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Disincentives for Continuing Medical Education in health professions.

Continuing Medical Education (CME) is an important part of medical education. In all health professions, postgraduate education is not only limited in University careers but also includes all the updated knowledge and skills a medical doctor/ health professional needs to work efficiently.

The most frequent disincentives for continuing medical education are:

1. Financial barriers.

2. High- level CME education is not available in your country.

3. Evaluators, responsible for your first work position or for a promotion, do not take into account your CME activitiesthey prefer candidates based on "other qualifications" (corruption).

4. You are not allowed to put into practice new methods and techniques at your workplace.

5. You are tired from continuing education, you are not motivated enough, and even free participation wouldn't work.

1. Financial Barriers

A real problem is that postgraduate education is not offered for free. It currently consists of a luxurious industry involving conference organizers, tourism offices and hotel owners. The real continuing education is shrinking if you think that most congresses take place at majestic places, available for enjoyment of sight-seeing, shopping, tours, shows and dining out. Poor countries where medical doctors cannot even support the living needs of their family with their earnings, have a bigger problem.

2. High- level CME education is not available in your country

Quality of medical conferences varies. Sometimes you feel that someone is killing your valuable time, when you see that the speaker you pay to see does not appear at all, or seems to have forgotten everything about his/her lecture, or knows less than expected. If you are unlucky, you may have repeated bad congress experiences. Why lose your time for congresses of low quality?

On the other hand, internet offers you free downloading of high quality research papers, and you can study for many hours at your free time, if you wish to learn more things about new discoveries in your field. It is a very good educational strategy that some journals offer online CME tests to their readers, who can reply to answers and receive CME credits. This is the best offer given through the internet along with webinars. Also, interactive learning activities available online or in an electronic form as accompanying material of educational books belong to the best ways of continuing medical education (free or low cost method, available worldwide, not so useful for use in the curriculum vitae).

3. Evaluators, responsible for your first work position or for a promotion, do not take into account your CME activities- they prefer candidates based on "other qualifications" (corruption)

Continuing medical education is used as a means for the quality evaluation of medical doctors. A good doctor should "collect" congress certificates to prove that he is continuously taking part to educational activities inside his country and abroad. However, who tells us that doctors who carry many certificates have really been present during the educative part of the congress? And who confirms that they did not just pay the registration fees and just had fun in the non educative parts of the congress? Several limitations for attendants have been invented to face this problem at congresses. In my opinion, medical doctors should be re-evaluated with exams every 5-7 years, so that they can prove that their knowledge is updated and viable. However, as a general rule, certificates of attendance are accepted as qualifications that prove the updated knowledge.

The assessment of medical doctors varies from country to country. For example, in the National System of Health in Greece, many evaluators may give a 9.5/10 mark to a medical doctor who has attended one congress during the 5 past years, and give a 10/10 mark to a medical doctor who has attended 100 congresses during the same period! This makes many Greek doctors avoid medical congresses, because they think that congress certificates are useless for their evaluation, and find that high registration fees of congresses are absolutely a real loss of money. The wide problem of corruption among evaluators for appointments in Public Hospitals is a major disincentive for continuing medical education in Greece. The same equals for public Universities, too. Many career evaluators will overlook the value of CME certificates if the candidate is not supported by nepotistic and elitistic criteria. In general, if they want to push you back, your continuing medical education, whatever it is, won't count.

Life is not only Medicine. You have to take care of your family! You have your personal needs! So, if you wish to be educated for yourself only, to feel updated enough either you work in the public or private sector, then do it. However, if you believe that continuing medical education should simultaneously be taken into account by your career evaluators, then it is very probable that you will at some point stop watching new discoveries. Because you will be pushed back all the time, whatever your updated certificates will prove!

I cannot forget an incredible interview, given 1 year ago, by the Director of an Evaluation Committee for Public Hospital appointments in Thessaloniki, Greece. He said on TV that doctors who attend many congresses are insane and dangerous for the patients. And they should not be allowed to work at Hospitals because they may harm patients! This man was a medical doctor himself, and he had a very strange opinion about continuing medical education. However, he is still a powerful evaluator... If I were to be evaluated by him, I would be discouraged to pay 200-300 Euros per congress and submit congress certificates for my evaluation! This is a real disincentive, isn't it? The truth is, that all those certificates are welcome by evaluators like this man when the candidate is promoted and supported by nepotistic elites, otherwise such "papers" don't count anything.

4. You are not allowed to put into practice new methods and techniques at your workplace

A problem that may arise with newly learnt methods and techniques is that you may not be allowed to put them into practice because your supervisors are not aware of them. Especially for surgical techniques, it is ironic that you may learn many important and useful details that you will never perform in the operation room of your Hospital, because the Director of your Department does not give his permission. So, if you have spent a lot of money in order to attend a course for novel surgical techniques, and some months later you already forgot what you have been taught, it is very probable that your attitude will change in the future as far as continuing medical education is concerned!

5. You are tired from continuing education, you are not motivated enough, and even free participation wouldn't work

Although medical doctors in many countries do not have the economic power to attend luxurious CME activities, they are online for many hours a day and keep in touch with all the new discoveries in their field. Perhaps, if you feel that you have to use the internet for your education, because you cannot afford expensive books and registration fees for "celebrity instructors", you have a special motivation for learning.

In Archives: The International Journal of Medicine, Dr Pless et al (1), editor in Chief of the Injury Prevention journal, published the results of a wonderful experiment. He gave a free journal subscription to 220 physicians. They found a statistically significant increase in awareness of the journal itself among the experimental group and a decline in awareness among controls. Fewer respondents in both groups agreed with the statement "a journal addressing injury prevention would be useful." All other questions addressing attitudes and behavior change showed no significant changes. The authors concluded that "their findings provided little reason to believe that offering a free subscription to a journal was a promising avenue for changing the attitudes and behaviour of physicians towards injury prevention". He ends with this: "It is probable that for physicians treating patients in this age group, this conclusion also applies to other non-clinical topics and to many clinical topics".

It would be interesting to know what would happen if all congresses were offered for free: is money the most important factor or there are other more powerful disincentives that make medical doctors stay behind and not attend CME activities as they should? Ask yourself!


(1.) Pless B, Gore G, Magdalinos H. A Free Journal Subscription: An experiment in futility? Archives Inter J Med 2008; 1(2):62-66.

Irene Christodoulou

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Title Annotation:editorial
Author:Christodoulou, Irene
Publication:International Journal of Health Science
Date:Oct 1, 2009
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