instructional design, delivery and evaluation of interactive case based e-cme contents

background and purpose: studies have shown the advantages of e-cme programs. developing case-based e-cme activities, one of the popular formats of e-cme programs, is difficult and time consuming. in this article we describe our experience of performing instructional system design for creating case-based e-cme contents.  methods: we performed a five-step instructional system design (i.e. system analysis, design, development, delivery and evaluation) to create e-contents. we held several sessions with experts of the field to perform system analysis. then we determined contents’ framework and a plan for faculty members’ development and incentives. in the development phase, we held workshops for faculty members and trained e-learning advisors who would help faculties to create contents. incentives were legitimized. then we delivered programs to the learners who would fill a program evaluation questionnaire after completing the study of each program.    results: 20 e-cme programs were developed and delivered to the learners. totally 3644 learner-programs were studied. cases rated the programs as 4.56 (sd= 0.65) on the 1–5 likert-type scale. conclusion: results showed that the learners rated this kind of learning activity very high. on the other hand we had some challenges for developing the contents. performing a comprehensive instructional system design would help to overcome the barriers.