Web-based continuing medical education for doctors provokes positive but also mixed feelings

Heidelberg 21 September 1999General practitioners who visited the poster sessions at the recent MedNet'99 Conference, could find out everything about a continuing medical education (CME) initiative via the Internet. The two-year Post-Doc project has been set up in January 1998 by a team of universities and network providers to develop and validate a Web-based learning environment for post graduate training in favour of European doctors. The consortium has received funding support from the Telematics Application Programme, Esprit, and TenTelekom as part of the Educational Multimedia Taskforce, as well as from sponsoring industrial partners. At the RWTH Aachen, the Rheinisch-Westfälische Technische Hochschule, a research team has tested the level of participation by general practitioners in the generation and the assessment of high-quality contents for this Post-Doc Web service but co-operation between doctors and developers was not as good as expected.

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The Post-Doc Web-training facility offers doctors four educational multimedia modules, including clinical simulations; practical skill tests; the case study approach, based on the Electra project, and integrating courses, discussions and an interactive forum on specific topics; and diagnostic units with therapy for mental disorders. The clinical simulation tool is built from a database where cases and case-related materials are stored separately from the simulation-shell. For the training of practical skills, a Skillslab has been created at the University of Maastricht in 1975. The material of the existing training courses is transformed into interactive and multimedia stand-alone distance learning packages. The training module for diagnosis of psychiatric disorders is based on DSM-IV, a world standard in the psychiatric domain, and also includes interactive discussion.

Currently, the learning applications are used by general practitioners as a demonstrator set-up in four different regions of Belgium, The Netherlands and Germany. These trainees have access to a virtual library; discussion platforms; medical specialists for general and patient specific consultation; information provided by the industry and health organisations on products and services; events and news on a European, national and regional level; and also synchronous and a-synchronous communications with trainers and colleagues. In order to install the Post-Doc service in other parts of Europe, the team has to make an analysis of the specific situation in several regions of Europe in collaboration with the doctor's organisations in those countries. Post-Doc uses the high speed network interconnecting the universities. The doctors in turn are linked to their "local" university.

The consortium plans to carry out a price-performance comparison between Integrated Services Digital Network (ISDN), Cable TV (CATV) and Asymmetric Digital Subscriber Line (ADSL) solutions. New protocols such as IPv6, will be taken into consideration, as well as non-obtrusive measures to handle issues like security and intellectual property rights. Developing high-quality content for continuing multimedia medical education is very expensive, which makes it necessary to decide about applications and accreditation mechanisms at a European level. Details with regard to learning packages, use of languages, cultural and legislative implications, and telematics infrastructure should be dealt with at a national level. The implementation of Post-Doc happens in the work environment of the general practitioner, which is the regional level. Its success depends on the participation of the doctors.

In Germany, fifty general practitioners were stimulated to actively participate in the design of the Post-Doc service for their individual needs. Last August, a first evaluation could be made by the RWTH researchers who distinguished three different user roles. Unregistered visitors have restricted access, which allows them to read public information, send feedback via e-mail and turn in requests via HTML forms. Registered doctors have a password, allowing them to use the interactive learning modules and communication. Editors are also registered with a password, allowing them to enter data directly into the data bases. All the participating general practitioners highly valued the integrated information and learning environment but most of them tended to reject the communication facilities or the active editorial work. Despite the stimulation of hands-on workshops and positive attitudes, additional motivation remains necessary for doctors to become active in the Web-based Post-Doc service.

Statistics show that the general practitioners consulted the service between 5 and 6 PM and from 8 to 9 PM. There were eleven user sessions per day of 7 minutes duration on average. Doctors are willing to use the Web for CME activities at home but only in a consumer manner. Active co-operation with the Post-Doc service fell short of initial expectations due to the doctors' time constraints, lack of Internet experience, unspecified requirements, the habit to prefer traditional ways of CME, and their individualism. As a result, major active content provision by doctors does not seem realistic. Therefore, other content providers such as universities, publishers, and medical associations must be searched for. However, the general practitioners should control the quality of the service's content, preferably in collaboration with accreditation organisations. More details are available at the Post-Doc project home page.


Leslie Versweyveld

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