E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers



Patients are asking health care providers about e-cigarettes, vaping, and other electronic nicotine delivery systems (ENDS). Provider advice on ENDS has varied greatly, suggesting a need for evidence-based continuing medical education (CME).


A novel free online CME course was developed on ENDS risks and benefits, product types (e.g., vape pens, pods), and screening and counseling best practices for adults, adolescents, and different smoker profiles (e.g., daily, social).


From January 2017 through June 2018, 1061 individuals accessed the course: 46% physicians, 7% physician assistants, 7% nurse practitioners, 15% nurses, 4% pharmacists, and 28% allied health/student/other; 41% were international.

Program Description

The course was built from observed online patient-provider interactions. Through video role-plays, expert interviews, and interactive activities, the course engaged learners in the evidence on ENDS. Completers earned 1.5 CME units.

Program Evaluation

A total of 555 health care providers earned 832.5 CME units. Pre- to post-test scores significantly increased from 57 to 90%; 76% rated the course as above average (41%) or outstanding (35%); 99% indicated the course was free of commercial bias.


Addressing the growing need for balanced provider education on ENDS, this interactive online CME engaged learners and increased knowledge on devices and evidence-based cessation approaches.

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We acknowledge Mark Rosenberg, Kimberly Walker, and Andrew Baek with the Stanford Center for CME for their collaboration in developing and disseminating the CME; Laura Corbett for assistance accessing the evaluation data; Dr. Maciej Goniewicz and Dr. Suzaynn Schick for participating as experts in the CME; Dr. Mark Rubinstein and Dr. Sean David for their external review and feedback on the course content; and Dr. Sue Kim and Dr. Sang-ick Chang for their course review as time testers.

Funding Information

Intramural research funding was provided by the Stanford Center for Continuing Medical Education, and postdoctoral training support was provided by the National Heart, Lung, and Blood Institute T32 Postdoctoral Training Grant No. 5T32HL007034-43. The Stanford University School of Medicine has received and has used undesignated program funding from Pfizer, Inc. to facilitate the development of innovative CME activities designed to enhance physician competence and performance and to implement advanced technology. A portion of this funding supports this activity.

Author information

Correspondence to Judith J. Prochaska PhD, MPH.

Ethics declarations

This project, which reports on learners’ outcomes in an online continuing medical education program, falls under exemption 1 of the common rule, 45 CFR 46.104(d)(1).

Conflict of Interest

None of the authors have received any financial or in-kind support from an e-cigarette or tobacco company. Dr. Prochaska has served as an expert witness against the tobacco companies in lawsuits and has provided consultation to pharmaceutical and technology companies that make medications and other treatments for quitting smoking. No other authors have disclosures to report related to this work.

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Fielding-Singh, P., Brown-Johnson, C., Oppezzo, M. et al. E-Cigarettes: Harmful or Harm-Reducing? Evaluation of a Novel Online CME Program for Health Care Providers. J GEN INTERN MED 35, 336–340 (2020).

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  • e-cigarettes
  • vaping
  • Juul
  • continuing medical education
  • nicotine
  • ENDS