The Continuing Medical Education Guide

One physician’s quest to determine which continuing education activities are worth the cost of admission. Residency was a long time ago. I remember my instructors warning me that half of what I would learn was wrong but which half was a mystery. Well I know which half now. And I look to my CME to figure out how much of the remaining half is wrong too. 

Continuing medical education: The CME CRIB sheet

One physician’s quest to determine which continuing education activities are worth the cost of admission.

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Residency was a long time ago. I remember my instructors warning me that half of what I would learn was wrong but which half was a mystery. Well I know which half now. And I look to my CME to figure out how much of the remaining half is wrong too.

I am in agreement with adult education experts in valuing CME that is interactive, engaging, and relevant to my clinical practice. There are so many options out there that I find it necessary to break CME events down into components to help decide how my time and money will be spent. I think of this analysis as my “CRIB notes”: Cost and location, Relevance, Instructor/Interactivity, and Bias. Here is my take on some current offerings:

Journals and Journal Clubs. With most journals available online, I find it very easy to skim through relevant articles. But critical appraisal is challenging when your time is limited. In my part of town journal clubs are inconvenient, not readily available, and often not a big return on the time investment.

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Emergency Medical Abstracts. One of the oldest and best-known audio programs, the banter between its hosts Jerry Hoffmann and Rick Bukata is entertaining but also contains an incisive analysis of current literature that others can only aspire to achieve. I have listened to their cassette tapes, then CDs and now enjoy the audio file downloads. Their enormous emergency medicine database and knowledge of not just a particular study, but also all the related studies is very useful. Other than promoting their own CME products, I find this one of the least biased educational programs available and the price reasonable.

EMRAP. Emergency Medicine Reviews and Perspectives is another audio product that has morphed into a multimedia online presence. The core of the program is Mel Herbert presenting didactic lectures from various speakers. Mel and/or Stuart Swadron provide a summary of key points from each talk during and after a presentation. Lighter on the evidence-based analysis and geared more to providing down-and-dirty advice on how to deal with common emergency department challenges. Reasonably priced and a broad range of topics.

CMEdownload.com. This site hosts a wide variety of CME activities, including many video lectures, from various sources. In general, it’s a little pricier, but there is a lot of material here. The lectures are of varying quality, some are dated, and the instructional videos tend to be short. While often useful, the videos I viewed were sometimes lacking in depth.

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Downloadable CME programs can be very effective learning tools. However, they require self-discipline to sit down and digest regularly. The lack of interaction and varying amounts of engaging material can be a problem even for the dedicated.

ACEP Scientific Assembly. An enormous annual event with something for everyone. Such a variety of topics can make it hard to choose. The speakers have some variability in teaching quality but usually are above average. There is a mix of workshops and didactic sessions. Slow topic/speaker turnover is the rule which allows attendees the chance to discover the most effective teachers when attending regularly. There is significant industry involvement in the enormous vendor display area.

244 physicians responded to EPM’s CME survey. Here is what you had to say:

Airway Courses. I took an airways management workshop called AIME (Airway Intervention and Management in Emergencies) that was offered as a road show, which made it convenient and kept the associated costs low. Expect to pay a high course fee because these workshops are labor and resource intensive. The instructors were experienced, engaging and there was plenty of hands-on. It was relevant as the focus was how to develop skills appropriate for the department where the attendee worked. However, course pearls are quickly forgotten unless you put them into action and revisit the information afterwards. Post-course reflection exercises are provided to solidify new knowledge.

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Ultrasound Workshops. Declaration: I am a bedside ultrasound instructor involved with The Emergency Department Echo (1 and 2) courses. I have attended CME both affiliated with professional groups and taught by private educational companies. Relevance is very dependent on what your own department practice is like. Ultrasound workshops are some of the most expensive CME available. Learning a new technology and skill set is so exciting that students give high praise to programs that could be much better. There is a large variation in instructor expertise and teaching skills. There is the bedside instructor as well as the lecturer to consider in choosing a course.

Ultrasound is a motor skill, and the more time spent at the bedside scanning, the greater the educational benefit. It is crucial to find out what instructor/student and machine/student ratios will be. Find the right level course. There are programs that throw a lot of applications at the student but are poor in breaking down how to learn and retain the necessary skills. Instructors can have potential bias because of industry supplied technology and promoting their own educational DVDs and texts. Also, they are run by enthusiasts who are unlikely to be completely objective about the evidence supporting ultrasound applications. (Yes, I am looking in the mirror right now.) Like other workshops, unless immediately practiced and further developed on the front lines, the skills are rapidly lost.

Physician Management Courses. I have participated in management programs for many years and recently attended one called the Physician Management Institute Course. Topics such as project management, negotiation, dealing with the difficult physician, and leadership skills are covered. The style is small group and very interactive. There is a lot of role-playing and working through scenarios relevant to anyone in a leadership position. The courses were expensive, as were some of the locations, though workshops can be taken on-site at your own hospital for far less. The tragedy of these courses is that all of us don’t take them. As physicians we all have to be leaders in our departments to deliver patient care. Honing these skills is a crucial part of CME, and I recommend everyone take a high quality leadership course.

Evidence based medicine. I recently took the Best Evidence in Emergency Medicine (BEEM) course in New York City. Course fees are reasonable but travel and accommodation can be expensive, as this group often holds courses in exotic locales. It is partly didactic with audience participation generated by remote keypad devices. Relevance is enhanced by a review process w
here a large number of front-line physicians screen the articles ahead of time to find those considered having the greatest potential impact on practice. The course seeks to avoid bias as much as possible. I really enjoyed how little filler there was with this program. The bottom line on current research is delivered consistently in a fashion that makes it easy to incorporate into practice.

I can’t end a discussion of continuing education without acknowledging the change brought about by the Internet. As the immersive and dynamic nature of web education evolves, I have no doubt it will become a more popular method of CME for most of us. Real-time multimedia can engage us, and being able to immediately interact by keyboard, voice or webcam can only enhance the CME experience. Many traditional courses now include a web-based component or have moved a great deal of content to the web to maximize hands-on instruction in the classroom. It is an exciting time for adult education and we all need to get off our behinds to enjoy what’s out there.

Author Declarations: Instructor/lecturer/co-author of The Emergency Department Echo Courses. 

References:
Dave Davis; Mary Ann Thomson O’Brien; Nick Freemantle; et al. Impact of Formal Continuing Medical Education: Do Conferences, Workshops, Rounds, and Other Traditional Continuing Education Activities Change Physician Behavior or Health Care Outcomes? JAMA. 1999;282(9):867-874

Forsetlund L, Bjørndal A, Rashidian A, Jamtvedt G, O’Brien MA, Wolf F, Davis D, Odgaard-Jensen J, Oxman AD. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD003030. DOI: 10.1002/14651858.CD003030.pub2

EMEDHOME.com
Easy to use, lots of nationally-recorded lectures with interesting non-CME features including clinical pearls and cases. Mobile edition and section for ACEP members.

Freeceme.com
You get what you pay for. Only one article, released in 2007, for emergency medicine

ACEP.org
Main ability to obtain CME is through PEER VII, EM:Prep, Critical Decisions. PEER VII is an excellent source to use when studying for the Emergency Medicine boards but may not be what the average person is looking for to get their yearly CME. It is a question and answer book with short explanations.

ClevelandClinic.org
May be the site for the user that wants their CME free and cardiology intensive.  However some lectures are only available by webcast and not downloadable. Newest EM lecture was uploaded to the site in June 2009.

Studentdoc.com
Mainly, the site is just a bunch of organized links to CMEWeb.com, which charges for each pdf you download!

BalanceLtd.com
A series of interactive clinical cases the user works through with instantaneous feedback. The site is free after registration. Many cases are emergency medicine related but created for other fields.

cmelist.com
A well-organized site that directs you to other sites where you can obtain CME. Also included are short reviews, number of CME hours possible, and costs for the different sites.