An accredited 3½-hour continuing medical education workshop titled "Improving Outcomes in Otitis Media," organized by Outcomes Management Educational Workshops (Boynton Beach, Fla), was conducted in Rochester, NY. The course consisted of 3 components: improving diagnostic accuracy (1 hour); improving familiarity with otitis media diagnostic tests, ie, tympanometry, acoustic reflexometry, audiometry, and tympanocentesis training (1½ hours); and judicious antibiotic selection strategies (1 hour). To improve diagnosis skills, participants were shown 30-second video clips of TMs projected on a large screen. Two example examinations were shown first: (1) a normal TM (translucent, slightly gray, fully mobile on pneumatic otoscopy, no evidence of middle ear effusion) and (2) a typical TM from a patient with AOM (bulging, red, opaque, diminished mobility on pneumatic otoscopy, and middle ear effusion). The distinguishing features of a normal examination compared with AOM and OME (gray, retracted, or neutral position, diminished mobility, and middle ear effusion) were reviewed. Then, 9 sequential video clips of TMs were shown. The video footage included a 10-second interval in still frame, 10 seconds with pneumatic otoscopy, and 10 seconds in still frame. All cerumen had been removed from the external auditory canal prior to filming. The participants were instructed to record the TM findings in a structured format and to diagnose the patient with 1 of 4 possible conditions: AOM, OME, retracted but otherwise normal, and normal. (The correct diagnosis had been previously established by consensus among an expert panel based on reviewing the video plus tympanometry and tympanocentesis findings.) Participants were afforded as much time as necessary for each member in the course to reach a conclusion and record his or her answers on a digitized personal keypad that was electronically linked to a laptop computer, thereby creating a database. Active instruction and interaction between instructor and participants occurred as the correct answers were reviewed for each diagnostic test.