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This Dalhousie University study, presented at the SACME fall meeting, looked at why, since interaction with other participants is required for accredited online CME in Canada, and since education and nursing participants thought the interaction was fine in their programs, research in online CME shows a low satisfaction with online interactivity.

The presenter, Dalhousie s Joan Sargeant, lost me a little with her explanation of diffusion theory, which as far as I could tell comes down to people basing their adoption of something new on their perceptions of the innovation. This perception, she said, is based on the relative advantage of the innovation, and how well it correlates with current experience and beliefs.

Experience and perception

So they asked physicians what their experiences were with accredited online CME, and what their perceptions of this way of learning are, in order to find out what s behind these perceptions.

In focus groups and interviews, the researchers asked those who have completed online programs (just a few, and more than five the latter were considered "experts"), those who haven t completed online programs, and people who haven t done anything online yet but are active in traditional CME.

They found that physicians based their perceptions on what they know best: face-to-face CME. These perceptions then were moderated by the ability of online CME to meet their specific learning preferences, and the quality and quantity of interactivity provided.

The three biggest factors in the learning preferences involved self-direction, opportunity for reflection, and educational design. Those with some experience with online CME liked being able to schedule their own CME online, while others wanted a more structured system. The experts said they liked that they could skip the parts they already know and spend more time on the stuff they need to learn more about. Experts also liked that online activities allow them time to reflect on how to put what they learn into the context of their patients, and that, as they complete the course over time, they re simultaneously treating patients and implmenting the changes as they go.

The experts also liked that they can feel like they re participating more than they would be sitting in a lecture, that it forces them to pay attention.

So, what about the interactivity?

One thing most physicians say they like about face-to-face CME is the opportunity to interact with their peers, to share experiences. Those with no online experience seemed a little cowed by the perceived anonymity. One said something like, "I don t know any of these people," and didn t feel comfortable taking suggestions from strangers. Experts found it easy to get to know their online peers, and to comment as the formal sessions go on. Experts valued the online discussion aspect in particular. The facilitator also makes a huge difference in the quality of the online activity, they said.

The continuing challenge, said Sargeant, is to find ways to encourage the uninitiated to give online CME a try, and to make sure that when they do, the activity is of the highest quality.

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