Educators have long made efforts to use technology to enhance the impact of their message and to improve access to their material. With the development of web-based education and broadband Internet access, it is now practical to view full-screen slide presentations accompanied by the presenter’s narrative in audio and sometimes video form. There is nearly immediate and free access to a vast catalogue of always-available information, which allows the educational activity to be highly self-directed, which is important to effective education.[1] An online presentation can be paused for a few moments to better review a detailed slide or contemplate a difficult concept. In addition, users can review the entire presentation if required to solidify key points. To physicians who practise in a location without ready access to live CME, the benefits are obvious.

Although experiencing web-based education is not identical to experiencing a live lecture, studies suggest that computer-based learning improves the participating physician’s knowledge, clinical skills, and confidence in treating clinical conditions. [2-4] For this and other reasons, the use of web-based medical education is on the rise. Bernard Sklar maintains a directory of online CME sites (www.cmelist.com [8]) that today includes more than 220 sites offering more than 19000 hours of instruction. The American Accreditation Council for Continuing Medical Education reported that in 2001 about 230 000 US physicians claimed online CME credits.[5] This accounted for about 5% of all physicians claiming CME activities.

Hardware and software

Luckily, the computer hardware requirements needed to access and use web-based education are rather modest when compared with the average hardware available today. Essentially, any system purchased in the last two or three years will have adequate capability, with the possible exception of a pair of external speakers or headphones needed to access the many sites that use sound. Thankfully, the confusing days of minutely detailing minimum processor speeds or the technical details of video cards and CD-ROM drives have passed.

More important than the power of the computer is the capacity, or “bandwidth,” of the Internet connection. Both cable and telephone companies offer inexpensive and widely available connections to the Internet that have revolutionized the way the web is used, both in terms of always-on and always-ready access, and in terms of the amount of data that can be transmitted per unit of time.

With the move away from platform-specific CD-ROM technology to web-based technology, the choice of a computer operating system is also much less important than it once was. Current generations of both mainstream operating systems (Microsoft Windows and Apple Macintosh) have more than enough capability to use almost every web site. Users are free to choose the operating system they prefer.

It is important, however, to have a current version of a web browser (Internet Explorer or Netscape) as older versions can be lacking in important functions. These browsers usually come with a considerable amount of support software already installed, although some additions are required to access all sites. Take care not to accidentally disable important functions, such as JavaScript, in the preferences area of each application.

There are four competing multimedia technologies in widespread use on the web, and all are used in various web-based educational sites. All have free playback software available for both Windows and Macintosh systems. Some of these multimedia players might already be installed on your computer system, but it can be difficult to tell which are installed and which are not. Probably, the most efficient and time-effective approach is to simply install them all at the outset and be done with it (see the “Multimedia sofware” box). Note that although several of these multimedia technologies have extra-cost players available, the free versions are all that you need to access web-based education.

Finding online CME

Now that your computer is ready, there are two basic ways to find web-based medical education. First, you can take advantage of someone else’s organizational labor and look at a local list of online educational resources, a categorized list of talks, a compiled list of sites or, optimally, a searchable database of activities. These sources have the advantage of being manually screened by an interested maintainer and categorized in a way that helps the user to the goal of the search more quickly. Second, you can use a brute-force method and type terms such as cme hypertension Canada into a search engine. This may turn up an appropriate activity, but is more of a hit-and-miss affair.

Manually organized directories listing online medical education providers are provided by several of the major search engines (Google, Yahoo, etc.). In addition to these more general search sites, some medically specific sites provide reasonably comprehensive lists of web-based medical education.

Searchable databases of educational activities are potentially faster and more effective routes to suitable activities. Search terms such as hypertension or renal failure are entered and the database search engines return a list of related activities (see the "Resources" box).

All of these directories and databases suffer from the fluid nature of the educational offerings on the web, so be prepared for new activities to appear but not be listed on these sources, or for links to go stale over time.

Evaluating online CME

One significant problem with web-based education is that the usual indicators of credibility may not be evident. When attending the national conference of a major medical organization and being seated in an auditorium with 3000 others, you can feel reasonably sure that the content of the message from the speaker is valid; if not, the audience is unlikely to sit still for it. Likewise, at the weekly local grand rounds, the speaker is usually invited by an organizing committee with a commitment to quality education. Finally, speakers in most situations are encouraged and usually required to indicate major and minor areas of potential bias.

On the web, look for similar validation of content quality. Association with a trusted organization is probably the most obvious indicator of credibility. The web site should allow viewer comments on the presentation to be readily visible, feedback should be encouraged, and sources of potential bias should be indicated.

Accreditation can also be a useful indicator of credibility. Because accreditation systems vary, take a moment to check specific requirements with your governing board. For example, Category 1 CME credits from an American online CME site may not be acceptable to the College of Family Physicians of Canada as equivalent to Mainpro-M1 credits, or acceptable to the Royal College of Physicians and Surgeons of Canada as equivalent to Section 1 CME credits.

Conclusion

Web-based educational activities are worth finding and using. From the comfort of home, a physician can take advantage of a recent lecture from a well-respected source on almost any topic. As the popularity, availability, and quality of presentations increases, web-based education for physicians promises to become an ever more useful source of current medical knowledge.

Competing interests
Dr Cunningham runs MedicalRounds, which currently makes little to no profit. Should the site become successful, Dr Cunningham could profit financially.

Kenneth F. Cunningham, MD, FRCPC

Dr Cunningham is an internist and intensivist at Lions Gate Hospital and a founding member of the Section of Medical Informatics at St. Paul’s Hospital. He operates a web-based medical education web site called MedicalRounds (www.medicalrounds.com/ [14]).