The explosion in the use of the Internet is due almost exclusively to the technology of hypertext mark-up language (HTML) and the development of the World Wide Web (WWW). Before there was HTML (which lets you point and click to negotiate the Internet), in order to get anywhere on the Internet you had to know what text commands to type into your computer. In other words, you had to know a special language to be able to talk on or with the Internet. This made the Internet a rather specialized instrument, used only by computer-literate types and particularly interested academics. It was inaccessible to most people because they had no idea how to communicate on it.

The WWW changed all this by making information accessible to anyone who has the most basic computer skills. The WWW superseded the need to communicate by typing in specialized language commands. This innovation eliminated much of the old-style of computer communication in much the same way that fax machines have essentially eliminated the telegraph and reduced special deliveries of urgent information in tangible paper form. The vast majority of people that use the Internet now do so with minimal typing; they just point and click a mouse.

One major holdout for text-based communication on the Internet is Electronic Mail, or E-mail. E-mail is used by most Internet users to send specific personal communications to each other. E-mail communication has become an important communication and collaborative tool. You can write a private note to a colleague to discuss or ask a question about a patient. So many people have joined the Internet since the WWW revolution that very few realize that typing text is actually exemplary of a previous era of Internet use. There are still some other old-style text-based communications that can be enormously useful for academic psychiatrists, and we would like to describe some of them here.

If you understand the Internet as a system to gain access to information, then you can see text-based information as one more way to obtain answers to questions. Similarly, if you have a large group of people who all want answers to the same questions, then it would make sense to develop a system that allows all of those people to receive the same E-mail. It is in this way and for these reasons that aspects of text-based communication have remained as primary methods for communication on the Internet.

One can also collaborate with a group of colleagues, much like attending a meeting. Similar to a conference seminar, this electronic-group collaboration can be private and only for those who are registered to participate. It is called a "listserve" or "list server." The term comes from the idea of having a computer (or server) that handles the E-mail communications of a group of people on a mailing list. Actually, the listserve is a storehouse of the subscribers' E-mail addresses, and the listserver acts as a central processing center and gatekeeper of all E-mail communications among the participants on the list, and forwards all communications to all the people registered on the mailing list.

Listserves are generally divided or designated by topic. There are many listserves where ideas can be shared and issues discussed. One relatively well-known example is the psychopharmacology group run and mediated by "PsyDoc," aka Ivan Goldberg, M.D., of New York. This group has numerous members from all over the United States and several other countries who collaborate on issues relevant to psychopharmacology. Clinical questions are asked by any member of the list and answered by one or many of the members. Difficult cases are presented, and generally wise advice is given. "It is like having a group of supervisors or several senior faculty who you can call upon for advice," recounts one member.

One novel outgrowth of the aforementioned psychopharmacology mailing list has been the noteworthy efforts of Dr. Bob Hsiung. He has culled together the best issues, concepts, and tips from the list and organized them in to the "Psychopharmacology Tips" website. It has become a valuable reference in our growing number of excellent websites. Listserves have advantages and disadvantages. The advantages of listserves include length, that is, E-mail is like writing a memo or a note; the length can be as long or as short as needed. Another advantage is that they are perhaps the most timely written communication. The time frame is quite short, as E-mail, for the most part, travels quickly around the globe. One disadvantage is that although E-mail travels quickly, it cannot be a substitute for the immediacy and/or intimacy of a phone call, and another problem can be the volume of messages. If the listserve is big, you may receive many more messages in your electronic inbox than you can deal with. Similarly, many different issues and topics are being discussed. You may need to review or read many messages to find messages of interest to you.

To subscribe to a mailing list, you send an E-mail message to the list administrator (this is not actually a person, but an automated process), and your E-mail address is added to the list. You will receive a reply that gives you all the details you need to know about the list and how to participate. You will then begin receiving mail from other list members. In general, someone sends out a message, and it goes to everyone on the list. You can reply to the messages, send new messages, or just "lurk," that is, reading the messages without participating in the discussion. Mailing lists can be public or private and involve as few as two people or as many as thousands. There are generally two types of lists: 1) announcement-type lists: you receive messages but do not "post" (write messages) to the list yourself; and 2) discussion-type lists: everyone on the list can join the "conversation."

Unlike newsgroups, which require additional software to run, all you need to participate in a listserve mailing list is an E-mail address. Subscribing to a mailing list does not cost anything; it just means you are asking to have your E-mail address added to the distribution list. To get off the mailing list, you have to "unsubscribe" from it. This process is handled by sending a particular type of E-mail message to the list administrator with your request.

Here are some additional tips for using mailing lists/listserves. First, subscribe to one or two mailing lists at a time, then wait to see how many messages you receive before you subscribe to any others. Save the list's subscription instructions. After you send your subscription-request E-mail message, you will get a response with instructions on how the group works and, perhaps most important, how to unsubscribe. You are expected to read and save these instructions. It is considered bad "netiquette" to send messages to the list requesting help in unsubscribing.

Second, turn off the list when you go on vacation. It's like stopping your newspaper delivery. Some lists have a "vacation" option. For others, you have to unsubscribe when you leave and resubscribe when you return. A high-traffic list can generate hundreds of messages a day, and your system administrator will not be happy if you leave those messages piling up in your E-mail inbox. In fact, on some systems you will be charged for disk-space storage. Third, remember that all of your postings (responses) are public. If you write a response to a question, everyone on the list reads it.

Newsgroups are public discussions. These are like using a public bulletin board to post a message, then anyone with software called a newsreader can subscribe to and participate in the discussion by posting a response. Newsgroups are generally defined around a topic and open to anyone with Internet access.

Chat is a popular form of immediate communication. It offers conferencing or bulletin board-type systems with "real-time" capabilities (i.e., immediate typed responses with everyone involved typing at the same time, as opposed to waiting for your E-mail). Many of the popular online services offer these chat rooms or chat groups. These are typed discussions, also known as real-time conversation, with other users. These can accommodate between 50 and 1,000 users simultaneously. Some of these chat groups require special software, and the newer types offer chat on the WWW by using your usual browser.

Document conferencing offers the simultaneous editing of a document in progress to people in remote locations working together. The document can be a spreadsheet or some word-processed report. However, some programs enable workgroups to connect/link together in a collaborative way through the use of a set of tools that enable the workgroup users to control and synchronize applications and presentations of text, graphics, images, sound, and video.

Although there are some CME courses available on-line, this concept is still a "work in progress." More will be developed as the "kinks and bugs" are worked out.

With the advent of computer networks, the everyday workplace has become a shared computer environment. There are local-area networks that are active, with workgroups sharing projects and information that electronically link people together. So with the Internet and WWW, the "global village" of electronic communication has begun, and the ease of use has extended this connection from work to home, from school to play. The workday of the clinician-academician never began at 9 am and ended at 5 pm. How many hours have we spent at home preparing for a lecture, writing an article, or working on some research project? Collaboration via the Internet has also extended the time period and reach of "after-office hours." This can be seen as a blessing or an intrusion. The demarcation between work life and home life have become blurred when a personal computer sits in your office and in your bedroom.

Connecting and communicating with colleagues has never been easier. A "real" old definition of CME (before the concept of credits) is "to collaborate with colleagues to continue to learn and grow as a clinician and further your education." Traditionally, professional meetings have offered the opportunity to meet with colleagues from other parts of the country or world to share and exchange ideas. At a meeting, you learn by attending a session, having a discussion with colleagues, and meeting with some friends, perhaps continuing with later discussions about a difficult patient or pharmacological intervention. Now, the same forms of communication can take place, only across great distances—and without ever leaving your desk. How is all this possible? Through the tips of your fingers on the keyboard via the Internet and WWW.

Dr. Kramer is assistant director for training, Arkansas Mental Health Research and Training Institute, Little Rock, AR; and Mr. Kennedy is director of fellowship training and director of computing services, Department of Psychiatry, Albert Einstein College of Medicine, Bronx, NY. Dr. Kramer's e-mail address is tamkmd@aol.com. Mr. Kennedy's e-mail address is kennedy@aecom.yu.edu.