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CONTINUING EDUCATION
Continuing Ed Takes Courses to the WebInstead of having to ditch their practices for a week and pay for plane fare and a hotel to attend a conference, clinicians seeking continuing medical education credits can now log on to HMS's CME website from their own homes or offices. Clinicians can pursue their credits during the gaps in their day, logging on and off at their convenience, their work saved from one session to the next.
Sanjiv Chopra says that online CME modules will be updated every year. (Photo courtesy of Sanjiv Chopra) More important, clinicians from all over the world can take advantage of this service, said Sanjiv Chopra, faculty dean for continuing education and HMS professor of medicine at Beth Israel Deaconess Medical Center, alluding to Harvard president Lawrence Summers's take on the subject. At a grand rounds last year, Summers said, "In the era of technology, we have an unprecedented opportunity, perhaps even a moral obligation, to share information and knowledge with colleagues around the world." Harvard has worked to fulfill that obligation. HMS offers 225 live CME courses and 400 in-hospital conferences, including grand rounds. But although these are attended by approximately 50,000 clinicians, only 2,000 of them come from outside the United States, with most of these from Canada. For clinicians from the wealthiest countries, the fee for online CME is $25 per credit. (U.S. doctors are required to obtain 50 CME credits annually.) The rest of the world gets a 50 percent discount, and Chopra hopes--through endowment, perhaps--eventually to be able to offer clinicians in developing countries much more substantial discounts. New Dimensions for EducationOnline CME provides more scope for learning than traditional venues. Whereas a grand rounds is generally restricted to an hour, an online module can be as lengthy as necessary, a fact that Chopra emphasizes to his authors when he signs them up. All the relevant visuals, whether medical images or tables, can be easily included. "We can show the EKG of a typical cardiac lesion; we can show the cardiac echo, a hemodynamic tracing, and cardiac catheterization," he said. "We can let the natural history of the disease unfold, and we can show what we would be likely to see five years hence if the patient went untreated."
Just three months after the first module became available, and without any marketing, 129 clinicians from more than 20 countries have taken advantage of the service. Users log on to http://cme.med.harvard.edu, then select "CME On-line." There, they choose from a smorgasbord of topics, such as "Clinical Challenges in Electrocardiography" or "St. John's Wort: What's the Evidence?" in addition to those subjects named above. From there, they can check out a sample case, or dive right into a module. Online SolutionsIn the typical case, the users read the patient's history, analyze the results of a physical examination and lab tests, and then get a question with several possible answers. If they give an incorrect answer, they get to try again. If they give the right answer, they still get to read the experts' advice about why each of the other answers is wrong.The plot thickens as they make their way through each of the several subsequent steps. The users decide what to do next based partly on new information about the patient. In the sample case, the users find out that the patient, a 42-year-old woman with fever, flank pain, vomiting, palpitations, and escalating feelings of anxiety, has hyperthyroidism. They then review the disorders other than Graves' disease that can cause the condition. They view a goiter and are asked which physical exam findings provided in the lesson would support the diagnosis. Even if users choose the correct answer, they are presented with the experts' explanations of why it is right and why the other answers are wrong. They progress through the rest of the questions, which are followed by more information about the case, a summary of what they have learned, and references with links to either full articles or abstracts. Keeping the courses current is critical. "We plan to update these modules on a yearly basis," said Chopra. "That could include updating the references, adding a case, or whatever it takes, and we have a process in place to do that." Chopra is enthusiastic about the task. "I feel privileged," he ex-plained, "because I work with some of the most brilliant, ebullient, and dedicated faculty." --David Holzman |
