Internationally, mandatory Continuing Medical Education (CME), tied to re-registration, has enhanced physicians’ skills in developed nations. However, success rates have been inconsistent in developing countries. The current literature highlights the disparity in the availability of CME activities in the Southeast Asian and Eastern Mediterranean regions. This study aims to identify the most crucial elements that will serve as a blueprint for the optimal implementation of mandatory CME in developing countries.
Vakani FS, Uebel K, Balasooriya C, Demirkol A. Building recommendations for mandatory continuing medical education in developing countries: a nominal group study of regional experts. MedEdPublish. 2026;16:2. doi: 10.12688/mep.21451.1.
García Dieguez M. Comment on the Mandatory Continuing Medical Education: Eight Keys to Moving from Intention to Implementation. [Internet]. Pan American Health Organization. Bibliographic Repository. Available at: https://campus.paho.org/en/repo/mandatory-continuing-medical-education-eight-keys-moving-intention-implementation
García Dieguez M.
CEEProS Universidad Nacional del Sur
This article is particularly relevant to health policymakers, regulatory bodies, academic institutions, and managers of continuing professional development programs interested in implementing mandatory continuing medical education systems. Unlike studies focused exclusively on educational activities, it addresses the structural conditions needed to establish sustainable and equitable systems.
Its main contribution is the identification, through a structured consensus process involving regional experts, of eight recommendations covering educational design, teaching modalities, geographical access, accreditation, and governance. Although it focuses on countries in Southeast Asia and the Eastern Mediterranean, it raises relevant issues for reflecting on continuing medical education systems in Latin America.
The study builds on 31 recommendations derived from the authors’ previous research, which included a scoping review covering 33 countries, a narrative review of five countries with mandatory systems, and a study of continuing medical education providers in Pakistan. Using a modified nominal group technique, eight regional experts participated in a virtual meeting involving two rounds of prioritization and discussion. Eight recommendations were identified and grouped into three dimensions.
Educational design. The experts emphasized the need to establish national priorities to guide continuing education programs initially. They also recommended combining online and face-to-face activities, selecting modalities according to the content, competencies, and available resources.
Educational implementation. Priority was given to strengthening institutions already providing continuing education in rural areas, rather than relying exclusively on new online platforms. Accrediting a broad range of providers was also recommended to promote equitable access.
Governance. The experts proposed establishing a national committee under the medical regulatory body and gradually introducing mandatory participation. Two further recommendations concerned educational independence: regulating commercial sponsorship and requiring full disclosure of the financial support received by providers.
An interesting finding is that the experts’ preferences changed after the discussion. For example, they initially prioritized online activities for rural practitioners, but ultimately considered strengthening local educational institutions more important. This change illustrates the value of incorporating contextual and feasibility considerations into educational decisions.
From a methodological perspective, the study’s strengths include its grounding in previous research and its use of a structured consensus procedure. However, it has important limitations: only eight experts participated, five completed the first round, and seven completed the second. The selection criteria and participant characteristics are insufficiently described. No explicit consensus threshold was established, as recommendations were selected mainly according to their relative ranking. Furthermore, the study was conducted in March 2021, during the pandemic. Although it is relevant to developing countries, cultural differences may limit its transferability to Latin America.
- Define educational priorities: combine national health problems with needs identified by practitioners through surveys, performance assessments, and portfolios.
- Implement blended learning: use asynchronous online activities to update knowledge and face-to-face sessions to discuss complex cases and practice skills.
- Reduce geographical inequalities: strengthen regional hospitals and educational institutions as training centers, rather than relying exclusively on centralized digital platforms.
- Diversify providers: establish accreditation criteria that allow universities, scientific societies, hospitals, and regional organizations to participate.
- Introduce mandatory participation gradually: establish an initial adaptation phase that includes training, accreditation mechanisms, and assessment of difficulties before enforcing compliance.