The present study included a total of 300 residents. Figure 1 shows the CME activities undertaken by the study participants in the previous year. During this period, 239 (79.7%) of the participants reported attending lectures and seminars for their CME needs. There were 102 who attended workshops (34%), whereas 89 (29.7%) reported attending group discussions and 119 (39.7%) reported attendance at case presentations. Electronic CMEs were used by a minority (n = 24, 8%), and only 82 (27.3%) attended journal clubs. There were 131 (43.7%) who attended conferences. Residents usually engage in more than one modality of CME activities.
Table 1 shows that the study included 176 (58.7%) males and 124 (41.3%) females among the participating residents, most of whom were Saudis (n = 289, 96.3%). Half of all residents were married. By specialty, 24.3% were residents in family medicine, 21.3% in internal medicine, and 12.7% in pediatrics. Other specialties, namely obstetrics and gynecology, ENT, and dermatology, made up approximately 5%, and orthopedics, preventive medicine, and general surgery about 4% of study participants each. Lower figures were shown for ophthalmology (3.7%), radiology (3.3%), and psychiatry (2%), while emergency medicine, restorative dentistry, and urology each made up less than 2% of the residents. By the level of residency, there were 89 residents (29.7%) in first year (R1); almost equal numbers of R2 and R3, 75 and 74 (25% and 24.7% respectively); 44 (14.7%) R4; and only 7 (2.3%) were R5.
Table 1 shows also the average total satisfaction scores. There were no significant differences between males and females regarding satisfaction with CME activities scores (p = 0.9816). Similarly, no significant differences in scores were found by nationality and marital status. Satisfaction scores with CME activities were variable across specialties (p = 0.039). The lowest satisfaction scores were among psychiatry residents and the highest was among the restorative dentistry and surgery residents. There were no significant differences in satisfaction scores by training level (p = 0.54).
Table 1: Satisfaction score with CME activities among the study residents (n=300) by characteristics
Characteristic
|
Frequency
|
Percentage (%)
|
Satisfaction score
Mean ± SD
|
P-value
|
Gender
Males
Females
|
176
124
|
58.7%
41.3%
|
21.017 ± 5.310
21.032 ± 5.847
|
0.9816 α
|
Marital Status
|
Married
Single
|
151
149
|
50.3%
49.7%
|
21.20±5.44
20.85±5.65
|
0.5882 α
|
Nationality
|
Saudi
Non-Saudi
|
289
11
|
96.3%
3.7%
|
21.017±5.541
21.182±5.456
|
0.9236 α
|
Training Specialty
|
0.0393β
|
Family Medicine
|
73
|
24.3%
|
21.88±5.19
|
Internal Medicine
|
64
|
21.3%
|
22.41±5.35
|
Paediatrics
|
38
|
12.7%
|
19.39±6.93
|
Obstetrics and Gynaecology
|
17
|
5.7%
|
20.76±6.09
|
ENT
|
15
|
5%
|
20.07±4.30
|
Dermatology
|
14
|
4.7%
|
21.29±5.12
|
Orthopaedics
|
14
|
4.7%
|
21.00±4.52
|
Preventative Medicine
|
14
|
4.7%
|
19.21±3.33
|
General Surgery
|
12
|
4%
|
18.83±6.71
|
Ophthalmology
|
11
|
3.7%
|
19.09±6.71
|
Radiology
|
10
|
3.3%
|
21.00±3.62
|
Psychiatry
|
6
|
2%
|
16.00±5.37
|
Emergency Medicine
|
4
|
1.3%
|
24.50±4.43
|
Restorative Dentistry
|
4
|
1.3%
|
26.00±1.83
|
Urology
|
4
|
1.3%
|
20.00±9.09
|
Training Level
R1
R2
R3
R4
R5
|
89
75
74
44
7
|
29.7%
25%
24.7%
14.7%
2.3%
|
20.27±4.85
21.19±6.72
21.47±5.14
21.82±5.14
21.29±5.59
|
0.5400 β
|
α “using student t test”
β “using ANOVA”
Table 2 describes the residents’ beliefs about continuous medical education as assessed by their level of agreement with various statements. To the statement, “I believe that my CME needs are currently satisfied,” 42.3% of the residents agreed, compared to 24.3% who disagreed. To the statement, “I believe that my medical school education encouraged me to be an independent self-learner,” 49.4% agreed and 24.3% were neutral. More than two-thirds (68.7%) agreed that “I believe that CME activities should be organized on a national level.” To the statement, “CME activities keep me up-to-date,” a majority (65%) agreed and 8% disagreed. Some (68.7%) agreed that “CME activities help me to improve my practice,” in contrast to 8.3% who disagreed. A majority (65%) agreed with the statement, “CME activities affect my professional confidence,” compared to 26.7% who were neutral. As to the statement “CME activities offer new learning opportunities,” 65.3% agreed and 7.7% disagreed or strongly disagreed, respectively. “CME activities provide sufficient scopes for questions and discussions” was agreed to by 57.7%, while 10.7% disagreed.
Table 2: Resident’s beliefs (n=300) about continuous medical education.
Statement
|
Agree
N0. (%)
|
Neutral
N0. (%)
|
Disagree
N0. (%)
|
I believe that my CME needs are currently satisfied
|
127 (42.3)
|
100 (33.3)
|
73 (24.4)
|
I believe that my medical school education encouraged me to be an independent self-learner
|
148 (49.4)
|
73 (24.3)
|
79 (26.3)
|
I believe that CME activities should be organized on a national level
|
206 (68.7)
|
66 (22.0)
|
28 (9.3)
|
CME activities keep me up to date
|
195 (65.0)
|
81 (27.0)
|
24 (8.0)
|
CME activities help me to improve my practice
|
203 (68.7)
|
72 (24.0)
|
25 (8.3)
|
CME activities affect my professional confidence
|
195 (65.0)
|
80 (26.7)
|
25 (8.3)
|
CME activities offer new learning opportunities
|
196 (65.3)
|
81 (27.0)
|
23 (7.7)
|
CME activities provide sufficient scope for questions and discussions
|
173 (57.6)
|
95 (31.7)
|
32 (10.7)
|
Table 3 describes the residents’ perceptions of the effectiveness of different CME activities (Conferences/symposia, workshops/ courses, and interdepartmental activities). The table shows that workshops and courses were significantly most effective compared to the other two methods in retention of knowledge, improving attitudes, improving clinical skills, improving managerial skills, and in proving practice behaviors. On the other hand, inter-departmental activities were significantly most effective compared to the other two methods in improving academic skills and improving departmental image.
Table 3: Residents’ perceptions (n=300) of the effectiveness of different CME activities.
Benefit of CME Activity
|
CME method analyzed for effectiveness
|
|
Conference/Symposia
N0. (%)
|
Workshop/courses
N0. (%)
|
Inter-Departmental Activities
N0. (%)
|
P α
|
A
|
B
|
C
|
A
|
B
|
C
|
A
|
B
|
C
|
|
Retention of knowledge
|
47
)15.7(
|
144 (48.0)
|
109 (36.3)
|
37 (12.3)
|
111 (37.0)
|
152 (50.7)
|
43 (14.3)
|
124 (41.3)
|
133 (44.4)
|
0.013
|
Improving attitude
|
55 (18.3)
|
132 (44.0)
|
113 (37.7)
|
36 (12.0)
|
117 (39.0)
|
147 (49.0)
|
40 (13.3)
|
116 (38.7)
|
144 (48.0)
|
0.025
|
Improving
clinical skills
|
56 )18.7(
|
127 )42.3(
|
117 )39.0)
|
21
(7.0)
|
95 (31.7)
|
184 (61.3)
|
37 (12.3)
|
108 (36.0)
|
155 (51.7)
|
0.001
|
Improving clinical outcomes
|
42 (14.0)
|
117 (39.0)
|
141 (47.0)
|
28 (9.3)
|
101 (33.7)
|
171 (57.0)
|
32 (10.7)
|
110 (36.7)
|
158 (52.7)
|
0.129
|
Improving managerial skills
|
54 (18.0)
|
131 (43.7)
|
115 (38.3)
|
29 (9.7)
|
109 (36.3)
|
162 (54.0)
|
32 (10.7)
|
122 (40.7)
|
146 (48.6)
|
0.001
|
Improving academic skills
|
56 (18.7)
|
103 (34.3)
|
141 (47.0)
|
35 (11.7)
|
101 (33.7)
|
164 (53.3)
|
30 (10.0)
|
106 (35.3)
|
164 (54.7)
|
0.019
|
Improving communication skills
|
50 (16.7)
|
123 (41.0)
|
127 (42.3)
|
34 (11.3)
|
106 (35.3)
|
160 (53.4)
|
42 (14.0)
|
111
(37.0)
|
147 (49.0)
|
0.055
|
Improving practice behavior
|
50 (16.7)
|
123 (41.0)
|
127 (42.3)
|
30 (10.0)
|
100 (33.3)
|
170 (56.7)
|
39 (13.0)
|
115 (38.3)
|
146
(48.7)
|
0.008
|
Improving departmental image
|
54 (18.0)
|
131 (43.7)
|
115 (38.3)
|
40 (13.3)
|
113 (37.7)
|
147
(49.0)
|
35 (11.7)
|
111 (37.0)
|
154 (51.3)
|
0.012
|
A = Least Effective, B = No Opinion, C = Most Effective
α “using Chi square test”
Table 4 shows participants’ preferred methods of instruction in the CME activities during the past one year. The highest frequency of residents preferred that lectures should take place in the form of a conference/symposium (n = 111, 37%). For demonstration-type CME activities, residents preferred that it should take place in workshops (n = 119, 39.7%), while for hands-on practice, most residents preferred that it should take place in workshops (n = 162, 54%). Similarly, for small group CME seminar practice, the highest frequency of residents preferred workshops (n = 108, 36%). However, for live-case-presentation CMEs, residents equally preferred workshops and conferences (n = 88, 29.3%; 89, 29.7%, respectively), while for simulation CMEs, workshops were the preference of 40.7% (123) of the residents. For distance learning CMEs and electronic meeting CMEs, the highest frequency of residents preferred conferences (n = 119, 39.7%; n = 134, 44.7%, respectively).
Table 4: Residents’ preferred methods (n=300) of instruction in the CME activities during the past one year
Inter- Departmental Activities
N0. (%)
|
Courses
N0. (%)
|
Workshop
N0. (%)
|
Conference
/Symposium
N0. (%)
|
CME methods
|
77 (25.7)
|
60 (20.0)
|
52 (17.3)
|
111 (37.0)
|
Lecturing
|
24 (8.0)
|
60 (20.0)
|
119 (39.7)
|
97 (32.3)
|
Demonstration
|
39 (13.0)
|
49 (16.3)
|
162 (54.0)
|
50 (16.7)
|
Hands-on practice
|
72 (24.0)
|
68 (22.6)
|
108 (36.0)
|
52 (17.4)
|
Small group seminar
|
74 (24.7)
|
50 (16.7)
|
88 (29.3)
|
89 (29.7)
|
Live case presentation
|
66 (22.0)
|
55 (18.3)
|
123 (40.7)
|
57 (19.0)
|
Simulations
|
27 (9.0)
|
84 (28.0)
|
70 (23.3)
|
119 (39.7)
|
Distant learning
|
31 (10.3)
|
82 (27.3)
|
53 (17.7)
|
134 (44.7)
|
Electronic conferencing
|
Table 5 shows the frequency distribution of respondents by their preferred CME resources, frequency of CME activity, and reasons for using different CME activities and barriers. The most prevalent self-reading method was reading medical books (n = 230, 76.7%), followed by online websites for self-reading (n = 196, 65.3%). One out of each five residents reported reading medical journals, which was lower than the 30.3% who reported using social media for self-reading purposes. When asked how often they read, the highest frequency of residents (n = 128, 42.7%) reported weekly self-reading, compared to 116 (38.7%) who reported daily self-reading. The reasons for using self-reading as a CME method were ease of time management (n = 208, 69.3%), ease of place (n = 104, 34.7%), price (n = 54, 18%), subject (n = 86, 28.7%), and reputation of provider (n = 13, 4.3%). Barriers to self-reading were reported as being busy (n = 212, 70.7%), lack of interest (n = 31, 10.3%), lack of provision (n = 26, 8.7%), lack of suitability (n = 15, 5%), and high cost (n = 26, 8.7%).
Table 5: Distribution of residents by their preferred CME resources, frequency of CME activity, reasons to use different CME activities and barriers to attending CME
Variable
|
Self-Reading
N0. (%)
|
Attending Lectures & Seminars
N0. (%)
|
Attending Courses
N0. (%)
|
CME Resources
|
Medical books:
230 (76.7%)
Medical journals:
63 (21%)
Online websites:
196 (65.3%)
Social media:
91 (30.3%)
|
Conferences:
106 (35.3%)
Live casts:
74 (24.7%)
Presentations:
195 (65.0%)
Distance learning:
19 (6.3%)
Other methods:
13 (4.3%)
|
Training courses:
186 (62%)
Workshops:
115 (38.3%)
Group discussions:
83 (27.7%)
Others:
16 (5.3%)
|
Frequency
weekly
daily
monthly
rarely
|
128 (42.7%)
116 (38.7%)
37 (12.3%)
17 (5.7%)
|
130 (43.3%)
46 (15.3%)
88 (29.3%)
57 (19%)
|
66(22%)
23(7.7%)
81(27%)
134(44.7%)
|
Reason
time
place
price
subject
speaker certification
reputation of provider
|
208(69.3%)
104(34.7%)
54(18%)
86(28.7%)
--------------
13(4.3%)
|
125(41.7%)
134(44.7%)
37(12.3%)
49(16.3%)
26(8.7%)
14(4.7%)
|
122(40.7%)
112(37.3%)
39(13%)
73(24.3%)
36(12%)
23(7.7%)
|
Barriers
being busy
lack of interest
lack of provision
lack of availability
lack of suitability
high cost
|
212(70.7%)
31(10.3%)
26(8.7%)
NA
15(5.0%)
26(8.7%)
|
155(51.7%)
50(16.7%)
50(16.7)
67(22.3%)
18(6%)
37(12.3%)
|
124(41.3%)
36(12%)
87(29%)
101(33.7%)
15(5%)
46(15.3%)
|
Another method of CME was attending lectures and seminars, for which 106 residents (35.3%) reported attendance at conferences, 74 (24.7%) live casts, 195 (65.0%) presentations, and 19 (6.3%) used distance learning. In terms of the frequency of lectures and seminars for CME activities among residents, the highest frequency of residents (n = 130, 43.3%) reported weekly attendance, compared to 46 (15.3%) who reported daily use of lectures and seminars for CME needs. Also, 88 (29.3%) reported monthly attendance, while 57 (19%) reported rarely attending lectures or seminars. As for why they chose lectures and seminars as a CME method, time was reported by 125 residents (41.7%), place by 134 (44.7%), price by 37 (12.3%), subject by 49 (16.3%), speaker certification by 26 (8.7%), and the reputation of the provider by 14 (4.7%). Barriers to using lectures and seminars for CME activities as reported by residents were being busy by 155 (51.7%), lack of interest by 50 (16.7%), lack of provision by 50 (16.7%), lack of availability by 67 (22.3%), lack of suitability by 18 (6%), and high cost by 37 (12.3%).
Attending courses as a CME activity was reported by 186 (62%) residents, 115 (38.3%) residents reported attending workshops, while group discussions were reported by 83 (27.7%). In terms of the frequency of attending CME courses, the highest frequency of residents (n = 134, 44.7%) reported rare attendance, compared to 81 (27%) who reported monthly attending CME courses. However, 66 (22%) reported weekly attendance and 23 (7.7%) daily. In terms of the reason for choosing courses as a CME method, time was reported by 122 (40.7%), place by 112 (37.3%), price by 39 (13%), subject by 73 (24.3%), speaker certification by 36 (12%), and reputation of provider by 23 (7.7%). Barriers to attending courses were; being busy (n = 124, 41.3%), lack of interest (n = 36, 12%), lack of provision (n = 87, 29%), lack of availability (n = 101, 33.7%), lack of suitability (n = 15, 5%), and high cost (n = 46, 15.3%).
Figure 2 shows residents’ preferences regarding various aspects of CME activities. The preferred duration for CME activities for the majority of participating residents (n = 153, 51%) was one to two days, followed by 137 (45.7%) who preferred three to seven days. The majority (n = 194, 64.7%) preferred that CMEs should take place on a workday, compared to 106 (35.3%) who preferred a non-workday. Mornings were preferred by most participants (n = 216, 72%), with only 45 (15%) preferring afternoons and 43 (14.3%) evenings. Regarding method of evaluation, the highest frequency of residents (n = 135, 45%) preferred a questionnaire evaluation for CME activities, compared to 114 (38%) who preferred group discussion and 55 (18.3%) who preferred verbal assessment.