casebeer

Physician internet medical information seeking and on‐line continuing education use patterns

Introduction: Although physician Internet use patterns have been studied, little attention has been paid to how current physician learning and change theories relate to physician Internet information seeking and on‐line learning behaviors. The purpose of this study was to examine physician medical information–seeking behaviors and their relevance to continuing education (CE) providers who design and develop on‐line CE activities. Methods: A survey concerning Internet use and learning was administered by facsimile transmission to a random sample of 2,200 U.S. office‐based physicians of all specialties. Results: Nearly all physicians have access to the Internet, know how to use it, and access it for medical information; the Internets professional importance to physicians currently is in the area of professional development and information seeking to provide better care rather than for patient‐physician communication. A particular patient problem was the most common reason for seeking information. The credibility of the source, quick and 24‐hour access to information, and ease of searching were most important to physicians. Barriers to use included too much information to scan and too little specific information to respond to a defined question. Discussion: The importance of the Internet to physician professional development is growing rapidly. Access to on‐line continuing medical education must be immediate, relevant, credible, and easy to use. A sense of high utility demands content that is focused and well indexed. The roles of the CE provider must be reshaped to include helping physicians seek and construct the kind of knowledge they need to improve patient care.

Standardizing evaluation of on-line continuing medical education: physician knowledge, attitudes, and reflection on practice.

Introduction: Physicians increasingly earn continuing medical education (CME) credits through on‐line courses, but there have been few rigorous evaluations to determine their effects. The present study explores the feasibility of implementing standardized evaluation templates and tests them to evaluate 30 on‐line CME courses. Methods: A time series design was used to compare the knowledge, attitudes, and reported changes in practice of physician participants who completed any of 30 on‐line CME courses that were hosted on an academic CME Web site and a CME Web portal during the period from August 1, 2002, through March 31, 2003. Data were collected at baseline, at course completion, and 4 weeks later. Paired t tests were used to compare the means of responses across time. Results: U.S. physicians completed 720 post‐tests. Quality of content was the characteristic of most importance to participants; too little interaction was the largest source of dissatis‐faction. Overall mean knowledge scores increased from 58.1% to 75.6% at post‐test and then decreased to 68.2% at 4 weeks following the course. Effect sizes of increased knowledge immediately following the course were larger for case‐based than for text‐based courses. Nearly all physicians reported making changes in practice following course completion, although reported changes differed from expected changes. Conclusions: Increases in physician knowledge and knowledge retention were demonstrated following participation in on‐line CME courses. The implementation of standardized evaluation tests proved to be feasible and allowed longitudinal evaluation analyses across CME providers and content areas.

Cost‐benefit analysis: Review of an evaluation methodology for measuring return on investment in continuing education

&NA; There is little evidence of measurement of return on investment for continuing medical education (CME) demonstrated in the current literature. The purpose of this review is to provide examples of cost‐benefit analysis and evaluation methodology used to measure return on investment, and to encourage exchange on this issue among CME professionals. The information in this article was gathered from reports of learning outcome evaluations and cost‐effectiveness measurements in continuing education for health care professionals, as well as cost‐benefit analyses from other settings. Evaluation methods are briefly reviewed from typical evaluation of program objectives, quality of educators, and overall participant satisfaction, to the current need for evaluating the effectiveness of educational programs, to the ultimate outcome of these effects on patient health. The need for cost‐benefit analysis in CME is becoming more evident in working with supporters of such medical educational activities. Presenting the actual measurement of benefits and costs of educational alternatives provides the funding decision maker and others with a comparison for the return on investment.

Evaluation of the effectiveness of an international diploma course in tropical medicine

Background: Numerous impediments to conducting continuing education (CE) courses in remote sites, particularly those courses that take place in developing countries, can include challenges associated with planning, infrastructure, and financial risk. This study reports the effectiveness of a course planned in the United States and executed in Peru, the Gorgas Course in clinical tropical medicine. Methods: A survey was conducted of participants who had completed the Gorgas Course as recently as 6 months and as long as 3 years earlier. The questionnaire sought to determine each participants reason for participation, whether the course was instrumental in the participants reaching the personal goal associated with participation, and whether the participant considered the course to be worth the time and money spent to enable participation. Results: Forty‐nine participants responded to the questionnaire, all of whom indicated that the Gorgas Course enabled achievement of the personal goal associated with participation. Fully 100% of course participants stated that participation was worth the time and monetary expenditure, most often citing their having access to patients with tropical diseases and the personal enrichment of living overseas as reasons the course was worth its high cost. Findings: It is logistically and financially feasible to conduct CE courses in developing countries, provided that the organization in the planning country has strong, pre‐established relationships with the host institution(s). Continued collaboration between planning partners and frequent, rigorous course evaluations are necessary to enable an international CE course to become a stable, continuous academic offering.

Needs assessment of learning outcome evaluation skills among continuing medical education providers

&NA; In a health care environment increasingly pressured by reform efforts, the effectiveness of continuing medical education (CME) providers in designing educational methods aimed at improving physician performance and the health status of their patients, as well as in measuring the results, has been inadequate. The purpose of this study was to conduct a needs assessment of CME professionals in order to better understand these inadequacies. A 1996 survey was conducted by mail of 1600 members of the Alliance for Continuing Medical Education with a response rate of 37.5% of targeted members. There was an inverse relationship between the types of evaluation measures most frequently used (physician satisfaction with program and perceptions of enhanced professional effectiveness) and the types of evaluation measures in which professionals would like to gain new skills (physician performance and the health outcomes of their patients). Major barriers to conducting outcomes evaluations were lack of time, funding, and staffing. Barriers had been overcome by using current technology, recruiting/training staff, and securing internal or external funding. In many institutions, quality utilization review departments were also measuring educational outcomes. Few publications were reported. Identified gaps offer professional development opportunities to CME professional organizations.