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Challenges of Continuing Medical Education in Saudi Arabia's Hospitals

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Challenges of Continuing Medical Education in Saudi Arabia's Hospitals Challenges of Continuing Medical Education in Saudi Arabia’s hospitals Awatif M. Alghamdi BSc Health SER ADM. MSc Ed. D Thesis submission for the degree of Doctor of Philosophy, September 2012 Newcastle University School of Medical Sciences Education Development Declaration I, Awatif Alghamdi, declare that ‘Challenges of Continuing Medical Education in Saudi Arabia’s hospitals’ is my own work and that all the sources that used or quoted have been acknowledged by means of complete references and that this study has not been submitted before for any other degree at any other organization. Date: September/ 2012 i Table of Contents Table of Contents ............................................................................................. ii List of Figures ....................................................................................................v List of Tables .................................................................................................... vi Acknowledgements ......................................................................................viii Abstract ............................................................................................................... 1 Chapter 1 Orientation to the Study ............................................................ 4 1.1 Setting the scene ....................................................................................................... 4 1.2 Worthiness of the study .......................................................................................... 6 1.3 Objectives of the research project ........................................................................... 7 1.4 Overview of the methodologies ............................................................................. 8 1.5 Overview of the thesis ........................................................................................... 10 Chapter 2 Literature Review ...................................................................... 13 2.1 Introduction ............................................................................................................ 14 2.2 Production and classification of CME courses ................................................... 15 2.3 Common trends in CME worldwide ................................................................... 16 2.3.1 CME requirements: Obligation and re-certification ..................................16 2.4 Challenges for continuing medical education ................................................... 20 2.4.1 Forces challenging the culture of medical education ................................21 2.4.2 Future needs of medical education ..............................................................21 2.4.3 Pharmaceutical industry ................................................................................42 2.5 Summary ................................................................................................................. 55 Chapter 3 Health care System of Saudi Arabia ..................................... 57 3.1 History of health care............................................................................................. 57 3.2 Organisation and management of the health system ....................................... 58 3.3 Delivery of health services in Saudi Arabia ....................................................... 59 3.3.1 The main government sector (MOH) ...........................................................59 3.3.2 Other government sector ...............................................................................61 3.3.3 Private sector ...................................................................................................61 3.4 Financing health care ............................................................................................. 62 3.5 Challenges confronting the Saudi health care system ...................................... 65 3.5.1 Managerial challenges ....................................................................................66 3.5.2 Workforce .........................................................................................................68 3.6 Summary ................................................................................................................. 70 Chapter 4 Medical education in Saudi Arabia ....................................... 72 ii 4.1 Historical background of medical education ..................................................... 72 4.2 New medical universities ...................................................................................... 73 4.3 Evaluation of universities educational strategies .............................................. 74 4.3.1 Rapid increase in number of medical universities .....................................76 4.3.2 Global changes in curriculum and educational strategies ........................76 4.3.3 Medical teachers ..............................................................................................77 4.4 Postgraduate medical education .......................................................................... 78 4.5 Training and development of manpower ........................................................... 78 4.5.1 Continuing medical education ......................................................................79 4.5.2 Saudi commission for health specialities (SCHS) .......................................80 4.5.4 Medical societies .............................................................................................81 4.6 Challenges encounter continuing medical education ....................................... 82 4.6.1 Administrative .................................................................................................82 4.6.2 Workforce .........................................................................................................83 4.6.3 Learning resources ..........................................................................................85 4.7 Summary ................................................................................................................. 86 Chapter 5 Methodology .............................................................................. 87 5.1 Methodological approaches .................................................................................. 88 5.2 Ethnography ........................................................................................................... 91 5.3 Justification of methodology ................................................................................ 93 5.4 Research Design and Process................................................................................ 95 5.4.1 Research design ...............................................................................................95 5.4.2 Data collection ...............................................................................................100 5.5 Data analysis ......................................................................................................... 114 5.5.1 Analysing qualitative interviews ................................................................115 5.5.2 Analysing quantitative materials................................................................117 5.5.3 Final analytical process ................................................................................117 5.5.4 The final themes of the study ......................................................................119 5.5.5 Writing up the research ................................................................................120 5.6 Validity .................................................................................................................. 121 5.7 Reliability and generalisability ........................................................................... 122 5.8 Ethical principles .................................................................................................. 123 5.8.1 Anonymity, privacy and confidentiality ...................................................124 5.9 Summary ............................................................................................................... 125 Chapter 6 Management challenges ........................................................ 126 Introduction ..................................................................................................................... 126 6.1 Organisational structure of hospitals ................................................................ 126 6.2 Results of the survey ............................................................................................ 129 6.3 Obstacles of management and their impact on learning ................................ 130 iii 6.4 Summary ............................................................................................................... 139 Chapter 7 Budgetary restrictions ............................................................ 140 7.1 Information from the interviews ........................................................................ 140 7.1.1 Finance for learning programmes ..............................................................140 7.1.2 Alternative financial support for CME ......................................................142 7.1.3 What is the pay-off for such support for the pharmaceutical firms? ....148 7.2 Information from the questionnaire .................................................................. 151 7.3 Organising a
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