CME NOTES Could the scope of CME grow greater? Most states require physicians to participate in CME, but doctors should have their competence evaluated regularly, according to a new study by the Pew Health Professions Commission.
Former Senator George Mitchell, chairman of the commission, calls present standards of qualification for health care professionals "minimal." At present, once they are licensed, health care providers are unlikely ever to be required to prove competence. Even states that require CME ask for nothing beyond proof of attendance. Nowhere are physicians expected to prove that they learned anything, or took courses appropriate to their practice.
Some specialty boards do require competency reviews when doctors get recertified. The American Board of Medical Specialties opposes programs to regularly test physicians, on the grounds of expense and the difficulty of deciding what physicians ought to know.
Is a Dummy a Smart Choice? An anesthesiologist at the Pennsylvania State University College of Medicine has shown that a robotic patient simulator can be an effective stand-in to teach doctors how new drugs affect real patients.
W. Bosseau Murray, MD, associate professor of anesthesiology at the College of Medicine, recently conducted physician training programs using a patient simulator to show 836 physicians and residents how to use a new anesthetic manufactured by Glaxo Wellcome. Murray presented his findings at the annual American Society of Anesthesiologists meeting in Orlando, Fla., in October.
The simulator, manufactured by Medical Education Technology Inc. (METI) of Gainesville, Fla., has a heart with a pulse that can be felt in the neck and arms, a chest that moves up and down like normal lungs, and speakers so you can hear the lung sounds.
The patient simulator was originally developed in 1987 by a group at the University of Florida at Gainesville and is produced commercially by METI, an offshoot of Loral Data Systems, the same company that makes aircraft simulators.
TECHNOLOGY NOTES Physicians are waking up to computers--slowly. And it seems CME has a role to play in helping physicians decide how best to use new technologies. In a lead editorial to a special report on computers in medicine in the October 21 issue of the Journal of the American Medical Association, Tom Ferguson, MD, wrote that health care professionals had to be concerned with the workload generated by such computer-driven services as e-mail response to patient requests for information, and with how they were to be reimbursed for time devoted to computer-driven tasks. He also suggested that physicians would have to decide when e-mail was appropriate, and included the following ethical question: "How should clinicians answer e-mail requests for specific advice about a personal medical concern from one of their current patients--or from one with whom the physician has had no previous contact? . . . How does providing medical 'information' differ from providing medical 'advice'?"
Ferguson, a consultant to online health care services, works with the Center for Clinical Computing, Boston, Mass., and the Department of Health Informatics, School of Allied Health Sciences, University of Texas Health Science Center, Houston. He can be reached at email@example.com
Online CME is coming from a powerful new player. Medscape, operator of a popular physician Web site (www.medscape.com), and MedPartners Inc., the largest physician practice management company in the United States, announced in October that Medscape's medical content and services have been integrated directly into MedExcellence, MedPartners' private physician Intranet. These companies are no ordinary providers of CME. Med-Partners, Inc. had annual revenues of approximately $6.3 billion in 1997. Medscape, a free Web site, has more than 600,000 registered members, including more than 125,000 physicians. It features continuing medical education programs, and live, online coverage of significant medical conferences. These are formidable competitors, indeed.
REGULATORY NOTES At press time, it looked certain that Jane Henney, MD, would be confirmed as new director of the Food and Drug Administration. She would fill the post vacated by David Kessler in February 1997. Dr. Henney is vice president for health sciences at the University of New Mexico, Albuquerque.
The National Institutes of Health (NIH) and the National Institute of Environmental Health Sciences (NIEHS) held a two-day conference in September on what kind of regulation might be appropriate for the growing U.S. herbal medicines market. The conference drew an international audience of nearly 400 government regulators and herbal medicine advocates.
Norman Farnsworth, the keynote speaker and an expert on medicinal plants at the University of Illinois, called criticism of the herbal medicine business unfair. But Phyllis Greenberger, director of Society for the Advancement of Women's Health Research, argued that consumers didn't really know what they were taking or how it worked.