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Medical Education: The On-Line Revolution


Only a small fraction of the revolutionary changes in medical education made possible by the World Wide Web have yet been realized. Ways of working, communicating—even thinking—are rapidly evolving in directions difficult to predict.

Perhaps only a few have taken the time to visualize the phenomenal transformation that is about to take place. Already, 277,000 US physicians use the Web, and 19% of CME credits are earned through CD-ROMs and on-line services. This radical change in communication format will not be unlike other cultural revolutions that we now study in history books. Are we ready?

The changes will be driven by strengths of the medium: The Internet permits a multimedia, interactive format ideally suited to problem-based, user-centered learning, which, in medicine, is a vast improvement over the topic- or sequence-oriented approach. It is also fast: Updating is easy and inexpensive.

Simultaneously, the combination of accessibility, global distribution, and content provided by experts from multiple institutions is breaking down the "real" walls that exist between institutions of higher learning—the bricks, mortar, and geographic separation that have given each institution its identity. Similarly, barriers are eroding between producers and users of knowledge. Physicians need to keep pace with the 70 million patients who have researched their diseases on the Web.

One result of these changes could be an integrated system in which the best content experts from around the world would, via the Web, present medical education material that is more thorough and authoritative than that provided by faculty from a single institution. In fact, these offerings could come to represent uniform, evidence-based practice guidelines.

Such cutting-edge learning technology is already being developed. Drs Stephen Schendel and Kevin Montgomery at the National Biocomputation Center at Stanford University ( are reconstructing three-dimensional images of congenital facial abnormalities from CT scans transmitted on-line. The resulting database gives a surgery resident a chance to "operate" on many more rare facial anomalies than is possible in a traditional training program.

The National Library of Medicine (NLM) has completed phase 1 of its ambitious Visible Human Project (, a digital library of MRI and CT cryosection images of representative male and female cadavers. These images, scanned at 1-mm intervals, constitute a complete on-line digital image library that can be used as a common reference point for the study of human anatomy. The NLM's long-term goal is to link its print-based physiology library with the digital anatomic image library, advancing applicability to a wide range of educational, diagnostic, artistic, industrial, and other uses worldwide.

But for now, let's return to the present! To meet the needs of our readers for fast, user-friendly, and cost-effective CME, The Physician and Sportsmedicine, together with our sponsor, the American College of Sports Medicine, is enhancing its Web-based Category 1 CME offering beginning October 1, 1999. At, you'll read the same practical, peer-reviewed information offered in the journal (1 month after print publication), take a self-correcting quiz, submit payment, and receive a certificate for your credits all in one stop. Visiting our award-winning Web site will also give you an opportunity to join our 15,000 weekly users in appreciating the depth of content and ease of use of our journal archives, patient information, sports medicine links, and other important resources.

Gordon O. Matheson, MD, PhD