ENSURING QUALITY ONLINE/DISTANCE CE PROGRAMS. Stephen M. Foreman DC, DABCO 86 th FCLB Annual Congress May 5, 2012

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1 ENSURING QUALITY ONLINE/DISTANCE CE PROGRAMS Stephen M. Foreman DC, DABCO 86 th FCLB Annual Congress May 5, 2012

2 THE ELEPHANT IN THE ROOM: I am a recovering post-graduate lecturer I am former California Board member known for enforcement. I co-founded MyiCourse.com (Learning Management System) LMS platform. 70K users, 180,000 hours of instruction/yr. Not limited to CE. Worldwide usage in multiple professions. We also provide online CE for DC s using the MyiCourse LMS. Several chiropractic colleges and multiple state associations utilize MyiCourse to provide CE hours. Several chiropractic boards use MyiCourse for testing.

3 Why is Continuing Education required for chiropractors? To give assurance of continued clinical competency. Why is ongoing clinical competency necessary? To better protect the public.

4 QUESTIONS ANSWERED BY THIS PRESENTATION What is the current landscape of online CE education? Why is the traditional model of live CE rapidly changing? Should your Board focus on content or accountability? Are the doctors cheating, and if so, how are they doing it? What is the current standard for technology in CE to ensure accountability? What can your Board reasonably require of distance programs? What can your board reasonably require of distance education? What can your board do to increase CE provider accountability? What can your board do to increase DC accountability?

5 WHAT IS THE CURRENT LANDSCAPE? The answer is very dependent on each state s regulatory laws/agencies. The variation in regulations allow for CDs, DVDs, written works (DC Tracts) Webinars Online Education: Download PDFs & fax test results View DVD and submit test results Read paragraph, wait 10 minutes. Read paragraph, wait 10 minutes rinse and repeat. Total content less than 3 pages of text. Ensure 50/60 minutes of content are taken, viewed & comprehended.

6 WHAT IS THE CURRENT STATUS OF DISTANCE CE UTILIZATION IN CHIROPRACTIC?

7 CURRENT STATUS OF DISTANCE CE IN CHIROPRACTIC INSTITUTIONS Colleges currently have 4 choices for online CE: 1. Outsource CE: Serve as a referral portal from their.edu site to a 3 rd party. No college created or hosted content. (2 colleges) 2. Internally developed CE content on either physical media (DVD, etc.) or using an internally hosted or licensed LMS. (4 colleges) 3. License existing CE content and platform for revenue sharing. (3 colleges) 4. No online/distance CE program offerings. (5 colleges)

8 WHY IS THE TRADITIONAL MODEL OF LIVE CE RAPIDLY CHANGING? 1. Excessive costs: Live CE meetings are facing ever-increasing costs for: - meeting halls, - AV equipment, - refreshments, costs to copy notes and handouts, - costs for speaker travel, honorarium, hotel and meals - increasing hotel meeting room fees, - seminar attendance staff, - advertising, - staff hours to work the meeting and staff time after the meeting to process attendance cards.

9 WHY IS THE TRADITIONAL MODEL OF LIVE CE RAPIDLY CHANGING? 2. Changes in technology: The increased choices and lowering costs for distance technology, such as online, DVDs, CDs, and webinars, are allowing alternative delivery that removes many of the rising costs listed in the previous section. 3. Doctor expectation: Doctors are now demanding distance alternatives that allow greater choice in topics and reduced costs for the doctor for travel, meals, hotel and time away from the office. If I can earn an entire degree online, why can t I earn my CE online too?

10 SHOULD YOUR BOARD FOCUS ON CONTENT OR ACCOUNTABILITY? Content focus Belief that the doctor and the public would be better served with high quality content. This focus has largely morphed into approving the provider rather than inspection of specific content and demands for CE hours in specific subject areas. Accountability focus Belief that the public would be better protected when ensuring that the doctor has met the regulatory requirements of specific hours. The challenge is to approve technologies that allows and verifies compliance.

11 SHOULD YOUR BOARD FOCUS ON CONTENT OR ACCOUNTABILITY? My perspective The highest quality, most informative content serves no purpose if the providers are not forced to ensure that the doctors attend ALL of the hours, see all of the material and participate in the course. AND The highest quality, most informative content serves no purpose if the doctors are not held accountable for attending the required hours through effective follow-up and deterrence with Board action. In short, no cheating.

12 ARE THE DOCTORS CHEATING, AND IF SO, HOW ARE THEY DOING IT?

13 METHOD 1. IGNORING THE CONTENT BEFORE SUBMITTING THE QUIZ

14 USING PASSIVE TECHNOLOGY FOR CE HOURS WITHOUT ACCOUNTABILITY State Boards typically require 50/60 minutes for each hour of earned CE. (webinars? DVD s?) DC begins course and then walks away, letting time toll.

15 Gaming Online Education: Webinars

16 Gaming Online Education: Webinars The technology may range from conference calls at the low end to web based remote seminars at the high end. - The KEY issue is accountability: How does the provider prove the attendee received all of the course material? - How does the provider document the time the attendee earned in the course? - How does the provider allow for board review of webinar content?

17 SUMMARY FOR OLDER TECHNOLOGIES 1. Older technologies such as tapes, CDs, DVD, most webinars were originally acceptable when alternatives were not available. 2. Providers have no ability to provide assurance to boards that the doctors reviewed all of the materials. 3. Providers have no ability to independently verify the CE hours were earned. 4. Boards have no ability to assure legislators and the public that the doctors have earned their continuing education hours.

18 SO, NEW WEB-BASED COURSES MUST BE THE ANSWER! RIGHT?

19 ONLINE COURSES ARE NOT ALWAYS SYNONYMOUS WITH ACCOUNTABILITY Instructions from a chiropractic CE site

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21 METHOD 2. TAKING MULTIPLE COURSES AT THE SAME TIME

22 METHOD 2. TAKING MULTIPLE COURSES AT THE SAME TIME Simultaneous taking of courses:

23 METHOD 2. TAKING MULTIPLE COURSES AT THE SAME TIME Logging in with multiple browsers:

24 METHOD 2. TAKING MULTIPLE COURSES AT THE SAME TIME Yes, this can be stopped. The doctors can be made to take one course at a time.

25 METHOD 3. EARNING TIME BY JUST CALLING OR LOGGING IN Doctors should not earn time when they take a break by a long phone call, treating patients or going to lunch. Require providers to show how they stop the student from earning excessive time while away from the course.

26 METHOD 3. EARNING TIME BY JUST CALLING OR LOGGING IN

27 WHAT CAN YOUR BOARD REASONABLY REQUIRE OF DISTANCE EDUCATION?

28 MYICOURSE HAS SET THE BAR IN THE CHIROPRACTIC CE COMMUNITY MyiCourse developed restrictions to provide accountability to licensing boards.

29 MYICOURSE HAS SET THE BAR IN THE CHIROPRACTIC CE COMMUNITY MyiCourse developed restrictions to provide accountability to licensing boards.

30 MYICOURSE HAS SET THE BAR IN THE CHIROPRACTIC CE COMMUNITY MyiCourse developed restrictions to provide accountability to licensing boards.

31 MYICOURSE HAS SET THE BAR IN THE CHIROPRACTIC CE COMMUNITY Built-in or attached web cameras are becoming increasingly popular for video chat and phone calls with Skype. And since they are there, we can use them to identify the user on the computer.

32 MYICOURSE HAS SET THE BAR IN THE CHIROPRACTIC CE COMMUNITY The system documents the date, time, photo of the students and the course page where the photo was taken. These can be printed by an admin for a hard copy file or sent by .

33 WHAT CAN YOUR BOARD DO TO INCREASE PROVIDER ACCOUNTABILITY? Require availability for Board to review courses. Require providers to accurately track course time. Require time-out safeguards to prevent unearned hours. Require providers to prove their students viewed the entire course. Require safeguards against taking multiple courses at the same time. Testing component, randomized questions? Webcam pictures taken during course?

34 WHAT CAN YOUR BOARD DO TO INCREASE LICENSEE ACCOUNTABILITY? 1. Audit, audit, audit. Far too many boards have drastically curtailed and even eliminated random audits. 2. Increase the ramifications to those doctors who do not take their required CE hours. Making-up hours is not a deterrent. Failure to take CE should have truly sentinel effect. 3. Widely publicize the disciplinary actions taken for failure to obtain CE in a timely manner as required in regulation. Publication improves compliance in other licensees.

35 WHAT CAN YOUR BOARD DO TO INCREASE LICENSEE ACCOUNTABILITY? 4. Limit the number of CE hours that can be earned in one day.

36 WHAT CAN YOUR BOARD DO TO INCREASE LICENSEE ACCOUNTABILITY? 4. Limit the number of CE hours that can be earned in one day. 5. Remove the ability for licensees to avoid hours by increasing standards on the providers.

37 WHY? Why are there so many CE providers who offer old technologies, out dated information, failure to monitor their students and non-clinical information that does not improve clinical competence and improve the eventual protection to the public? Why do so many DCs avoid their CE hours by attending programs that do not enforce standards or that emphasize non-clinical topics that do not increase their clinical competence and improve the eventual protections of the public? BECAUSE YOU LET THEM!

38 " WHEN YOU COME TO A FORK IN THE ROAD...TAKE IT YOGI BERRA

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