Total of 300 residents during year of 2018 academic year were participated in this study. Figure 1 presents the CME activity undertaken by the study participants in the past one 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. Note that residents usually engage in more than one modality of CME activities.
Table 1 represents that there were 176 (58.7%) males and 124 (41.3%) females among the participating residents, most of whom were Saudi (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 (29.7%) R1 residents; 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.
We analyzed the total satisfaction score by adding up the ordinal responses of residents by satisfaction score between 0 and 4. A considerable number of residents rated the CME activities they received last year as good (n = 101, 33.7%) or very good (n = 26, 8.7%), with 92 (30.7%) thinking it was fair and 78 (26%) believing it was poor. Only 3 (1%) rated it as excellent (data not shown). There was no significant association between gender and satisfaction with CME activities (p = 0.982), and the mean satisfaction score with CME was in male (21.17±5.310) and in female residents (21.032±5.847). Also, we found no significant association between nationality and satisfaction with CME activities (p = 0.924); the mean satisfaction with CME score was almost same in non-Saudi residents (21.18±5.456) and Saudi residents (21.02±5.541). Satisfaction with CME activities was variable across specialties (p = 0.039), such that psychiatry residents were far less satisfied than their restorative dentistry counterparts (p = 0.0046), as well as for general surgery residents (mean = 18.83, p = 0.0230), ophthalmology residents (mean = 19.09, p = 0.0301), pediatrics residents (mean = 19.39, p = 0.0214), and preventive medicine residents (mean = 19.21, p = 0.0283). The mean satisfaction with CME score for psychiatric residents was the lowest (16.00±5.37), and the highest was for restorative dentistry residents (26.00±1.83). There was no significant association between training level and satisfaction with CME activities (p = 0.54), and the mean satisfaction score with CME was slightly lower in R1 residents (20.27±4.85) than R4 residents (21.82±5.14). Similarly, age and years of experience did not show statistically significant associations with satisfaction score (p = 0.557 and 0.673, respectively)
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 3 describes the residents’ perceptions of the effectiveness of different CME activities. Regarding the effectiveness of CME activities, 141 (47%) residents agreed that conferences and symposia “improved their clinical practice outcomes” and “improved their academic/teaching skills.” Also, 184 (61.3%) of participants agreed that workshops and courses “improved their clinical skills” and 171 (57%) agreed that they also “improved their clinical practice outcomes.” For inter-departmental activities, 164 (54.7%) agreed that they “improved their academic/teaching skills” and 158 (52.7%) agreed they “improved their clinical practice.”
Table 4 shows participants’ preferred methods of instruction in the CME activities during the past one year. Most residents preferred that lectures should take the form of a conference/symposium (n = 111, 37%). For demonstration-type CME activities, residents preferred workshops (n = 119, 39.7%), while for hands-on practice, most residents preferred workshops (n = 162, 54%). Similarly, for small group CME practice, most 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 123 (40.7%) of the residents. For distance learning CMEs and electronic meeting CMEs, a majority of residents preferred conferences (n = 119, 39.7%; n = 134, 44.7%, respectively).
Table 5 presents the frequency distribution of respondents by their preferred CME resource, 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 in 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 majority (n = 128, 42.7%) of residents 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%).
Another method of CME was lectures and seminars, for which 106 (35.3%) reported attendance at conferences, 74 (24.7%) live casts, and 195 (65.0%) presentations, and 19 (6.3%) used distance learning and 13 (4.3%) used other methods for lectures and seminars. In terms of the frequency of lectures and seminars for CME activities among residents, the majority (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 (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 and 115 (38.3%) residents reported attending workshops, while group discussions were reported by 83 (27.7%) and 16 (5.3%) used other methods for courses. In terms of the frequency of attending CME courses, the majority (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 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%).
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. Only a minority preferred a month or three months (n = 2, 0.7%) or less than a day or more than a week (n = 1, 0.3%). 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. Most participants (n = 167, 55.7%) preferred that the duration of a CME activity should be limited to hours, 108 (36%) preferred that it should be limited to days, and 26 (8.7%) preferred a week limit for any CME activity. By method of evaluation, some (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.