By William L. Newkirk, MD, FACPM

"Traditional continuing medical education courses are dead."

An experienced medical educator made this statement at a recent medical meeting – probably intending it as an overstatement designed to drive home this significant point:

Continuing medical education (CME) in occupational health is poised to undergo fundamental change.

For years, CME has meant going to a conference, usually in a large city or a resort. The conference would last from three to five days, consist of lectures, exhibits and receptions and cost between $1000 to $2000 including tuition, travel, lodging and meals.

Several factors are making this approach to CME obsolete:

• Downsizing: Staff reductions in the occupational health industry have made it increasingly difficult for a healthcare provider to schedule the blocks of time away from work that are required for traditional CME conferences.

• Budget Constraints: Increasing financial pressure in healthcare is reducing the budget for CME. Requests for education, particularly those in resort locations, are scrutinized and often rejected.

• Demands of Two-Income and Single Parent Families: The parenting demands of two-income and single parent families are sometimes overwhelming. This makes it very difficult for the health provider who is also a parent to be away from home for a few days. Being away means reducing already limited and fragmented family time.

Fortunately, advances in information technology now provide us with a way out of this dilemma. This multimedia issue of the Tracker, for example, contains an accredited four-hour continuing medical education course covering new developments in occupational health and the issues involved in merging and joint venturing. The course was initially delivered in the traditional CME setting. New technology now allows the course to also be delivered on CD and across the Internet. Such an approach has only become feasible in the last several months.

In the current occupational health environment, this new approach has several advantages over the traditional CME:

• Time: It dramatically reduces the time required for continuing education by eliminating the non-essential activities traditionally associated with acquiring CME, e.g., spending nights in hotels, travel, and waiting between courses. This new approach eliminates virtually all of this non-productive time.

• Cost: By utilizing new technology, cost is slashed to virtually nothing. The cost of travel, meals, and most of tuition is eliminated. In the case of courses provided in this multimedia issue, there is no cost for members of the SYSTOC network and a $10 per course charge for non-members to process their continuing medical education certification.

• Convenience: The health care provider can take the course during breaks in the day, at lunch, in the evening or on weekends. The course can be started and stopped if there are interruptions. In addition, if the participant finds that a particular class is inappropriate or boring, he or she can skip it and move directly to another class without wasting time.

• Quality: Presenting the course in a digital format improves quality. The lectures have been enhanced and edited to improve the quality, sound and delivery of the lecture. The lecture slides are clearly displayed. Slides can even be downloaded, edited, and re-used by the participant in his or her own lectures.

• Comprehension: The course includes a brief examination at the end to insure that the participant has learned the key features of the lecture. If the participant has not, he or she can repeat slides and lecture sections until comprehension is complete.

Until recently, presenting CME is this way was impossible. Over the last few years, multimedia personal computers (those containing a CD drive and speakers) have become commonplace. Many occupational health providers have Internet connections at work, and often at home. This new approach to CME takes advantage of these developments.

Although those technological developments made the direction change in CME possible, two additional breakthroughs were required for this new approach to become feasible.

• Media Compression: One problem in using computers to deliver audio or video media has been the large size of the media file required. Downloading a ten second media file from the Internet in a non-compressed format can take several minutes. Before compression, downloading long lectures was impractical; downloading the lecture took several times longer than listening to the lecture. Recent developments of data compression techniques have reduced the size of the files necessary to be transmitted by over 90%. This has moved media data transmission below the critical time threshold where downloading the lecture takes less time than the lecture itself. Once this threshold was passed, the stage was set for media streaming.

• Media Streaming: Media streaming allows an audio or video transmission to be viewed or heard as soon as an adequate amount of the file has reached the destination computer ("filled the buffer"). With media streaming, instead of having to wait for the entire lecture to reach the participant before starting, the participant can start as soon as a minimal amount of the file has arrived. While the participant listens to the lecture, the computer keeps downloading it. Since, with media compression, the lecture’s download time is now less than its playing time, the download generally is able to stay ahead of listening. This makes apparent real-time media delivery possible.

For many occupational health care providers and programs, meeting continuing medical education requirements in the modern occupational health market represents both a financial and time challenge. With the multimedia CME in this issue, we apply new technology to help solve the problem.

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