www.mdbriefcase.com

In the competitive world of online CME, "md Brief Case" is perhaps unique.

Their publisher claims to be the single most popular source of electronic and online CME in Canada by providing a combination of quality multimedia, interactive and accredited learning programs. They also claim to provide some 90 per cent of all online courses to more than 4000 Canadian physicians per month.

The funding for md BriefCase seems to be entirely via educational grants and allocations as guided by the policies of the Canadian Medical Association and the Canadian Family Practice College. There is certainly no apparent advertising content and their site specifically states they do not accept industry advertising.

More importantly perhaps from the user's standpoint, it is notable md BriefCase requires no subscriptions, but, as with their Canadian "competitor" Doc Guide, only simple registration. md BriefCase is accessible and free to all those who register, Canadian and otherwise, at www.mdpassport.com

In Canada, the site is marketed to some 35,000 physicians who are said on average to participate in 32 courses per year.

The publisher has also managed to find out a few more fascinating statistics: physicians can spend 300 hours per year searching for medical information online. In Canada, several surveys have indicated participation in regular local online CME to be as high as 60-70 per cent - and, maybe considering the breadth of the country from Vancouver to Nova Scotia, the popularity of online CME can perhaps be readily appreciated.

The site designers arrange for courses to be provided through partners who are university continuing education departments or, in other cases, physician associations.

A number of sponsorships are provided by some 20 pharmaceutical and healthcare operations. Indeed, md BriefCase claims to be the exclusive provider for such organisations as the Canadian Cardiovascular Society, the Society of Obstetricians and Gynaecologists, the Canadian Rheumatology Association, and the Canadian Society of Endocrinology.

One certainly has the impression that, in Canada at least, a number of professional bodies have opted to pass on the responsibility for maintaining professional CME resources to partnership arrangements such as this, rather than trying to administer and duplicate their own CME infrastructures.

The site provides case studies, e-symposia and "Virtual Practices". Programmes are written by "prestigious educational institutes", with some of the examples being the Centre for Effective Practice (University of Toronto), the Canadian Cardiovascular Society, the Society of Obstetricians and Gynaecologists, the Canadian Society of Endocrinology and Metabolism, Queens University, McGill University, McMaster University, University of Montreal and University Laval.

From the purely parochial standpoint, md BriefCase is open to all "Canadian" physicians, students, residents and nurse practitioners. All courses are available to any registrant but, as mentioned earlier, a one-off registration is required.

There are interactive options with real-time discussion forums. The site also provides a wide range of videos, slideshows, easy-to-use treatment algorithms, and links to guidelines and references.

It is difficult to criticise a well-organised publication such as md BriefCase, but one cannot help but get the feeling the selection of topics is always going to appear a little non-integrative from the primary care clinician's standpoint.

This may depend on the choice of topics - whether they are derived from the relevant institution sponsoring the topic or from the publisher. For example, there appear to be no organisations representing a number of medical specialties such as gastroenterology, paediatrics, respiratory medicine, ENT, surgery, rheumatology, orthopaedics or physical medicine, etc. One cannot help but just occasionally get the feeling when scrolling through the list of featured programmes that "something is missing".

It is accepted the above-mentioned and highly prestigious universities supply review programmes that also cover topics such as infectious diseases management, etc, but there is the ongoing impression academia has a preoccupation with evidence-based reviews - and a lot of what we do in general practice is quite unable ever to be scrutinised or validated within the constraints of evidence-based medicine.

Sometimes a different approach to CME is warranted, one which better recognises clinical opinion, clinical guidance and the "art" of medicine. For example, I would not expect to see articles here at md BriefCase such as "Investigating and managing acute and chronic pancreatitis" or "Assessing neurological symptoms in patients with lower back pain" or "The assessment of the patient with dyspnoea".
In many ways, we lament the loss of some of those pre-Pharmac Journals such as New Ethicals Journal which were well produced, well integrated and well received, and our CME is now more fragmented.

We can but continue our quest for that "holistic" source of all-powerful CME for general practice in the new millennium - as long as we leave a small part of our week for seeing at least a few patients, and for ticking those boxes on the computer screen so we can get those all important PHO incentive payments to buy more window envelopes and pay our ever inflating postage bills.