After musing about using multimedia for online CME cases, I got to speak with Destry Sulkes, MD, managing director of MedsiteCME, which recently started incorporating multimedia into its online cases.

Me: Where did the idea to incorporate multimedia in your online cases come from?



Sulkes: I used to do almost NASA-grade simulations of patient interactions. But downloading times were long, streaming was tough, and doctors became confused. It just got a little too complex. So at MedsiteCME what we do is strip our cases to be as simple as possible. You read a screen, get a question, click to get the answer, and move on to the next screen. Then we have some faculty who said, ‘Here are the cases and the 15 questions, but you really can‘t explain the resolution of cervical dystonia unless you show a video of a patient before and after treatment.” Then we got another one where someone said we‘re not sure you can tell the difference between pseudo epileptic seizures and epileptic seizures, so he sent some video on that. Then we got another case where we wanted to talk about cerebral palsy injections with Botox, and how to inject the right muscles so you release the contractures but not the wrong muscles and/or arteries, veins, and nerves. So we created a 3D animation on where to insert the needle and how to validate you‘re in the right spot. They‘re just little snippets, five to 10 seconds long, and they‘re persistently available throughout the case so they can go back to the media at any time.




Me: Have you done any outcomes measures to see whether the cases with animations have better outcomes than the plain cases?




Sulkes: We haven‘t assessed these cases versus other cases. What I don‘t want to do is say a case with video is better than a case without video. It depends on the case, the faculty, the structure of the case, and the learning objectives. The video might zap the learning objective and have a high impact on the doctor. But if you drop an animation into the wrong case it can be disruptive and boring and cause the doctor to leave the case. You don‘t want to have media for media‘s sake. You choose the format and the media for the learning objectives and the audience. It changes. You need to be at a national society meeting, and online, and on teleconferences, but you‘re achieving different objectives and you‘re getting different outcomes with each one of those. You can‘t really take one yardstick out and say what are the outcomes for an online case versus a society meeting.




Me: Do the physicians seem to like the multimedia additions, whether or not they affect outcomes?




Sulkes: Most of our doctors are repeat users of our site and they know what we offer. We get a lot of “appreciate the animation,” and “like the video of the patient.”

What I’d be curious to know is if anyone has done two identical cases—same faculty, same case, same learning objective, etc.—with the only difference being that one includes multimedia and one doesn’t, and then measured the outcomes. If anyone has done such a thing, please drop me an e-mail or leave a comment below.