Distance Medical Education

Can distance delivery of continuing medical education (CME) really improve physician’s ability to provide patient care? According to Dr. Samuel Smal, of Gillam, Manitoba, it can! Access to the CME opportunities made possible by videoconferencing “has made me a better physician.” Dr. Smal and his colleague, Dr. Kelly, have participated, since April 2002, in the monthly physician continuing education programs offered by The University of Manitoba over the MBTelehealth Network. Gillam, located in northeastern Manitoba, serves as a support community to several major hydro-electric operations in northern Manitoba. Located over 1000 kilometers from Winnipeg, the residents of Gillam and the surrounding communities, are dependent for their health care on the experience of their two local physicians.

Dr. Kelly, like so many of the rural and northern Manitoba family physicians, finds it a challenge to make the long and expensive journey to Winnipeg for the required professional education programs offered there. “You have a hard time to keep up CME points (50hrs a year) in Gillam”. Like any other new mother, Dr. Kelly does not want to leave her small community for long overnight trips for conferences. She also does not want to leave her only colleague, Dr. Smal as the sole physician responsibility for the care of Gillam’s patients for extended periods. According to Dr. Kelly, access to the videoconferencing technology “helps quite a bit, it is beneficial not to have to travel so far.”

To maintain a medical license, physicians are required to participate in a specified number of annual professional education programs. In order to maintain clinical competency, the diversity and constant changes in medical practices, policies and pharmaceuticals makes it critical for all physicians to have access to continuing education. From a collegial perspective, extreme weather and long distances that prevent interaction among physicians directly challenge a remote communities’ ability to attract and retain health professionals. Drs. Kelly and Smal’s participation in the videoconferencing distance education programs has allowed them to address their licensing, competency and collegial learning needs.

As a new form of education available to Manitoba’s rural and northern physicians, the videoconferencing distance education program is designed to ‘localize’ the content. The specialist facilitators work with small groups of family physicians and ensure that the clinical issues are discussed using local cases, with reference to available equipment, pharmaceuticals and human resources, rather than assuming that all communities are homogenous with the urban centre. This intense level of instruction is only possible by grouping similar practice communities together for a videoconference session. For example, a program on emergency medicine for physicians in southern Manitoba’s agricultural area may focus on chemical inhalation, while topics on miner’s respiration may be of priority in Manitoba’s shield area, and treating ‘Seal Finger’ will only concern the family physicians in the far north.

MBTelehealth provides high quality audio and visual transmission using their video-over-internet H.323 Internet Protocol system. The virtual learning environments created on this system allows facilitators and learners to immediately concentrate on the clinical content of the session rather than the technology. The visual display of, for example, dermatology slides, allows family physicians exposure to clinical issues


Dr. Smal and his colleague, Dr. Kelly, have participated, since April 2002, in the monthly physician continuing education programs offered by The University of Manitoba.

in real-time with the specialists. The sound quality supports natural interaction and conversations quickly develop. The soft-spoken Dr. Kelly finds that her questions and comments are immediately picked-up and responded to by her colleagues who are located 1000 km from her. Support resources, such as current references, new pharmaceutical names and prescription protocols, are sent in advance either electronically or via fax to augment the live interactive videoconferencing programs. The combined learning package available in this distance format, involving expert clinicians, localized cases and current resources, has been praised by both learners and facilitators as being far superior to mass conference-style presentations.

For the specialist facilitators, the learning interaction that evolves in the distance delivery program is much preferred to lecture-hall formats. Dr. Eileen Murray, a Winnipeg dermatologist and professor at University of Manitoba, has been involved with the videoconferencing network for both clinical and education uses. “ I think just talking face to face (with the rural physicians) for even such a short time makes you feel more like you are working as a team and that has to be a benefit for patients.” The team work has not just been limited to the family physician and their facilitator. As members of a team of dermatologists serving as education facilitators, the distance education program necessitated a group effort among the specialists. “We learned from each other while designing the program” notes Dr. Murray. By combining their knowledge of referred conditions from their learners’ communities, the specialists have become more aware of the challenges that the family physicians have in regards to identification, diagnosis and treatment of dermatology conditions. During the sessions, the specialists helped family physicians recognize the early ‘pitfalls’ of a disease and its treatment in order to prevent additional complications from developing. For example, the visual clarity offered with the videoconferencing allowed ‘better than my naked eye’ look at the best technique of how an ointment should be applied, a common challenge for educating patients for their at-home care. Being involved in the distance delivery program helped the specialists connect their practice to the most immediate needs of the rural and northern patients.

Family physicians, due to the broad nature of their practices, have an ever increasing and changing body of knowledge to assimilate, organize and apply. Having access to their specialist colleagues through distance education programs allows the rural and northern physicians to maintain their knowledge base and continue their life long challenge of providing competent and caring health services. MBTelehealth works with health education providers in all of Manitoba’s regional health authorities to compliment and expand distance delivery of discipline specific (e.g. physicians, nurses, mental health workers, physiotherapists) and treatment specific (e.g. cancer, diabetes) programs. Distance education via videoconferencing technology, has, as Dr. Smal reports, “helped to equalize the difference in rural/northern CME opportunities compared to southern physicians”. The high quality audio and visual transmission available through videoconferencing provides family physicians of rural and northern Manitoba with assurance that their continuing education needs can be met while still remaining in their home communities where they are of most service to their patients.

By Stephanie Giberson, MBTelehealth Education Coordinator

Save My Marriage Today