Exploring Factors of Physicians' Preferences for Continuing Medical Education

Exploring Factors of Physicians' Preferences for Continuing Medical Education | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Exploring Factors of Physicians' Preferences for Continuing Medical Education Ruzica Nikolic Mandic, Vesna Bjegovic-Mikanovic, Zoran Bukumiric, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4272140/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Achieving sustainability in continuing medical education (CME) involves regular assessment of the evolving needs of healthcare professionals and updates in educational content accordingly. The aim of this study was to examine the topics physicians in Serbia consider the most important for their professional development and to analyze the factors associated with different domains of the competencies identified by the physicians Method This cross-sectional study was conducted among 2,625 physicians who are members of the medical chamber in Serbia. Besides similar studies, the Delphi process among medical experts served to create the research instruments, while obtained data were analyzed using factor analysis and robust regression analysis. Results The results pointed to a significant association between the scores in all identified domains (management, clinical practice, communication, public health, essentials and clinical emergency) and female gender. The score in the communication domain was additionally associated with work in privately owned institutions (B=0.563). The scores in the public health domain and the basic medical skills (essentials domain) were additionally associated with age (B=0.077 and B=0.100), work in a primary healthcare institution (B=2.327 and B=2.155) and being a specialist (B=-1.795 and B=-2.901). The score on the clinical emergency domain, besides the female gender, was associated with work in primary health care (B=0.748), being a specialist (B=-1.592) and being a subspecialist (B=-1.023). Conclusion Our results can serve as a guide for developing sustainable CMEs directed to different physician populations. Integrating sustainability into CME is an ongoing and collaborative effort which ensures that CME programs equip medical professionals with the necessary knowledge and skills to spearhead the transition towards a more sustainable healthcare system. Continuing medical education (CME) continuous professional development (CPD) competencies physicians healthcare workers Background The provision of sustainable healthcare requires healthcare professionals to improve their competencies continually. The importance of these requirements became more evident than ever during the COVID-19 pandemic [1]. Continuing medical education (CME) is commonly used to improve healthcare professionals' knowledge and skills [2]. Achieving sustainability in continuing education in medicine involves implementing practices that promote long-term effectiveness, relevance, and accessibility [3]. Sustainable efforts in CME development are also pointed out in the “Global Strategy on Human Resources for Health: Workforce 2030”, indicating the need for “a more sustainable and responsive skills mix, harnessing opportunities from the education and deployment” [2]. However, investment in health workforce education and training is lower than assumed, reducing sustainability of workforce globally. Although CMEs vary by country, they usually improve professional practice and help healthcare professionals achieve their goals [2, 4]. Modalities of conducting CMEs differ from traditional classroom-based lectures through different seminars or demonstrations to online-based educational programs [5]. The traditional idea behind the CME programs has been to keep healthcare professionals informed about the most recent developments in their field of practice [6]. One of the initial aims of CME programs was to improve the quality of healthcare provision and to align patients' expectations of healthcare and its delivery [6, 7]. Therefore, doctors and other professionals accept CME and development as a professional and ethical obligation that brings personal progress and benefits users, the patient and society as a whole [8]. Along with the benefits observed in improving the quality of the healthcare provision and performance of healthcare professionals, CME was shown to increase the levels of motivation, satisfaction and work commitment among healthcare professionals [9]. Additionally, healthcare professionals who regularly have and use CME opportunities are more likely to stay at their current place of work [2]. Importantly, while undergraduate medical education is structured, the physicians can choose the CME programs based on personal preferences and can navigate through the process balancing their daily duties and responsibilities, leading to different programs having higher or lower attendance based on the needs and even requests [10]. In Serbia, the CME was recognized as an important factor in improving healthcare quality and actual benefits for healthcare professionals. It is part of the licensing requirements for physicians at the national level. The movement for sustainable paths in CMEs was initiated in Serbia by implementing system laws in 2005. These laws, which included Health Care Law, Health Insurance Law, and Law on Health Professional Chambers, aimed to make CMEs an essential part of health system development. They made it mandatory for physicians, nurses, dentists, pharmacists, and biochemists to participate in CME programs as a prerequisite for re-licensing. According to the Law on Chambers of Health Workforce, re-licensing is required every seven years based on a pre-defined number of CME credits. To ensure high-quality CME, the Health Council of Serbia obtained a major role in national accreditation of CME training events in 2008. According to the Law on Health Care, the Health Council is the principal advisory body of the Ministry of Health for the long-term planning and development of strategic documents aligned with international health policies. Besides, the CMEs development follows the recommendations and experience of the European Association of Medical Specialists (UEMS). With the help of chambers, the Health Council reviews training events according to established criteria, including evidence-based background of the educational topic, specified target groups, objectives and outcome of training, before-after knowledge testing, and evaluation. Providers of the CME training events come from various institutions, including public and private health organisations, educational institutions, and governmental and non-governmental organizations. During the period from 2011 to 2020, the responsible institutions in Serbia, including the Ministry of Health, the Health Council of Serbia, and chambers of regulated health professions, invested much effort in stabilizing the system of CME [11]. In these efforts, developers or organizers of CMEs have to identify the significance of relevant topics to offer attendees the highest interest and most appropriate CMEs [12]. Based on evidence from numerous studies [13, 14], physicians need training to acquire competencies for quality improvement through "the combined and continuous efforts of health professionals, patients and their families, researchers, health insurers, planners, and educators to make changes that will lead to better outcomes for patients, better functioning of the system and better professional development" [15]. A European study on continuing education in primary health care showed many differences in content between European countries and different organizations within individual countries [16]. This is partly attributed to the absence of a widely accepted model that describes the competencies required of physicians to fully participate in improving the quality of health care [17]. According to contemporary authors, competency models can improve CME/CPD (Continuing Medical Education/Continuing Professional Development) in several ways [18]. A competency-based curriculum focuses attention on learning outcomes and how they improve the work of physicians and healthcare workers rather than focusing solely on the acquisition of knowledge (as is often the case with traditional education programs). A framework of specific competencies can provide a basis for self-assessment to help individual physicians and other health care professionals identify their training needs, and can also provide a model of organizational structure to guide the development and evaluation of educational programs [19]. A recent review of the literature showed that there are currently no comprehensive models for developing competencies through CME/CPD systems [20, 21]. For example, a model from the United States [22] identified the main aspects of health care quality and patient safety, efficiency, patient-centeredness, timeliness, efficiency and equity - and these are included in continuing education for improving the quality of health care. The Canadian Educational Framework for Medicine (CanMeds), which was developed primarily for doctors in residency and then adopted for undergraduate students, includes six groups of competencies: the development of a medical expert, communicator, collaborator, manager, health advocate, scientist and professional [23]. In the field of CME, Greiner and co-authors [24] defined five core competency groups for healthcare professionals: providing healthcare to the patient, working in interdisciplinary teams, using evidence-based practice, implementing quality improvement, and using informatics. However, this Greiner model and other models do not recognize competencies related to ethics and professionalism. The Bellagio model [25] presents nine essential groups of competencies for the provision of effective health care: leadership, public trust (accountability and transparency), population-oriented management, vertical and horizontal integration, networking of professionals, infrastructure, mix of payments for health services, standardized measurement and active involvement of patients. This approach provides a comprehensive competency model for providing quality health care. Also noted are the set of competencies necessary for the American Board of Medical Specialties (ABMS) CME/CPD system: patient care, medical knowledge, interpersonal and communication skills, professionalism, systemic practice, and practice-based learning and improvement. The same competencies were also adopted for undergraduate students [26]. These frameworks form the initial basis of training for most health workers in the Western world. There are studies in the literature devoted to the competencies of pharmacists only, among all healthcare workers in Serbia [27, 28]. In Serbia and the countries of Southeastern Europe, there has been no combined research on the competencies necessary for post-graduate training of physicians so far. Examining the factors associated with the potential involvement of physicians in CME, their needs, and their experiences with the CMEs attended previously can, therefore, significantly improve the curricula of CMEs and adapt the topics and modalities to the actual needs of physicians. The aim of this study was to examine the topics physicians in Serbia consider the most important for their professional development and to analyze the factors associated with different domains of the competencies identified by the physicians. Methods The study was conducted as a cross-sectional study in two steps: 1) the development of a set of necessary and appropriate competencies for the continuing professional development of physicians by establishing a consensus of experts based on the Delphi process, and 2) the examination of competencies for continuous professional development of physicians, factors that determine them and expectations from continuous education through a cross-sectional study and a questionnaire as a research instrument. Developing a set of necessary and appropriate competencies The first step included developing the set of necessary and adequate competencies for the CMEs of physicians in Serbia through the Delphi process to generate consensus. Three rounds of the Delphi process were conducted to evaluate groups (clusters, domains) of competencies and make changes in the initial framework of the competencies draft. The panel members, 35 experts in different fields of medicine, were members of the program councils of the CME Centers of all five medical faculties in the Republic of Serbia (Belgrade, Kragujevac, Niš, Kosovska Mitrovica and Novi Sad). Consensus development panels provided agreement in areas characterized by uncertainty or lack of definitive information. Also, consensus development panels helped bringing experts together to comment on and develop research instruments and techniques directly. The initial questionnaire was created based on a questionnaire in a previous study that aimed to examine and understand the needs of physicians in different aspects of CME [29]. In the first round of the Delhi process, the list of 53 competencies was provided to the panel members, who rated all listed competencies and could add competencies they considered important and not listed. In the following iteration, all initial competencies with scores above 5 were listed, along with the competencies added by the panel members in the first step to rate them again. This round was then repeated, and all the competencies with a median rating of 5 or more were included in the instrument for the quantitative analyses. The final list was created based on the opinion of experts (75% and more agreement), factor analysis and mutual connection (correlation) of individual competencies. Examining competencies for continuing professional development of physicians The second step included distributing the questionnaire developed through the Delphi process in the first step and validated through a pilot study (around 50 respondents). The study population included all physicians in Serbia with a license to practice medicine, meaning all members of the Serbian Medical Chamber. Serbian Medical Chamber is the only licensing institution in Serbia for physicians, and a license issued by the Serbian Medical Chamber is necessary for medical practice [30–32]. The questionnaire consisted of five sections: 1) demographic characteristics of the respondents, 2) their needs for continuing medical education (CME), competencies that participants considered as important to be covered by the CME program, 3) topics that should be covered with the CME program, 4) type of education program and learning environment, and 5) attitudes and opinions on CME. The first section of the questionnaire regarded the demographic characteristics of the respondents (age, sex – male/female), the type of healthcare institution where they work (University, clinical centre, clinical-hospital centre, general hospital, primary healthcare institutions, non-governmental organization, or other institution), work in private or state sector or both, and academic education (specialization, fellowship/ master or doctoral degree). The second section referred to competencies that participants consider necessary for daily work. The participants were asked to rate each competency on a scale from 1- of little importance to 7- of very high importance. The third section of the research instrument referred to topics that participants considered important for CPDs. The participants were asked to rate each offered topic on a scale from 1- of little importance to 7- of very high importance. The fourth section referred to organizers, modalities of courses (live educational events, online educational events, or e-learning materials, blended learning events), days in which the courses should be organized. All items are given on a seven-point scale from 1- completely disagree to 7- completely agree. The final section referred to the practices regarding regular attendance of CPD programs, assessment of needs for CPD programs, types of programs, and modalities of programs. All items were given on a seven-point scale, and the participants were asked to rate each item from 1- not interested at all to 7- completely interested. The questionnaire was distributed through the mailing list of the Serbian Medical Chamber as an online questionnaire, and the filling-in was open for 30 days. The population of 27,029 physicians was contacted through email, and 2,625 physicians filled in questionnaires (the population response rate was 9.7%). All the participants were given written explanations about the study, its processes, and aims and were asked to fill in the online questionnaire. We considered that all participants who completed the questionnaire and submitted it consented to participate in the research. The Ethical Committee of the Faculty of Medicine, University of Belgrade, approved the study (the decision of the Ethical Committee No 1322/V-9). Statistical analysis All listed competencies were classified into six domains: management, clinical practice, communication, public health, essential, and clinical emergency (Suppl 1). The classification was conducted using triangulation of the results from the exploratory factor analyses, correlation coefficients between different competencies, and the concept of each competency. The concept of competencies was based on previous studies [29, 33, 34]. For all the domains, the ratings were computed to obtain the total score for each domain. A total of 12 variables were analyzed: the dependent variables were scores on each domain (management, clinical practice, communication, public health, essential and clinical emergency). The independent variables were sex, age, type of health care institution the participants worked in (hospital, institute, primary health care), institutional ownership (public, private, or both public and private), highest professional degree (medical doctor, specialist, subspecialist), highest academic degree (medical doctor, Magister or PhD level). Statistical analyses involved descriptive and analytical methods. Normality was examined using the Kolmogorov-Smirnov test. Robust regression analyses served to examine the association between the potential factors associated with each dependent numerical variable without normal distribution (scores on examined domains: management, clinical practice, communication, public health, essential and clinical emergency). All analyses were done using the R statistical package (v4.2.2). Results The study included 2,625 physicians in Serbia. The average age of the participants was 44.5±11.5 years. Most of the participants were females (1,845-70.3%), specialists (1,204-45.9%), and a quarter of the participants had a PhD as the highest scientific degree (656-25.0%). More than half reported working in hospitals (1,397-54.8%), and more than two-thirds worked in publicly owned institutions (2,022-77.0%). The characteristics of the participants are presented in Table 1. Table 1 Out of 74 listed competencies, rated between 1 and 7, the majority had the median 7, indicating high importance (40 out of 74 competencies). Physicians rated the management domain as the highest (with a median of 106), followed by the domain of essential competencies (with a median of 90) and the public health domain (with a median of 80). They assessed clinical practice and clinical emergency domains with medians above 50 (59 and 52, respectively), while the communication domain gained the least importance (with a median of 40) (Table 2). Table 2 Table 3 presents factors of higher scores of preferred competencies for inclusion in future CMEs, obtained by the robust regression analysis. There was a significant association between sex and all competencies domains. Female physicians appreciate more than males all competencies grouped in management (B=3.535, p<0.001), clinical practice (B=1.182, p<0.001), communication (B=0.830, p<0.001), public health (B=2.801, p<0.001), essentials (B=3.361, p<0.001), and clinical emergency domains (B=1.601, p<0.001). The higher age of physicians correlates with higher preferences related to scores in the public health domain (B=0.077, p=0.045) and the domain of essential competencies (B=0.100, p=0.011). Regarding the highest professional degree, the results pointed that those physicians with specialisation judged as less important competencies in public health (-1.795, p=0.046), group of essentials competencies (-2.901 p=0.002|) and clinical emergency domain (-1.592, p<0.01). Also, physicians having subspecialisation less appreciate clinical emergency domain (-2.023, p=0,037). There were no significant predictors related to academic degrees (physicians with master's or PhD levels in addition to the basic integrated study of medicine). Physicians who work in primary healthcare institutions appreciate more the public health domain (B=2.327, p=0.002), essential group of competencies (2.155, p=00.5) and clinical emergency (0.748, p=0.002). Regarding the sector in which physicians work, the only significant correlation was found with those working in the private sector who prefer more competencies grouped in the communication domain (0.563, p=0.005). Table 3 Discussion The need for sustainable paths in learning, renewing and improving the knowledge and skills of health professionals is today conditioned by the intensive development of science and evidence-based health services, constant changes in the health sector with the application of digital technologies, but also demographic challenges, accelerated development of social relations and increased burden of diseases and injuries [34, 35]. Continuing professional development in medicine, public health and other fields enables the realization of personal, professional and scientific potential, and it is also an individual process that should be complementary to collective perspectives. Therefore, physicians and other health professionals accept CME as a professional and ethical obligation that brings personal progress and benefits users, patients and society as a whole. In this context, induction CME programs attract particular interest in improving learning outcomes among trainees with different backgrounds and expectations [36]. Our study aimed to examine which competencies the physicians in Serbia consider the most important to be included in the CMEs and the factors associated with recognising different competencies ‘domains. In preparing this research, we conducted three rounds of the Delphi method, and the experts, who were members of program councils of the CME centres at every University in Serbia, reached a consensus on the necessary competencies. Based on defined competencies, the questionnaires were distributed through the Serbian Medical Chamber mailing list with an acceptable response rate among more than 500 participants [37, 38]. Interestingly, more than half of the listed competencies were rated with a maximum of 7, possibly indicating that the participants in the Delphi method understood the importance of sustainable learning and defined different competencies applicable in physicians’ everyday work that continuously needs improvement. Six groups of competency domains for physicians in our study embrace clinical medicine, public health and managerial skills. Several authors obtained similar results, slightly different (in the number of domains and their wording) but also oriented to clinical practice, system thinking, communication and management [23-26]. The self-assessed needs are associated with the areas each of the physicians considers as the areas that require improvement, which may not correlate with their level of skills [10]. Our analyses showed the association of scores in every domain and female sex. One notable characteristic of medical doctors in Serbia is the significantly higher percentage of women among employed medical doctors compared to men (68% vs. 32%) [39]. Some other authors found additional relations between female physicians and career advancement [40, 41]. Also, working in privately owned institutions was positively associated with the score in the communication domain, probably due to the need for better patient-physician communication and higher requirements for higher levels of patient satisfaction in privately owned institutions [42-44]. Regarding the public health domain of competencies besides the female sex, age was positively associated and the work in primary health care institutions. As the competencies classified as 'public health' in our study included the competencies necessary for the adequate conduction of health education, lifestyle improvement, and behavioral change techniques, the physicians at the primary health care level may have recognized all these competencies as valuable as they are part of capitation formula and can influence the physicians' salary. Another factor that may have influenced the association of the work at the primary health care level and the score on public health domain was the recognition of the need for improvements in vaccination uptake, physical inactivity, poor diet, and the need for promotion of smoking cessation among the general population which are all considered as public health issues [45]. In Serbia, due to the high prevalence of risk behaviour in the population [39], physicians in primary health care have pointed to the need for strong competencies in the domain of public health. On the other hand, being a specialist was negatively associated with the score in the public health domain, which may also be because most of the public health issues are faced at the primary healthcare level. Specialists are commonly focused on specific skills and illnesses and rely on primary health care to deal with their patients' common poor lifestyle choices. Similar results were obtained for the domain of essential medical knowledge. Again, physicians at the primary health care level are often forced to work in many disciplines, while the specialists working in larger institutions may see the competencies within essential medical knowledge as necessary for other professionals in their team. These results align entirely with the results obtained with clinical emergency domain. Again, primary healthcare physicians may need competencies to deal with emergencies independently; specialists and subspecialists usually work in larger institutions and feel that they can rely on colleagues from other medical areas in emergencies [46]. To confirm these associations, we also conducted sensitivity analyses with different classifications of domains, in accordance with the recommendations of the Institute of Medicine Core Competencies and only related to the concept of the competencies, and we obtained almost identical results [22]. Our study has a few possible limitations. The first is in the Delphi process organization, as this has led us to obtain a higher number of competencies considered important than the initial list. However, this has enabled us to analyze the numerous competencies possible thoroughly. Additionally, the large sample enabled the recognition of all these competencies as relevant. The association of the different domains with the female sex and especially work in different institutions at different levels can successfully guide the development of CME programs directed to different physician populations. Conclusion CME and sustainability might seem like unlikely partners, but their connection is becoming increasingly crucial as CME can be a powerful tool for promoting sustainability in healthcare. Healthcare has a significant environmental footprint, and educated medical professionals are vital in mitigating it. Our results can serve as a guide for developing sustainable CMEs directed to different physician populations. Integrating sustainability into CME is an ongoing process that requires collaboration among CME providers, medical institutions, policymakers, and healthcare professionals. By working together, they ensure that CME equips medical professionals with the knowledge and skills to lead the way towards a more sustainable healthcare system. Abbreviations CME Continuing Medical Education CPD Continuing Professional Development Declarations Acknowledgements We would like to thank all participating experts and members of Continuing Education Centers at faculties of medicine in Serbia (Belgrade, Novi Sad, Nis, Kragujevac, Kosovska Mitrovica) for providing their answers in the Delphi process. This study was supported by the Faculty of Medicine, University of Belgrade (No 451-03-66/2024-03/200110 / year 2024). Author contributions Conceptualization, R.N.M. and V.B.M.; methodology, V.B.M. and Z.B.; software, Z.B.; validation, R.N.M., Z.T.S., J.T., S.G. and D.N.; formal analysis, R.N.M., V.B.M. and Z.B.; investigation, R.N.M.; data curation, R.N.M., Z.T.S., J.T., S.G. and D.N.; writing—original draft preparation, R.N.M. and V.B.M.; writing—review and editing, V.B.M.; visualization, R.N.M.; supervision, U.L. All authors have read and agreed to the published version of the manuscript. Funding This research received no external funding. Data availability The research data presented in this study are available on request from the corresponding author, V.B.M. Ethics approval and consent to participate The study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Faculty of Medicine, the University of Belgrade (protocol code No 1322/V-9).Informed consent was obtained from all participants involved in the study. Consent for publication Not applicable Competing interests The authors declare no competing interests. References Puradiredja DI, Kintu-Sempa L, Eyber C, Weigel R, Broucker B, Lindkvist M, et al. Adapting teaching and learning in times of COVID-19: a comparative assessment among higher education institutions in a global health network in 2020. BMC Med Educ. 2022; 22 (1): 507-519. https://doi.org/10.1186/s12909-022-03568-4 Global strategy on human resources for health: Workforce 2030; WHO Document Production Services: Geneva, Switzerland, 2016. Available from: https://www.who.int/publications/i/item/9789241511131 Cervero RM, Gaines JK. Effectiveness of Continuing Medical Education: Updated synthesis of systematic reviews. Accreditation Council for Continuing Medical Education: Chicago, IL, USA, 2014. Available from: https://www.accme.org/sites/default/files/652_20141104_Effectiveness_of_Continuing_Medical_Education_Cervero_and_Gaines.pdf de Andrade F, Griebenow R, Costello RW, Guenova M, Schaefer R, Chalmers JD et al. The future of accreditation of continuing medical education (CME)-continuing professional development (CPD) in Europe: harmonisation through dialogue and consensus. J Eur C. 2018; 7(1):1506202. https://doi.org/1080/21614083.2018.1506202 Merry L, Castiglione SA, Rouleau G, Létourneau D, Larue C, Deschênes M-F, et al. Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review. BMC Med Educ. 2023;23(1):498. https://doi.org/10.1186/s12909-023-04427-6 Balmer JT. The transformation of continuing medical education (CME) in the United States. Adv Med Educ Pract. 2013; 4: 171–82. https://doi.org/2147/AMEP.S35087 Cerenzia W, Janowiak D, Castles R, Triebel A, Williams S, Becker M. Outcomes in CME/CPD - Special Collection Standardising Outcomes Assessment: Demonstrating the Power of Comparative Outcomes Data. J Eur CME. 2020; 9(1): 1832797. https://doi.org/1080/21614083.2020.1832797 Shah MD, Goyal V, Singh V. Lele J. Preferences and attitudes of physicians in India towards continuing medical education. J Eur CME. 2017; 6(1):1332940. https://doi.org/1080/21614083.2017.1332940 Reis T, Faria I, Serra H, Xavier M. Barriers and facilitators to implementing a continuing medical education intervention in a primary health care setting. BMC Health Serv Res. 2022; 22: 638. https://doi.org/1186/s12913-022-08019-w McAdams CD, McNally MM. Continuing Medical Education and Lifelong Learning. Surg Clin North Am. 2021; 101(4): 703–15. https://doi.org/10.1016/j.suc.2021.05.015 Nikolić-Mandić R, Bjegović-Mikanović V, Wenzel H, Lalić N, Laaser U, Nešić D. A standstill of the continuing medical education in Serbia 2011–2017. Srp Arh Celok Lek. 2021; 149(5-6): 334-342. https://doi.org/10.2298/SARH210107041N Sturesson Stabel LS, McGrath C, Björck E, Elmberger A, Bolander Laksov K. Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners’ Continued Professional Development. Vocations and Learning. 2022;15 (3): 427-448. https://doi.org/10.1007/s12186-022-09295-7 Dzara K, Pusic M, Carlile N, Krupat E, Alexander EK. Educational adaptation to clinical training during the COVID-19 pandemic: a process analysis. BMC Med Educ. 2022;22(1):200. https://doi.org/10.1186/s12909-022-03237-6 Merry L, Castiglione SA, Rouleau G, Létourneau D, Larue C, Deschênes M-F, et al. Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review. BMC Med Educ. 2023;23(1):498. https://doi.org/10.1186/s12909-023-04427-6 McLees AW, Nawaz S, Thomas C, Young A. Defining and assessing quality improvement outcomes: a framework for public health. Am J Public Health. 2015; 105 (Suppl 2): S167-73. https://doi.org/10.2105/AJPH.2014.302533 Klemenc-Ketis Z, Vanden Bussche P, Rochefort A, Emaus C, Eriksson T, Kersnik J. Teaching quality improvement in family medicine. Educ Prim Care. 2012. 23:378–381. https://doi.org/10.1080/14739879.2012.11494147 ILO; OECD; WHO. Five-Year action plan for health employment and inclusive economic growth (2017–21). WHO Document Production Services: Geneva, Switzerland, 2017. Available from: https://iris.who.int/bitstream/handle/10665/272941/9789241514149-eng.pdf Griebenow R, Campbell C, McMahon GT, Reigner K, Gordon J, Pozniak E, et al. Roles and Responsibilities in the Provision of Accredited Continuing Medical Education/ Continuing Professional Development. J Eur CME. 2017; 6 (1):1314416. https://doi.org/10.1080/21614083.2017.1314416 Filipe HP, Mack HG, Golnik KC. Continuing professional development: Progress beyond continuing medical education. Ann Eye Sci. 2017;2(7). Allen T, Donde N, Hofstädter-Thalmann E, Keijser S, Moy V, Murama JJ, et al. Framework for industry engagement and quality principles for industry-provided medical education in Europe. J Eur CME. 2017; 6(1):1348876. https://doi.org/10.1080/21614083.2017.1348876 Patterson F, Roberts C, Hanson MD, Hampe W, Eva K, Ponnamperuma G, et al. 2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions. Med Teach. 2018;40(11):1091–101. https://doi.org/1080/0142159X.2018.1498589 Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. PMID: 25057539. Frank JR, ed. The Can MEDS 2005 Physician Competency Framework. Better standards. Better physicians. Better care. Ottawa (Ontario): Royal College of Physicians and Surgeons of Canada; 2005. Greiner AC, Knebel E, eds. Health Professions Education: A Bridge to Quality. Washington (DC): Institute of Medicine (US); 2003. Schlettes S, Lisac M, Wagner E, Gensichen J. The Bellagio Model: Population-Oriented Primary Care. Z Evid Fortbild Qual Gesundhwes. 2009; 103(7): 467-74. https://doi.org/10.1016/j.zefq.2009.06.006 American Board of Medical Specialties. Standards for Continuing Certification. Available from: https://www.abms.org/board-certification/board-certification-standards/standards-for-continuing-certification/ Stojkov-Rudinski S, Tadić I, Crnjanski T, Krajnović D. Analysis, adaptation and validation of the instrument for the competence evaluation of the pharmacists in community pharmacies. Arhiv za farmaciju. 2012; 62(3): 208-218. Stojkov s, Tadic I, Crnjanski T, Krajnovic D, Bates I. Evaluation of competences at the community pharmacy settings. Indian J Pharm Educ Res. 2014; 48 (4):22–30. Maher B, Faruqui A, Horgan M, Bergin C, Tuathaigh CO, Bennett D. Continuing professional development and Irish hospital doctors: a survey of current use and future needs. Clin Med. 2017; 17(4): 307–15. https://doi.org/10.7861/clinmedicine.17-4-307 Healthcare Law (Zakon o zdravstvenoj zaštiti) Official Gazette RS, 25/2019 and 92/2023. Available from: https://www.paragraf.rs/propisi/zakon_o_zdravstvenoj_zastiti.html Rulebook on closer conditions for the implementation of continuing education for healthcare workers and healthcare associates (Pravilnik o bližim uslovima za sprovođenje kontinuirane edukacije za zdravstvene radnike i zdravstvene saradnike), Official Gazzete RS 17/2022. Available from: https://www.paragraf.rs/propisi/pravilnik_o_blizim_uslovima_za_sprovodjenje_kontinuirane_edukacije_za_zdravstvene_radnike_i_zdravstvene_saradnike.html Rulebook on detailed conditions for issuing, renewing or revoking licenses to members of health workers' chambers (Pravilnik o bližim uslovima za izdavanje, obnavljanje ili oduzimanje licence članovima komora zdravstvenih radnika), Official Gazete RS 76/2022. Available from: https://www.paragraf.rs/propisi/pravilnik_o_blizim_uslovima_za_izdavanje_obnavljanje_ili_oduzimanje_licence.html Timmerberg JF, Krosschell KJ, Dunaway Young S, Uher D, Yun C, Montes J. Essential competencies for physical therapist managing individuals with spinal muscular atrophy: A delphi study. PLoS One. 2021; 16(4): e0249279. https://doi.org/10.1371/journal.pone.0249279 Kriston L, Hahlweg P, Harter M, Scholl I. A skills network approach to physicians’ competence in shared decision making. Health Expect. 2020; 23: 1466–1476. https://doi.org/10.1111/hex.13130 Dascalu CG, Antohe ME, Topoliceanu C, Purcarea VL. Medicine Students’ Opinions Post-COVID-19 Regarding Online Learning in Association with Their Preferences as Internet Consumers. MDPI sustainability. 2023; 15: 3549. https://doi.org/3390/su15043549 Gambhir N, Gangadharan A, Pope L. Knowing me, knowing you: evaluation of the impact of trainer involvement at an enhanced induction programme for International Medical Graduates (IMGs). Educ Prim Care. 2024; 13: 1-6. https://doi.org/1080/14739879.2023.2297670 Wu MJ, Zhao K, Fils-Aime F. Response rates of online surveys in published research: A meta-analysis. Comput Hum Behav Reports. 2022; 7: 100206. https://doi.org/1016/j.chbr.2022.100206 Parekh N, Savage S, Helwig A, Alger P, Metes ID, McAnallen S, et al. Physician satisfaction with health plans: results from a national survey. Am J Manag Care. 2019; 25(7): e211–e218. PMID: 31318512 Statistical Office of the Republic of Serbia. The 2019 Serbian National Health Survey; Statistical Office of the Republic of Serbia and Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”: Belgrade, Serbia, 2021. Pp: 1–137. Available from: https://publikacije.stat.gov.rs/G2021/pdfE/G20216003.pdf Mukkamala S, Rodrigues Armijo P, Flores L, Shillcutt SK. Positive association of a women’s continuing medical education conference on career advancement and promotion. Med Educ Online. 2021; 26(1): 1981127. https://doi.org/10.1080/10872981.2021.1981127 Ngai J, Capdeville M, Sumler M, Oakes D. A Call for Diversity: Women, Professional Development, and Work Experience in Cardiothoracic Anesthesiology. J Cardiothorac Vasc Anesth. 2023; 37(6): 870-880. https://doi.org/10.1053/j.jvca.2022.12.002 Jayas A, Andriole DA, Grbic D, Hu X, Dill M, Howley LD. Physicians' continuing medical education activities and satisfaction with their ability to stay current in medical information and practice: A cross-sectional study. Health Sci Rep. 2023; 6(2): e1110. https://doi.org/10.1002/hsr2.1110 Kwateng KO, Lumor R, Acheampong FO. Service quality in public and private hospitals: A comparative study on patient satisfaction. Int J Healthc Manag. 2019; 12 (4): 251-258. https://doi.org/10.1080/20479700.2017.1390183 Andersson T, Eriksson N, Müllern T. Patients' perceptions of quality in Swedish primary care – a study of differences between private and public ownership. J Health Organ Manag. 2021; 35(9): 85-100. https://doi.org/10.1108/JHOM-09-2020-0357 Valaitis RK, O’Mara L, Wong ST, MacDonald M, Murray N, Martin-Misener R, et al. Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors. Prim Health Care Res Dev. 2018;19(4):378–91. Pannick S, Davis R, Ashrafian H, Byrne BE, Beveridge I, Athanasiou T, et al. Effects of Interdisciplinary Team Care Interventions on General Medical Wards. A Systematic Review. JAMA Intern Med. 2015; 175(8):1288-1298. https://doi.org/10.1001/jamainternmed.2015.2421 Tables Tables 1-3 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Table3.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4272140","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":291999519,"identity":"51272f3e-448e-407c-9023-c26adaf78720","order_by":0,"name":"Ruzica Nikolic Mandic","email":"","orcid":"","institution":"University of Belgrade","correspondingAuthor":false,"prefix":"","firstName":"Ruzica","middleName":"Nikolic","lastName":"Mandic","suffix":""},{"id":291999520,"identity":"b4d2c9d6-8631-437d-b0db-8f9e61cd7578","order_by":1,"name":"Vesna Bjegovic-Mikanovic","email":"data:image/png;base64,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","orcid":"","institution":"University of Belgrade","correspondingAuthor":true,"prefix":"","firstName":"Vesna","middleName":"","lastName":"Bjegovic-Mikanovic","suffix":""},{"id":291999521,"identity":"d1fc41a1-77c2-43f7-926c-cfc208f9d752","order_by":2,"name":"Zoran Bukumiric","email":"","orcid":"","institution":"University of Belgrade","correspondingAuthor":false,"prefix":"","firstName":"Zoran","middleName":"","lastName":"Bukumiric","suffix":""},{"id":291999522,"identity":"7606e98d-03ef-47c6-9fca-d1e02ff4129e","order_by":3,"name":"Zorica Terzic-Supic","email":"","orcid":"","institution":"University of Belgrade","correspondingAuthor":false,"prefix":"","firstName":"Zorica","middleName":"","lastName":"Terzic-Supic","suffix":""},{"id":291999523,"identity":"2de665ee-99bf-4098-8581-b0a574169003","order_by":4,"name":"Jovana Todorovic","email":"","orcid":"","institution":"University of Belgrade","correspondingAuthor":false,"prefix":"","firstName":"Jovana","middleName":"","lastName":"Todorovic","suffix":""},{"id":291999524,"identity":"ec9223b4-d7d5-4653-970c-f8afcdb6d9ce","order_by":5,"name":"Sandra Grujicic","email":"","orcid":"","institution":"University of Belgrade","correspondingAuthor":false,"prefix":"","firstName":"Sandra","middleName":"","lastName":"Grujicic","suffix":""},{"id":291999525,"identity":"194640da-4c66-444c-8f16-9b7e8756f9e8","order_by":6,"name":"Dejan Nesic","email":"","orcid":"","institution":"University of Belgrade","correspondingAuthor":false,"prefix":"","firstName":"Dejan","middleName":"","lastName":"Nesic","suffix":""},{"id":291999526,"identity":"c989dd48-0115-4278-8f60-5a67fc6edf3c","order_by":7,"name":"Ulrich Laaser","email":"","orcid":"","institution":"Bielefeld University","correspondingAuthor":false,"prefix":"","firstName":"Ulrich","middleName":"","lastName":"Laaser","suffix":""}],"badges":[],"createdAt":"2024-04-15 23:44:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4272140/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4272140/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":61201884,"identity":"32140bce-695e-4603-b619-fa97dfef94a2","added_by":"auto","created_at":"2024-07-27 02:46:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":287677,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4272140/v1/4ec74d10-5134-4335-b326-88d15f12f2f2.pdf"},{"id":55014423,"identity":"92230681-fda9-4895-90e1-a494586ad213","added_by":"auto","created_at":"2024-04-19 21:41:00","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":20887,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4272140/v1/0642e1508da86074ea0c9143.docx"},{"id":55014422,"identity":"f96434f6-d9fe-4e1d-a02c-f55a3030107b","added_by":"auto","created_at":"2024-04-19 21:41:00","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":28177,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-4272140/v1/1b4328044ad70601a2d8cec9.docx"},{"id":55014518,"identity":"b7a9dc66-6826-4672-a0a8-ada1ed61a48e","added_by":"auto","created_at":"2024-04-19 21:49:00","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":24825,"visible":true,"origin":"","legend":"","description":"","filename":"Table3.docx","url":"https://assets-eu.researchsquare.com/files/rs-4272140/v1/e3ce82c2d8e288070438af0e.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring Factors of Physicians' Preferences for Continuing Medical Education","fulltext":[{"header":"Background","content":"\u003cp\u003eThe provision of sustainable healthcare requires healthcare professionals to improve their competencies continually. The importance of these requirements became more evident than ever during the COVID-19 pandemic [1]. Continuing medical education (CME) is commonly used to improve healthcare professionals\u0026apos; knowledge and skills [2]. Achieving sustainability in continuing education in medicine involves implementing practices that promote long-term effectiveness, relevance, and accessibility [3]. Sustainable efforts in CME development are also pointed out in the \u0026ldquo;Global Strategy on Human Resources for Health: Workforce 2030\u0026rdquo;, indicating the need for \u0026ldquo;a more sustainable and responsive skills mix, harnessing opportunities from the education and deployment\u0026rdquo; [2]. However, investment in health workforce education and training is lower than assumed,\u0026nbsp;reducing sustainability of workforce globally.\u003c/p\u003e\n\u003cp\u003eAlthough CMEs vary by country, they usually improve professional practice and help healthcare professionals achieve their goals [2, 4]. Modalities of conducting CMEs differ from traditional classroom-based lectures through different seminars or demonstrations to online-based educational programs [5]. The traditional idea behind the CME programs has been to keep healthcare professionals informed about the most recent developments in their field of practice [6].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOne of the initial aims of CME programs was to improve the quality of healthcare provision and to align patients\u0026apos; expectations\u0026nbsp;of\u0026nbsp;healthcare and its delivery [6, 7]. Therefore, doctors and other professionals accept CME and development as a professional and ethical obligation that brings personal progress and benefits users, the patient and society as a whole [8].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlong with the benefits observed in improving the quality of the healthcare provision and performance of healthcare professionals, CME was shown to increase the levels of motivation, satisfaction and work commitment among healthcare professionals [9]. Additionally, healthcare professionals who regularly have and use CME opportunities are more likely to stay at their current place of work [2]. Importantly, while undergraduate medical education is structured, the physicians can choose the CME programs based on personal preferences and can navigate through the process balancing their daily duties and responsibilities, leading to different programs having higher or lower attendance based on the needs and even requests [10].\u003c/p\u003e\n\u003cp\u003eIn Serbia, the CME was recognized as an important factor in improving healthcare quality and actual benefits for healthcare professionals. It is part of the licensing requirements for physicians at the national level. The movement for sustainable paths in CMEs was initiated in Serbia by implementing system laws in 2005. These laws, which included Health Care Law, Health Insurance Law, and Law on Health Professional Chambers, aimed to make CMEs an essential part of health system development. They made it mandatory for physicians, nurses, dentists, pharmacists, and biochemists to participate in CME programs as a prerequisite for re-licensing. According to the Law on Chambers of Health Workforce, re-licensing is required every seven years based on a pre-defined number of CME credits. To ensure high-quality CME, the Health Council of Serbia obtained a major role in national accreditation of CME training events in 2008. According to the Law on Health Care, the Health Council is the principal advisory body of the Ministry of Health for the long-term planning and development of strategic documents aligned with international health policies. Besides, the CMEs development follows the recommendations and experience of the European Association of Medical Specialists (UEMS). With the help of chambers, the Health Council reviews training events according to established criteria, including evidence-based background of the educational topic, specified target groups, objectives and outcome of training, before-after knowledge testing, and evaluation. Providers of the CME training events come from various institutions, including public and private health organisations, educational institutions, and governmental and non-governmental organizations. During the period from 2011 to 2020, the responsible institutions in Serbia, including the Ministry of Health, the Health Council of Serbia, and chambers of regulated health professions, invested much effort in stabilizing the system of CME [11]. In these efforts, developers\u0026nbsp;or organizers of CMEs have to identify the significance of relevant topics to offer attendees the highest interest and most appropriate CMEs [12].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on evidence from numerous studies [13, 14], physicians need training to acquire competencies for quality improvement through \u0026quot;the combined and continuous efforts of health professionals, patients and their families, researchers, health insurers, planners, and educators to make changes that will lead to better outcomes for patients, better functioning of the system and better professional development\u0026quot; [15]. A European study on continuing education in primary health care showed many differences in content between European countries and different organizations within individual countries\u0026nbsp;[16]. This is partly attributed to the absence of a widely accepted model that describes the competencies required of physicians to fully participate in improving the quality of health care [17]. According to contemporary authors, competency models can improve CME/CPD\u0026nbsp;(Continuing Medical Education/Continuing Professional Development)\u0026nbsp;in several ways [18]. A competency-based curriculum focuses attention on learning outcomes and how they improve the work of physicians and healthcare workers rather than focusing solely on the acquisition of knowledge (as is often the case with traditional education programs). A framework of specific competencies can provide a basis for self-assessment to help individual physicians and other health care professionals identify their training needs, and can also provide a model of organizational structure to guide the development and evaluation of educational programs [19].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA recent review of the literature showed that there are currently no comprehensive models for developing competencies through CME/CPD systems [20, 21]. For example, a model from the United States [22] identified the main aspects of health care quality and patient safety, efficiency, patient-centeredness, timeliness, efficiency and equity - and these are included in continuing education for improving the quality of health care. The Canadian Educational Framework for Medicine (CanMeds), which was developed primarily for doctors in residency and then adopted for undergraduate students, includes six groups of competencies: the development of a medical expert, communicator, collaborator, manager, health advocate, scientist and professional [23]. In the field of CME, Greiner and co-authors [24] defined five core competency groups for healthcare professionals: providing healthcare to the patient, working in interdisciplinary teams, using evidence-based practice, implementing quality improvement, and using informatics. However, this Greiner model and other models do not recognize competencies related to ethics and professionalism. The Bellagio model [25] presents nine essential groups of competencies for the provision of effective health care: leadership, public trust (accountability and transparency), population-oriented management, vertical and horizontal integration, networking of professionals, infrastructure, mix of payments for health services, standardized measurement and active involvement of patients. This approach provides a comprehensive competency model for providing quality health care. Also noted are the set of competencies necessary for the American Board of Medical Specialties (ABMS) CME/CPD system: patient care, medical knowledge, interpersonal and communication skills, professionalism, systemic practice, and practice-based learning and improvement. The same competencies were also adopted for undergraduate students [26]. These frameworks form the initial basis of training for most health workers in the Western world.\u003c/p\u003e\n\u003cp\u003eThere are studies in the literature devoted to the competencies of pharmacists only, among all healthcare workers in Serbia [27, 28]. In Serbia and the countries of Southeastern Europe, there has been no combined research on the competencies necessary for post-graduate training of physicians so far. Examining the factors associated with the potential involvement of physicians in CME, their needs, and their experiences with the CMEs attended previously can, therefore, significantly improve the curricula of CMEs and adapt the topics and modalities to the actual needs of physicians.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe aim of this study was to examine the topics physicians in Serbia consider the most important for their professional development and to analyze the factors associated with different domains of the competencies identified by the physicians.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study was conducted as a cross-sectional study in two steps: 1) the development of a set of necessary and appropriate competencies for the continuing professional development of physicians by establishing a consensus of experts based on the Delphi process, and 2) the examination of competencies for continuous professional development of physicians, factors that determine them and expectations from continuous education through a cross-sectional study and a questionnaire as a research instrument.\u003c/p\u003e\n\u003cp\u003eDeveloping a set of necessary and appropriate competencies\u003c/p\u003e\n\u003cp\u003eThe first step included developing the set of necessary and adequate competencies for the CMEs of physicians in Serbia through the Delphi process to generate consensus. Three rounds of the Delphi process were conducted to evaluate groups (clusters, domains) of competencies and make changes in the initial framework of the competencies draft.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe panel members, 35 experts in different fields of medicine, were members of the program councils of the CME Centers of all five medical faculties in the Republic of Serbia (Belgrade, Kragujevac, Ni\u0026scaron;, Kosovska Mitrovica and Novi Sad). Consensus development panels provided agreement in areas characterized by uncertainty or lack of definitive information. Also, consensus development panels helped bringing experts together to comment on and develop research instruments and techniques directly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe initial questionnaire was created based on a questionnaire in a previous study that aimed to examine and understand the needs of physicians in different aspects of CME [29]. In the first round of the Delhi process, the list of 53 competencies was provided to the panel members, who rated all listed competencies and could add competencies they considered important and not listed. In the following iteration, all initial competencies with scores above 5 were listed, along with the competencies added by the panel members in the first step to rate them again. This round was then repeated, and all the competencies with a median rating of 5 or more were included in the instrument for the quantitative analyses. The final list was created based on the opinion of experts (75% and more agreement), factor analysis and mutual connection (correlation) of individual competencies.\u003c/p\u003e\n\u003cp\u003eExamining competencies for continuing professional development of physicians\u003c/p\u003e\n\u003cp\u003eThe second step included distributing the questionnaire developed through the Delphi process in the first step and validated through a pilot study (around 50 respondents). The study population included all physicians in Serbia with a license to practice medicine, meaning all members of the Serbian Medical Chamber. Serbian Medical Chamber is the only licensing institution in Serbia for physicians, and a license issued by the Serbian Medical Chamber is necessary for medical practice [30\u0026ndash;32].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questionnaire consisted of five sections: 1) demographic characteristics of the respondents, 2) their needs for continuing medical education (CME), competencies that participants considered as important to be covered by the CME program, 3) topics that should be covered with the CME program, 4) type of education program and learning environment, and 5) attitudes and opinions on CME.\u003c/p\u003e\n\u003cp\u003eThe first section of the questionnaire regarded the demographic characteristics of the respondents (age, sex \u0026ndash; male/female), the type of healthcare institution where they work (University, clinical centre, clinical-hospital centre, general hospital, primary healthcare institutions, non-governmental organization, or other institution), work in private or state sector or both, and academic education (specialization, fellowship/ master or doctoral degree). The second section referred to competencies that participants consider necessary for daily work. The participants were asked to rate each competency on a scale from 1- of little importance to 7- of very high importance. The third section of the research instrument referred to topics that participants considered important for CPDs. The participants were asked to rate each offered topic on a scale from 1- of little importance to 7- of very high importance. The fourth section referred to organizers, modalities of courses (live educational events, online educational events, or e-learning materials, blended learning events), days in which the courses should be organized. All items are given on a seven-point scale from 1- completely disagree to 7- completely agree. The final section referred to the practices regarding regular attendance of CPD programs, assessment of needs for CPD programs, types of programs, and modalities of programs. All items were given on a seven-point scale, and the participants were asked to rate each item from 1- not interested at all to 7- completely interested.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe questionnaire was distributed through the mailing list of the Serbian Medical Chamber as an online questionnaire, and the filling-in was open for 30 days. The population of 27,029 physicians was contacted through email, and 2,625 physicians filled in questionnaires (the population response rate was 9.7%). All the participants were given written explanations about the study, its processes, and aims and were asked to fill in the online questionnaire. We considered that all participants who completed the questionnaire and submitted it consented to participate in the research. The Ethical Committee of the Faculty of Medicine, University of Belgrade, approved the study (the decision of the Ethical Committee No 1322/V-9).\u003c/p\u003e\n\u003cp\u003eStatistical analysis\u003c/p\u003e\n\u003cp\u003eAll listed competencies were classified into six domains: management, clinical practice, communication, public health, essential, and clinical emergency (Suppl 1). The classification was conducted using triangulation of the results from the exploratory factor analyses, correlation coefficients between different competencies, and the concept of each competency. The concept of competencies was based on previous studies [29, 33, 34]. For all the domains, the ratings were computed to obtain the total score for each domain. A total of 12 variables were analyzed: the dependent variables were scores on each domain (management, clinical practice, communication, public health, essential and clinical emergency). The independent variables were sex, age, type of health care institution the participants worked in (hospital, institute, primary health care), institutional ownership (public, private, or both public and private), highest professional degree (medical doctor, specialist, subspecialist), highest academic degree (medical doctor, Magister or PhD level).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStatistical analyses involved descriptive and analytical methods. Normality was examined using the Kolmogorov-Smirnov test. Robust regression analyses served to examine the association between the potential factors associated with each dependent numerical variable without normal distribution (scores on examined domains: management, clinical practice, communication, public health, essential and clinical emergency). All analyses were done using the R statistical package (v4.2.2).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study included 2,625 physicians in Serbia. The average age of the participants was 44.5\u0026plusmn;11.5 years. Most of the participants were females (1,845-70.3%), specialists (1,204-45.9%), and a quarter of the participants had a PhD as the highest scientific degree (656-25.0%). More than half reported working in hospitals (1,397-54.8%), and more than two-thirds worked in publicly owned institutions (2,022-77.0%). The characteristics of the participants are presented in Table 1.\u003c/p\u003e\n\u003cp\u003eTable 1\u003c/p\u003e\n\u003cp\u003eOut of 74 listed competencies, rated between 1 and 7, the majority had the median 7, indicating high importance (40 out of 74 competencies). Physicians rated the management domain as the highest (with a median of 106), followed by the domain of essential competencies (with a median of 90) and the public health domain (with a median of 80). They assessed clinical practice and clinical emergency domains with medians above 50 (59 and 52, respectively), while the communication domain gained the least importance (with a median of 40) (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2\u003c/p\u003e\n\u003cp\u003eTable 3 presents factors of higher scores of preferred competencies for inclusion in future CMEs, obtained by the robust regression analysis. There was a significant association between sex and all competencies domains. Female physicians appreciate more than males all competencies grouped in management (B=3.535, p\u0026lt;0.001), clinical practice (B=1.182, p\u0026lt;0.001), communication (B=0.830, p\u0026lt;0.001), public health (B=2.801, p\u0026lt;0.001), essentials (B=3.361, p\u0026lt;0.001), and clinical emergency domains (B=1.601, p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eThe higher age of physicians correlates with higher preferences related to scores in the public health domain (B=0.077, p=0.045) and the domain of essential competencies (B=0.100, p=0.011).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the highest professional degree, the results pointed that those physicians with specialisation judged as less important competencies in public health (-1.795, p=0.046), group of essentials competencies (-2.901 p=0.002|) and clinical emergency domain (-1.592, p\u0026lt;0.01). Also, physicians having subspecialisation less appreciate clinical emergency domain (-2.023, p=0,037). There were no significant predictors related to academic degrees (physicians with master\u0026apos;s or PhD levels in addition to the basic integrated study of medicine).\u003c/p\u003e\n\u003cp\u003ePhysicians who work in primary healthcare institutions appreciate more the public health domain (B=2.327, p=0.002), essential group of competencies (2.155, p=00.5) and clinical emergency (0.748, p=0.002). Regarding the sector in which physicians work, the only significant correlation was found with those working in the private sector who prefer more competencies grouped in the communication domain (0.563, p=0.005).\u003c/p\u003e\n\u003cp\u003eTable 3\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe need for sustainable paths in learning, renewing and improving the knowledge and skills of health professionals is today conditioned by the intensive development of science and evidence-based health services, constant changes in the health sector with the application of digital technologies, but also demographic challenges, accelerated development of social relations and increased burden of diseases and injuries\u0026nbsp;[34, 35]. Continuing professional development in medicine, public health and other fields enables the realization of personal, professional and scientific potential, and it is also an individual process that should be complementary to collective perspectives. Therefore, physicians and other health professionals accept CME as a professional and ethical obligation that brings personal progress and benefits users, patients and society as a whole. In this context, induction CME programs attract particular interest in improving learning outcomes among trainees with different backgrounds and expectations [36].\u003c/p\u003e\n\u003cp\u003eOur study aimed to examine which competencies the physicians in Serbia consider the most important to be included in the CMEs and the factors associated with recognising different competencies \u0026lsquo;domains. In preparing this research, we conducted three rounds of the Delphi method, and the experts, who were members of program councils of the CME centres at every University in Serbia, reached a consensus on the necessary competencies. Based on defined competencies, the questionnaires were distributed through the Serbian Medical Chamber mailing list with an acceptable response rate among more than 500 participants [37, 38].\u003c/p\u003e\n\u003cp\u003eInterestingly, more than half of the listed competencies were rated with a maximum of 7, possibly indicating that the participants in the Delphi method understood the importance of sustainable learning and defined different competencies applicable in physicians\u0026rsquo; everyday work that continuously needs improvement.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSix groups of competency domains for physicians in our study embrace clinical medicine, public health and managerial skills. Several authors obtained similar results, slightly different (in the number of domains and their wording) but also oriented to clinical practice, system thinking, communication\u0026nbsp;and management [23-26]. The self-assessed needs are associated with the areas each of the physicians considers as the areas that require improvement, which may not correlate with their level of skills [10]. Our analyses showed\u0026nbsp;the association of scores in every domain and female sex.\u0026nbsp;One notable characteristic of medical doctors in Serbia is the significantly higher percentage of women among employed medical doctors compared to men (68% vs. 32%)\u0026nbsp;[39]. Some other authors found additional relations between female physicians and career advancement [40, 41]. Also, working in privately owned institutions was positively associated with the score in the communication domain, probably due to the need for better patient-physician communication and higher requirements for higher levels of patient satisfaction in privately owned institutions [42-44].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding the public health domain of competencies besides the female sex, age was positively associated and the work in primary health care institutions. As the competencies classified as \u0026apos;public health\u0026apos; in our study included the competencies necessary for the adequate conduction of health education, lifestyle improvement, and behavioral change techniques, the physicians at the primary health care level may have recognized all these competencies as valuable as they are part of capitation formula and can influence the physicians\u0026apos; salary. Another factor that may have influenced the association of the work at the primary health care level and the score on public health domain was the recognition of the need for improvements in vaccination uptake, physical inactivity, poor diet, and the need for promotion of smoking cessation among the general population which are all considered as public health issues [45]. In Serbia, due to the high prevalence of risk behaviour in the population [39], physicians in primary health care have pointed to the need for strong competencies in the domain of public health. On the other hand, being a specialist was negatively associated with the score in the public health domain, which may also be because most of the public health issues are faced at the primary healthcare level. Specialists are commonly focused on specific skills and illnesses and rely on primary health care to deal with their patients\u0026apos; common poor lifestyle choices.\u003c/p\u003e\n\u003cp\u003eSimilar results were obtained for the domain of essential medical knowledge. Again, physicians at the primary health care level are often forced to work in many disciplines, while the specialists working in larger institutions may see the competencies within essential medical knowledge as necessary for other professionals in their team. These results align entirely with the results obtained with clinical emergency domain. Again, primary healthcare physicians may need competencies to deal with emergencies independently; specialists and subspecialists usually work in larger institutions and feel that they can rely on colleagues from other medical areas in emergencies [46].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo confirm these associations, we also conducted sensitivity analyses with different classifications of domains, in accordance with the recommendations of the Institute of Medicine Core Competencies and only related to the concept of the competencies, and we obtained almost identical results [22].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study has a few possible limitations. The first is in the Delphi process organization, as this has led us to obtain a higher number of competencies considered important than the initial list. However, this has enabled us to analyze the numerous competencies possible thoroughly. Additionally, the large sample enabled the recognition of all these competencies as relevant. The association of the different domains with the female sex and especially work in different institutions at different levels can successfully guide the development of CME programs directed to different physician populations.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCME and sustainability might seem like unlikely partners, but their connection is becoming increasingly crucial as CME can be a powerful tool for promoting sustainability in healthcare. Healthcare has a significant environmental footprint, and educated medical professionals are vital in mitigating it. Our results can serve as a guide for developing sustainable CMEs directed to different physician populations. Integrating sustainability into CME is an ongoing process that requires collaboration among CME providers, medical institutions, policymakers, and healthcare professionals. By working together, they ensure that CME equips medical professionals with the knowledge and skills to lead the way towards a more sustainable healthcare system.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCME\u0026nbsp; \u0026nbsp;\u0026nbsp;Continuing Medical Education\u003c/p\u003e\n\u003cp\u003eCPD \u0026nbsp; \u0026nbsp; Continuing Professional Development\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe would like to thank all participating experts and members of Continuing Education Centers at faculties of medicine in Serbia (Belgrade, Novi Sad, Nis, Kragujevac, Kosovska Mitrovica) for providing their answers in the Delphi process. This study was supported by the Faculty of Medicine, University of Belgrade (No\u0026nbsp;451-03-66/2024-03/200110 / year 2024).\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eConceptualization, R.N.M. and V.B.M.; methodology, V.B.M. and Z.B.; software, Z.B.; validation, R.N.M., Z.T.S., J.T., S.G. and D.N.; formal analysis, R.N.M., V.B.M. and Z.B.; investigation, R.N.M.; data curation, R.N.M., Z.T.S., J.T., S.G. and D.N.; writing\u0026mdash;original draft preparation, R.N.M. and V.B.M.; writing\u0026mdash;review and editing, V.B.M.; visualization, R.N.M.; supervision, U.L. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe research data presented in this study are available on request from the corresponding author, V.B.M.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the Declaration of Helsinki, and approved by the Ethics Committee of the Faculty of Medicine, the University of Belgrade (protocol code No 1322/V-9).Informed consent was obtained from all participants involved in the study.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003ePuradiredja DI, Kintu-Sempa L, Eyber C, Weigel R, Broucker B, Lindkvist M, et al. Adapting teaching and learning in times of COVID-19: a comparative assessment among higher education institutions in a global health network in 2020. BMC Med Educ. 2022; 22 (1): 507-519. https://doi.org/10.1186/s12909-022-03568-4\u003c/li\u003e\n\u003cli\u003eGlobal strategy on human resources for health: Workforce 2030; WHO Document Production Services: Geneva, Switzerland, 2016. Available from: https://www.who.int/publications/i/item/9789241511131\u003c/li\u003e\n\u003cli\u003eCervero RM, Gaines JK. Effectiveness of Continuing Medical Education: Updated synthesis of systematic reviews. Accreditation Council for Continuing Medical Education: Chicago, IL, USA, 2014. Available from: https://www.accme.org/sites/default/files/652_20141104_Effectiveness_of_Continuing_Medical_Education_Cervero_and_Gaines.pdf\u003c/li\u003e\n\u003cli\u003ede Andrade F, Griebenow R, Costello RW, Guenova M, Schaefer R, Chalmers JD et al. The future of accreditation of continuing medical education (CME)-continuing professional development (CPD) in Europe: harmonisation through dialogue and consensus. J Eur C. 2018; 7(1):1506202. https://doi.org/1080/21614083.2018.1506202\u003c/li\u003e\n\u003cli\u003eMerry L, Castiglione SA, Rouleau G, L\u0026eacute;tourneau D, Larue C, Desch\u0026ecirc;nes M-F, et al. Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review. BMC Med Educ. 2023;23(1):498. https://doi.org/10.1186/s12909-023-04427-6\u003c/li\u003e\n\u003cli\u003eBalmer JT. The transformation of continuing medical education (CME) in the United States. Adv Med Educ Pract. 2013; 4: 171\u0026ndash;82. https://doi.org/2147/AMEP.S35087\u003c/li\u003e\n\u003cli\u003eCerenzia W, Janowiak D, Castles R, Triebel A, Williams S, Becker M. Outcomes in CME/CPD - Special Collection Standardising Outcomes Assessment: Demonstrating the Power of Comparative Outcomes Data. J Eur CME. 2020; 9(1): 1832797. https://doi.org/1080/21614083.2020.1832797\u003c/li\u003e\n\u003cli\u003eShah MD, Goyal V, Singh V. Lele J. Preferences and attitudes of physicians in India towards continuing medical education. J Eur CME. 2017; 6(1):1332940. https://doi.org/1080/21614083.2017.1332940\u003c/li\u003e\n\u003cli\u003eReis T, Faria I, Serra H, Xavier M. Barriers and facilitators to implementing a continuing medical education intervention in a primary health care setting. BMC Health Serv Res. 2022; 22: 638. https://doi.org/1186/s12913-022-08019-w\u003c/li\u003e\n\u003cli\u003eMcAdams CD, McNally MM. Continuing Medical Education and Lifelong Learning. Surg Clin North Am. 2021; 101(4): 703\u0026ndash;15. https://doi.org/10.1016/j.suc.2021.05.015\u003c/li\u003e\n\u003cli\u003eNikolić-Mandić R, Bjegović-Mikanović V, Wenzel H, Lalić N, Laaser U, Ne\u0026scaron;ić D. A standstill of the continuing medical education in Serbia 2011\u0026ndash;2017. Srp Arh Celok Lek. 2021; 149(5-6): 334-342. https://doi.org/10.2298/SARH210107041N\u003c/li\u003e\n\u003cli\u003eSturesson Stabel LS, McGrath C, Bj\u0026ouml;rck E, Elmberger A, Bolander Laksov K. Navigating Affordances for Learning in Clinical Workplaces: A Qualitative Study of General Practitioners\u0026rsquo; Continued Professional Development. Vocations and Learning. 2022;15 (3): 427-448. https://doi.org/10.1007/s12186-022-09295-7\u003c/li\u003e\n\u003cli\u003eDzara K, Pusic M, Carlile N, Krupat E, Alexander EK. Educational adaptation to clinical training during the COVID-19 pandemic: a process analysis. BMC Med Educ. 2022;22(1):200. https://doi.org/10.1186/s12909-022-03237-6\u003c/li\u003e\n\u003cli\u003eMerry L, Castiglione SA, Rouleau G, L\u0026eacute;tourneau D, Larue C, Desch\u0026ecirc;nes M-F, et al. Continuing professional development (CPD) system development, implementation, evaluation and sustainability for healthcare professionals in low- and lower-middle-income countries: a rapid scoping review. BMC Med Educ. 2023;23(1):498. https://doi.org/10.1186/s12909-023-04427-6\u003c/li\u003e\n\u003cli\u003eMcLees AW, Nawaz S, Thomas C, Young A. Defining and assessing quality improvement outcomes: a framework for public health. Am J Public Health. 2015; 105 (Suppl 2): S167-73. https://doi.org/10.2105/AJPH.2014.302533\u003c/li\u003e\n\u003cli\u003eKlemenc-Ketis Z, Vanden Bussche P, Rochefort A, Emaus C, Eriksson T, Kersnik J. Teaching quality improvement in family medicine. Educ Prim Care. 2012. 23:378\u0026ndash;381. https://doi.org/10.1080/14739879.2012.11494147\u003c/li\u003e\n\u003cli\u003eILO; OECD; WHO. Five-Year action plan for health employment and inclusive economic growth (2017\u0026ndash;21). WHO Document Production Services: Geneva, Switzerland, 2017. Available from: https://iris.who.int/bitstream/handle/10665/272941/9789241514149-eng.pdf\u003c/li\u003e\n\u003cli\u003eGriebenow R, Campbell C, McMahon GT, Reigner K, Gordon J, Pozniak E, et al. Roles and Responsibilities in the Provision of Accredited Continuing Medical Education/ Continuing Professional Development. J Eur CME. 2017; 6 (1):1314416. https://doi.org/10.1080/21614083.2017.1314416\u003c/li\u003e\n\u003cli\u003eFilipe HP, Mack HG, Golnik KC. Continuing professional development: Progress beyond continuing medical education. Ann Eye Sci. 2017;2(7).\u003c/li\u003e\n\u003cli\u003eAllen T, Donde N, Hofst\u0026auml;dter-Thalmann E, Keijser S, Moy V, Murama JJ, et al. Framework for industry engagement and quality principles for industry-provided medical education in Europe. J Eur CME. 2017; 6(1):1348876. https://doi.org/10.1080/21614083.2017.1348876\u003c/li\u003e\n\u003cli\u003ePatterson F, Roberts C, Hanson MD, Hampe W, Eva K, Ponnamperuma G, et al. 2018 Ottawa consensus statement: Selection and recruitment to the healthcare professions. Med Teach. 2018;40(11):1091\u0026ndash;101. https://doi.org/1080/0142159X.2018.1498589\u003c/li\u003e\n\u003cli\u003eInstitute of Medicine (US) Committee on Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US); 2001. PMID: 25057539.\u003c/li\u003e\n\u003cli\u003eFrank JR, ed. The Can MEDS 2005 Physician Competency Framework. Better standards. Better physicians. Better care. Ottawa (Ontario): Royal College of Physicians and Surgeons of Canada; 2005.\u003c/li\u003e\n\u003cli\u003eGreiner AC, Knebel E, eds. Health Professions Education: A Bridge to Quality. Washington (DC): Institute of Medicine (US); 2003.\u003c/li\u003e\n\u003cli\u003eSchlettes S, Lisac M, Wagner E, Gensichen J. The Bellagio Model: Population-Oriented Primary Care. Z Evid Fortbild Qual Gesundhwes. 2009; 103(7): 467-74. https://doi.org/10.1016/j.zefq.2009.06.006\u003c/li\u003e\n\u003cli\u003eAmerican Board of Medical Specialties. Standards for Continuing Certification. Available from: https://www.abms.org/board-certification/board-certification-standards/standards-for-continuing-certification/\u003c/li\u003e\n\u003cli\u003eStojkov-Rudinski S, Tadić I, Crnjanski T, Krajnović D. Analysis, adaptation and validation of the instrument for the competence evaluation of the pharmacists in community pharmacies. Arhiv za farmaciju. 2012; 62(3): 208-218.\u003c/li\u003e\n\u003cli\u003eStojkov s, Tadic I, Crnjanski T, Krajnovic D, Bates I. Evaluation of competences at the community pharmacy settings. Indian J Pharm Educ Res. 2014; 48 (4):22\u0026ndash;30.\u003c/li\u003e\n\u003cli\u003eMaher B, Faruqui A, Horgan M, Bergin C, Tuathaigh CO, Bennett D. Continuing professional development and Irish hospital doctors: a survey of current use and future needs. Clin Med. 2017; 17(4): 307\u0026ndash;15. https://doi.org/10.7861/clinmedicine.17-4-307\u003c/li\u003e\n\u003cli\u003eHealthcare Law (Zakon o zdravstvenoj za\u0026scaron;titi) Official Gazette RS, 25/2019 and 92/2023. Available from: https://www.paragraf.rs/propisi/zakon_o_zdravstvenoj_zastiti.html\u003c/li\u003e\n\u003cli\u003eRulebook on closer conditions for the implementation of continuing education for healthcare workers and healthcare associates (Pravilnik o bližim uslovima za sprovođenje kontinuirane edukacije za zdravstvene radnike i zdravstvene saradnike), Official Gazzete RS 17/2022. Available from: https://www.paragraf.rs/propisi/pravilnik_o_blizim_uslovima_za_sprovodjenje_kontinuirane_edukacije_za_zdravstvene_radnike_i_zdravstvene_saradnike.html\u003c/li\u003e\n\u003cli\u003eRulebook on detailed conditions for issuing, renewing or revoking licenses to members of health workers' chambers (Pravilnik o bližim uslovima za izdavanje, obnavljanje ili oduzimanje licence članovima komora zdravstvenih radnika), Official Gazete RS 76/2022. Available from: https://www.paragraf.rs/propisi/pravilnik_o_blizim_uslovima_za_izdavanje_obnavljanje_ili_oduzimanje_licence.html\u003c/li\u003e\n\u003cli\u003eTimmerberg JF, Krosschell KJ, Dunaway Young S, Uher D, Yun C, Montes J. Essential competencies for physical therapist managing individuals with spinal muscular atrophy: A delphi study. PLoS One. 2021; 16(4): e0249279. https://doi.org/10.1371/journal.pone.0249279\u003c/li\u003e\n\u003cli\u003eKriston L, Hahlweg P, Harter M, Scholl I. A skills network approach to physicians\u0026rsquo; competence in shared decision making. Health Expect. 2020; 23: 1466\u0026ndash;1476. https://doi.org/10.1111/hex.13130\u003c/li\u003e\n\u003cli\u003eDascalu CG, Antohe ME, Topoliceanu C, Purcarea VL. Medicine Students\u0026rsquo; Opinions Post-COVID-19 Regarding Online Learning in Association with Their Preferences as Internet Consumers. MDPI sustainability. 2023; 15: 3549. https://doi.org/3390/su15043549\u003c/li\u003e\n\u003cli\u003eGambhir N, Gangadharan A, Pope L. Knowing me, knowing you: evaluation of the impact of trainer involvement at an enhanced induction programme for International Medical Graduates (IMGs). Educ Prim Care. 2024; 13: 1-6. https://doi.org/1080/14739879.2023.2297670\u003c/li\u003e\n\u003cli\u003eWu MJ, Zhao K, Fils-Aime F. Response rates of online surveys in published research: A meta-analysis. Comput Hum Behav Reports. 2022; 7: 100206. https://doi.org/1016/j.chbr.2022.100206\u003c/li\u003e\n\u003cli\u003eParekh N, Savage S, Helwig A, Alger P, Metes ID, McAnallen S, et al. Physician satisfaction with health plans: results from a national survey. Am J Manag Care. 2019; 25(7): e211\u0026ndash;e218. PMID: 31318512\u003c/li\u003e\n\u003cli\u003eStatistical Office of the Republic of Serbia. The 2019 Serbian National Health Survey; Statistical Office of the Republic of Serbia and Institute of Public Health of Serbia \u0026ldquo;Dr Milan Jovanovic Batut\u0026rdquo;: Belgrade, Serbia, 2021. Pp: 1\u0026ndash;137. Available from: https://publikacije.stat.gov.rs/G2021/pdfE/G20216003.pdf\u003c/li\u003e\n\u003cli\u003eMukkamala S, Rodrigues Armijo P, Flores L, Shillcutt SK. Positive association of a women\u0026rsquo;s continuing medical education conference on career advancement and promotion. Med Educ Online. 2021; 26(1): 1981127. https://doi.org/10.1080/10872981.2021.1981127\u003c/li\u003e\n\u003cli\u003eNgai J, Capdeville M, Sumler M, Oakes D. A Call for Diversity: Women, Professional Development, and Work Experience in Cardiothoracic Anesthesiology. J Cardiothorac Vasc Anesth. 2023; 37(6): 870-880. https://doi.org/10.1053/j.jvca.2022.12.002\u003c/li\u003e\n\u003cli\u003eJayas A, Andriole DA, Grbic D, Hu X, Dill M, Howley LD. Physicians' continuing medical education activities and satisfaction with their ability to stay current in medical information and practice: A cross-sectional study. Health Sci Rep. 2023; 6(2): e1110. https://doi.org/10.1002/hsr2.1110\u003c/li\u003e\n\u003cli\u003eKwateng KO, Lumor R, Acheampong FO. Service quality in public and private hospitals: A comparative study on patient satisfaction. Int J Healthc Manag. 2019; 12 (4): 251-258. https://doi.org/10.1080/20479700.2017.1390183\u003c/li\u003e\n\u003cli\u003eAndersson T, Eriksson N, M\u0026uuml;llern T. Patients' perceptions of quality in Swedish primary care \u0026ndash; a study of differences between private and public ownership. J Health Organ Manag. 2021; 35(9): 85-100. https://doi.org/10.1108/JHOM-09-2020-0357\u003c/li\u003e\n\u003cli\u003eValaitis RK, O\u0026rsquo;Mara L, Wong ST, MacDonald M, Murray N, Martin-Misener R, et al. Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors. Prim Health Care Res Dev. 2018;19(4):378\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003ePannick S, Davis R, Ashrafian H, Byrne BE, Beveridge I, Athanasiou T, et al. Effects of Interdisciplinary Team Care Interventions on General Medical Wards. A Systematic Review. JAMA Intern Med. 2015; 175(8):1288-1298. https://doi.org/10.1001/jamainternmed.2015.2421\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1-3 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Continuing medical education (CME), continuous professional development (CPD), competencies, physicians, healthcare workers","lastPublishedDoi":"10.21203/rs.3.rs-4272140/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4272140/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground \u003c/strong\u003eAchieving sustainability in continuing medical education (CME) involves regular assessment of the evolving needs of healthcare professionals and updates in educational content accordingly. The aim of this study was to examine the topics physicians in Serbia consider the most important for their professional development and to analyze the factors associated with different domains of the competencies identified by the physicians\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e This cross-sectional study was conducted among 2,625 physicians who are members of the medical chamber in Serbia. Besides similar studies, the Delphi process among medical experts served to create the research instruments, while obtained data were analyzed using factor analysis and robust regression analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e The results pointed to a significant association between the scores in all identified domains (management, clinical practice, communication, public health, essentials and clinical emergency) and female gender. The score in the communication domain was additionally associated with work in privately owned institutions (B=0.563). The scores in the public health domain and the basic medical skills (essentials domain) were additionally associated with age (B=0.077 and B=0.100), work in a primary healthcare institution (B=2.327 and B=2.155) and being a specialist (B=-1.795 and B=-2.901). The score on the clinical emergency domain, besides the female gender, was associated with work in primary health care (B=0.748), being a specialist (B=-1.592) and being a subspecialist (B=-1.023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e Our results can serve as a guide for developing sustainable CMEs directed to different physician populations. Integrating sustainability into CME is an ongoing and collaborative effort which ensures that CME programs equip medical professionals with the necessary knowledge and skills to spearhead the transition towards a more sustainable healthcare system.\u003c/p\u003e","manuscriptTitle":"Exploring Factors of Physicians' Preferences for Continuing Medical Education","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-19 21:40:55","doi":"10.21203/rs.3.rs-4272140/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5b2a8e2c-72a3-4391-880d-85d2e4909263","owner":[],"postedDate":"April 19th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-27T02:38:37+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-19 21:40:55","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4272140","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4272140","identity":"rs-4272140","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}