Geographic isolation and poor technological and telecommunications infrastructure were identified as key barriers to CPE delivery and access. Financial factors, such as funding to support travel or cost of attendance, were also identified as major challenges. Tele-education programming was identified as a best practice approach to improve CPE access, as were regional CPE activities and self-directed learning programs. Employer-sponsored initiatives, including staff coverage or locum support, remuneration for time off and paid travel expenses for CPE participation were also identified as best practice approaches.

BackgroundInternet-based instruction in continuing medical education (CME) has been associated with favorable outcomes. However, more direct comparative studies of different Internet-based interventions, instructional methods, presentation formats, and approaches to implementation are needed. The purpose of this study was to conduct a comparative evaluation of two Internet-based CME delivery formats and the effect on satisfaction, knowledge and confidence outcomes.MethodsEvaluative outcomes of two differing formats of an Internet-based CME course with identical subject matter were compared. A Scheduled Group Learning format involved case-based asynchronous discussions with peers and a facilitator over a scheduled 3-week delivery period. An eCME On Demand format did not include facilitated discussion and was not based on a schedule; participants could start and finish at any time. A retrospective, pre-post evaluation study design comparing identical satisfaction, knowledge and confidence outcome measures was conducted.ResultsParticipants in the Scheduled Group Learning format reported significantly higher mean satisfaction ratings in some areas, performed significantly higher on a post-knowledge assessment and reported significantly higher post-confidence scores than participants in the eCME On Demand format that was not scheduled and did not include facilitated discussion activity.ConclusionsThe findings support the instructional benefits of a scheduled delivery format and facilitated asynchronous discussion in Internet-based CME.

The idea that health professionals should be accountable to the society they serve is not a new concept and by the 1990 s, the continuing professional development (CPD) of health professionals was being seen as one way in which Canadians' level of health could be improved. The public was, and is still today, increasingly demanding a system that is more responsive to regional and community needs. As a result, there is a need for more health professional education at all stages of the education continuum - undergraduate, postgraduate, and continuing professional development - that meets the health and social needs of the populations being served. The trend is now towards 'socially accountable' health care, meaning that the broader context of CPD must also include the personal, social, and political aspects of health care and as such, involve a widening of accountability to patients, the community, managers and policymakers. CPD planning must take into account local and national priorities as well as personal learning needs. However, the definition of social accountability and the stages at which it is addressed is sometimes vague and this added to the difficulty of identifying relevant studies in the literature. Nonetheless, there were some "best practices" evident via Canadian and American studies which focused on models of socially accountable CPD, as well as examples of interdisciplinary collaboration in Canada, the United States, Australia, Great Britain, and the United Arab Emirates. However, there is a definite need for increased research and publication of such "best practice" initiatives. There is also a need for Canadian health professional schools to facilitate this process by sharing their experiences and resources if possible. An extensive literature review was conducted between January and March 2004. Due to time constraints, it was limited to articles written in the English language. The databases/sources utilized included: Medline (now known as Pubmed), CINAHL, ERIC, PsychInfo, Canadian Business & Current Affairs (CBCA) Full-text Education (now known as CBCA Education), Research and Development Resource Base in Continuing Medical Education (RDRB/CME) at the University of Toronto, EMBASE (Excerpta Medica). This literature review was one of the first activities conducted under the auspices of "Issues of Quality and Continuing Professional Development: Maintenance of Competence", a national project funded by the Primary Health Care Transition Fund, Health Canada. The purposes of this review were to identify literature which focuses on aspects of continuing professional development, social accountability, and determinants of health; "best practices" of socially accountable CPD and inter/intra-disciplinary collaboration, and the critical success factors and challenges to implementing CPD, especially CPD that meets the needs of both health professionals and the populations they serve.

Interactive participation will not occur just because CMC is being used. The design of Web-based CME learning activities, participant characteristics, and facilitation are key factors that influence the effective use of CMC.

Recent studies focusing specifically on asthma were non-Canadian pilot studies with small sample sizes. The study findings highlight a similar initiative in Canada, which provided health professionals who care for patients with asthma access to relevant CPD with a Canadian perspective. The findings show that course participants were extremely satisfied and that they increased their knowledge in this clinical area. Further development of such Internet-based programs may encourage health professionals to improve their knowledge in a variety of therapeutic areas.