Challenges of continuing medical education in Saudi Arabia's hospitals

Abstract

Background Health care professionals are responsible for maintaining their proficiency throughout their careers. Continuing medical education (CME) is an integral part of the medical profession that aims to enhance physicians’ knowledge and skills. Health care services in Saudi Arabia are expanding rapidly. However, the country is struggling to cope with a shortage of competent health professionals. CME in the Kingdom is facing some challenges that are preventing learning programmes from responding appropriately to professionals’ demands and needs, and to the complexity of health care. Research questions The research questions addressed in this thesis are: 1. What is the current status of continuing medical education in Saudi Arabian governmental hospitals? 2. What are the barriers preventing continuing medical education from implementing competitive learning programmes? 3. How might Saudi culture be influencing the health context and how does this impact upon the field of CME? Methodology This study adopted a mixed methods approach supplemented by ethnography. Two forms of individual, semi-structured interviews targeted two groups of respondents; the interviews were followed up by a questionnaire (sent by email) listing all the challenges to CME identified by the interviewees, and asking the participants to rank them in order of importance. In addition, observation was conducted throughout the fieldwork. Sampling Three public hospitals were selected from different geographical areas (N=3). Judgemental approach resulted in the selection of 33 medical education representatives from different medical and paramedical departments (N=33). Purposive sampling resulted in the selection of 11 medical librarians (N=11). Results The major CME challenges were identified and grouped into four themes: 1. Management, including the lack of knowledge on the part of decision makers about the importance of lifelong learning, and their influence over learning programmes. 2. Poor status of medical libraries, in terms of location, space and services provided. 3. Lack of transparency in the CME budget, which leads to a too close relationship between the pharmaceutical industry and physicians. 4. Diversity of staff, including their different training backgrounds, and their resistance to making changes in their performance after training. Discussion and conclusions The study found a strong correlation between health stakeholders’ lack of managerial skills and knowledge of the significance of CME and the learning programme limitations in Saudi Arabia; this factor also received the highest ranking by the participants in the study. 3 Hospital officials lack the necessary knowledge about the importance of CME, and lifelong learning has become complex. Their negative attitude towards learning has resulted in several challenges: some of these have been identified in this study, including a lack of support for the learning process in hospitals, an inability to motivate staff to continue developing their skills, and a lack of transparency when allocating budgets to learning elements, including CME and library services. This ambiguity has resulted in poor libraries and a heavy reliance on pharmaceutical industry sponsorship for CME events and medical professionals’ trips, which can affect the quality of the events and/or cause bias. The study has also clarified the issue of staff diversity. Although the majority of health care professionals are foreigners, the concern is that health care stakeholders are recruiting professionals from developing countries where the quality of health care and training might be low. Despite the varied training and educational backgrounds among the staff, no efforts have been made to design learning programmes that meet their actual and wide-ranging needs. Rather, current activities are based on desires and wishes of chiefs of medical departments.