Best practice to improve continuing medical education in developing countries

Abstract

Internationally, mandatory Continuing Medical Education (CME) linked to re-registration has improved physicians’ competencies and been implemented widely in developed countries but there has been mixed success in developing countries due to problems in three broad areas: educational design, educational delivery, and CME governance. The aim of this research was to analyse the status of CME in South East Asia Region (SEAR) and Eastern Mediterranean Region (EMR) with reference to WHO guidelines and to develop recommendations on best practice for developing countries. A scoping review of CME current practices for all 33 countries in SEAR and EMR regions showed evidence of CME provision in most countries, with 14 implementing mandatory CME linked to re-registration. All 14 countries have statutory bodies regulating CME. An in-depth review of five of these 14 countries showed that all specify a wide scope and range of educational activities and workplace learning as accredited CME and accredit a wide range of local providers with variation in assessing physicians' learning needs. Three have designated CME sub-committees introducing the CME programme with a structured phase-in period, while one is implementing regionally on a state-by-state basis. All five countries regulate against commercial entities providing accredited CME events. In order to explore in detail the CME situation in one country that has struggled to implement mandatory CME, in-depth interviews with medical education stakeholders in Pakistan identified the presence of a number of accredited institutions providing structured activities and credits to physicians. The previous attempt to implement mandatory CME faltered due to inadequate rural coverage, limited accredited providers, rapid implementation and lack of infrastructure. The implementation strategies proposed included a preparatory phase-in period, involving the national licensing body for CME regulation, and accrediting a wide range of providers. Findings from these reviews and interviews were compiled into 31 recommendations. These were put to a panel of regional experts in an online meeting using nominal group technique to develop a consensus on best practice for implementing CME for developing nations. The panel discussion identified eight of the 31 recommendations as most relevant for developing countries seeking to implement mandatory CME.