Continuing medical education is a multibillion-a-year business that, in the digital age, reaches literally into doctors' offices, homes, boats, cabins and cars. But don't think that its pervasiveness means you can make blithe decisions.

"It's increasingly important for physicians to know a little something about the CME provider: whether it's a for-profit or nonprofit company, whether commercial support was used in the development of the CME course, and how the provider resolved any conflict of interest that may have resulted from commercial support," says Lon Osmond, vice president and executive editor at California Medical Association-affiliated Audio-Digest Foundation in Glendale.

"To maintain certification in a specialty, physicians of the future will be expected to evaluate their clinical practice according to specialty-specific standards and to assess the quality of care they provide compared with peers and national benchmarks," Osmond says. "They will be expected to prove through formalized examination that they have the fundamental knowledge and skills to provide quality care. And they will be expected to participate in lifelong learning and self-assessment programs that meet specialty-specific standards."

That means you need to understand the changing CME landscape and match available opportunities to your needs. Here are seven ideas to help.

1) Make the most of your time.
You may listen to some CME courses while on the go; other courses may carry you away. For example, Sea Courses Cruises programs maximize a doctor's learning time and offer a break from routine, according to Martin Gerretsen, MD, ECC, director of continuing health education for the Vancouver, B.C.-based company. "Physicians are often faced with time restraints in getting away from the office," he says. "A CME cruise provides an opportunity to combine accredited, high-quality education while enjoying a vacation cruise experience."

You can leverage the onboard time to expand your referral network as well, Gerretsen adds. "Our conferences cater to all physicians, all specialties," he says. "This is one of the few CME venues that has a mix of attendees from an array of specialties-allowing for interspecialty learning and sharing of ideas."

2) Turn to your malpractice insurer.
The SCPIE Companies has an interest in the quality of its insureds' care, of course, and has long offered CME credits through a partnership with TIV Inc., notes Barbara Worsley, vice president for risk management at the Los Angeles-based company. "Our objective for getting involved in the educational process is to enhance the physician's ability to care for patients," she says. "As a commercial carrier, our primary topics are risk prevention and patient safety."

3) Put online CME options in context.
There's no question that online CME options are expanding, but to what extent? Worsley offers an observation: "Since [SCPIE] started offering online courses in 2002, participation in them has tripled, but still makes up just 18 percent of the credits we grant. There is increasing use of what is clearly a very attractive modality for CME, but there are still many physicians who would much rather attend that conference in person or have that booklet in hand."

4) Don't count on traditional funding.
The organization that accredits CME providers and the organizations that require CME credits are increasingly disallowing courses with commercial support, and that has reduced the monetary resources for grand rounds, Worsley says. "How do we pay for that now?" she asks. "Pharmaceutical companies used to be able to provide a great deal of monetary support for educational programs, but they can't anymore. So hospitals have to look at other ways to fund them."

5) Learn at your local hospital.
Pulmonologist Paul Selecky, MD, chair of the CME committee at Newport Beach's Hoag Memorial Hospital notes that his facility offers some 35 events every month for its medical staff, nurses and others in a mix of classic grand rounds lectures, guest speakers and case conferences. Hoag convenes focus groups periodically to ask doctors what information they need and what kind of venues are most useful to them. Three months after each program, the institution checks in with doctors to see if they're implementing the program's clinical recommendations, Dr. Selecky says.

6) Take control of your own education.
Historically, CME has been a teacher-centered process, Osmond says. Courses were developed based on what the teacher believed the learner needed to know and, to some degree, what the learner said he or she wanted to know. "But CME of the future will be a learner-centered process based on practice-specific problems the physician identifies through regular self-assessment," he says. "CME providers will be expected to help physicians identify those problems, to develop CME courses that address them, and to demonstrate that their CME courses help to close the knowledge gaps."

7) Demand the best.
"The challenge for each physician is to figure out the right CME for him or her," says Dara Warn, vice president at Boston-based Pri-Med, a major CME conference and publication producer. "There are hundreds of providers, so how do you find quality?"

The CME providers worth doing business with will make that part easy for you, Warn says. "CME providers must make sure the content is relevant to physicians," she says. "That will help them access CME and use it the way they should-as an educational opportunity, not as a burden."