https://orcid.org/0000-0003-4288-6535
ABSTRACT
The Saudi Commission for Health Specialties (SCFHS), the regulatory agency for health professions in the Kingdom of Saudi Arabia (KSA), sought to evolve the continuing professional development (CPD) ecosystem for the country and to promote the concept of life-long learning for healthcare professionals. SCFHS audited its own CPD accreditation system, reviewed internationally recognised CPD accreditation criteria, adopted a new set of standards, and trained its staff and provider community in their adoption. SCFHS also deployed a range of programmes and grants to support healthcare educators and researchers engaged in CPD. SCFHS recruited and trained new staff and deployed an updated IT system to support system change. The adopted criteria and standards now align with best practices, as outlined by the Accreditation Council for Continuing Medical Education (ACCME) and the International Academy for CPD Accreditation. More than 170 educators have participated in programmes to learn effective CPD pedagogy. The adoption of new standards resulted in 396 providers seeking provider accreditation. The number of CPD accredited activities produced in the KSA and approved by the SCFHS has grown from 1,000 activities in 2002 to 10,500 in 2022. With leadership support, regulatory evolution to align with best practices supports healthcare educators and effectively expands of the diversity and quality of CPD.
Introduction
In 2021 there were a total of 99,617 physicians, 196,795 nurses 30,840 pharmacists and 131,003 allied health personnel in the Kingdom of Saudi Arabia (KSA), which totals 458,255 healthcare professionals serving a total population of 36.5 million [Citation1]. These professionals provide care within and around a healthcare system comprised about 497 hospitals, including 159 private hospitals, with a total of approximately 77,244 hospital beds [Citation1]. The population of healthcare professionals in KSA has a high turnover, resulting in a need for a high-quality national continuing professional development (CPD) programme that helped to acculturate, normalise, build skills, and nurture interprofessional team formation.
The Saudi Commission for Health Specialties (SCFHS) is the regulator of post-graduate training and assessment, registration and classification, healthcare societies, and CPD of healthcare professionals across the KSA. The vision of the commission is to be an efficient health society, and its mission is the protection and promotion of health led by compassionate and competent healthcare professionals [Citation2].
The SCFHS has three essential CPD operational functions: to accredit CPD activities; to accredit CPD provider organisations; to recognise self-directed learning; and to recognise CPD activities from non-KSA developed organisations submitted by healthcare professionals towards the re-registration process in the Kingdom [Citation2].
CPD is an effective and strategic intervention that effectively nurtures curiosity, maintains and builds skills, and addresses many challenges in the health care environment [Citation3,Citation4]. Developing CPD was recognised to be a key initiative to achieve the national strategic plan of Saudi Vision 2030, a plan to diversify the economy, and develop public service sectors, such as health, with goals that include a life expectancy increase from 78 to 80 years of age between 2023 and 2030 [Citation1].
Among the strategic initiatives aimed to achieve Vision 2030 goals and objectives is the Human Capability Development Programme (HCDP), which is designed to boost the knowledge, skills, and attitude of the Saudi workforce to reach fluid talents that can also serve on a global scale. HCDP aims to create a dynamic, adaptable society through enhanced education, vocational training, and lifelong learning, which showcases the national support for CPD in the health sector and emphasises the importance of regulating its practices. This manuscript describes the status of CPD for healthcare professionals in the KSA and documents the transformation of the system to meet national goals for the Saudi context [Citation5–8].
Methods
The SCFHS leadership recognised the opportunity of leveraging CPD to drive healthcare quality and help the nation achieve the goals of the Saudi 2030 initiative. Once CPD was recognised as a key component of the strategic plan and with leadership buy-in and support, the first step was to designate key staff as responsible for the initiative and to identify the Accreditation Council for Continuing Medical Education (ACCME) as an implementation partner. The commission went through the following steps to implement the change:
Perform an Audit of the Status of CPD in the Kingdom
The first step was to assess the CPD accreditation system operated by the SCFHS in the KSA by evaluating its staffing, processes, quality control, and the satisfaction and experiences of organisations offering CPD in the Kingdom. Key strategic goals for the system of CPD were clarified to focus on promoting a growing and diverse system of offerings of CPD, encouraging diverse types of educational providers, ensuring activities met the needs of a large interprofessional audience. Further, the standards should represent the minimum expectations to achieve the goals to make them pragmatic and not constrain innovation. The commission surveyed providers of continuing professional development (CPD) in the KSA to determine the capacity of the healthcare system to meet basic accreditation requirements, its ability to operate local and workplace-based continuing education activities and its ability to ensure faculty development.
Contextualize Global Standards for the Kingdom
The leadership staff at SCFHS contextualised an initial transformative approach. And with the support from staff at ACCME, reviewed a variety of international standards for CPD including the ACCME standards. A draft set of revised standards and accreditation processes were developed for both activities and providers. The new approach included quality control and complaints/appeals procedures. The revised standards introduced, for the first time in the Kingdom, objective criteria for the accreditation of CPD provider organisations. The standards were revised to ensure the activities were based on sound educational principles and independent of commercial influence. The criteria follow the general framework of the Substantive Equivalency principles and criteria as outlined by the International Academy of CPD Accreditors, which have been developed over the last decade and were refined following the Cologne Consensus Conference in September 2019. This framework includes guidance that individual CPD accreditors and activities should address the needs of healthcare professionals using a broad range of strategies including performance or practice measures and health status of patients where applicable; should facilitate the translation of the highest quality of scientific evidence and professional practice standards using effective educational strategies; should evaluate the achievement of established objectives or intended outcomes; and should be developed without influence from commercial interests, such as pharmaceutical or device manufacturers.
The SCFHS moved from an activity-based accreditation system to a CPD provider-based system along with an activity-based system with the understanding that an organisation’s processes to plan, develop, and implement education to improve the professional practice of its learners are the most important areas to assess in terms of their ability to meet the activity accreditation criteria. The purpose of this transition was to ensure the quality of activities is not compromised and to develop capabilities of the CPD providing organisations until they reach the desired maturation level that meets international practices.
Train CPD Accreditation Staff at the Commission
The staffing changes included evolving the SCFHS CPD governance and staff structure to support and reflect a high functioning independent system of CPD accreditation administration and regulation. Then a variety of surveyors were recruited from the community of CPD providers and medical education professionals. The SCFHS conducted training for these surveyors to 1) describe the concepts and expectations in the SCFHS Accreditation Criteria; 2) identify indicators of compliance and non-compliance with the accreditation criteria in provider materials; and 3) evaluate compliance and non-compliance in provider materials. The training provided the groundwork of comprehension for the accreditation requirements using a variety of case-based and active learning principles using an online learning system.
Communicate with the Community of CPD Providers
Once the standards had been created, SCFHS produced a website containing the materials, and delivered a variety of communications to the provider community outlining the timing for implementation and implications for the providers, which was part of the change management plan for the providers.
Reconstruct the Information Technology Infrastructure
The availability of accurate and timely data is essential to accreditors. SCFHS had already created a system with an excellent foundation for effective and seamless CPD data services. It then further enhanced its system with additional data reporting requirements for accredited CPD provider organisations themselves, their activities, and learners.
Train Providers on the New Standards and Process
(a) The SCFHS put in place both guidelines and resources to ensure a basic level of competency with growth expectations in developing programmes, recognising a range of resource levels in different organisations.
(b) The new structure allows for stakeholder and community input, as well as a mission focus that targets the best interests of the patient as well as the entire healthcare community.
Select International Systems of Accreditation to Recognize Credits Earned Outside the KSA
The SCFHS established a reciprocity of CE credit for credit systems that follow the general framework of the Substantive Equivalency principles and criteria as outlined by the International Academy of CPD Accreditors or by systems recognised as Substantially Equivalent by the ACCME, which include the following: [Citation9,Citation10]
The Royal College of Physicians and Surgeons of Canada
The Committee on Accreditation of Continuing Medical Education (Canada)
The European Board for Accreditation of Continuing Education for Healthcare Professionals
The Oman Medical Specialty Board as part of the Ministry of Health of the Sultanate of Oman
The Qatar Council for Health Practitioners
The Federation of the German Chambers of Physicians
Over time, the SCFHS may introduce requirements that can be used to determine whether credits issued outside of the KSA can be accepted. Ultimately, after a notification with a given timeline, certificates issued by systems of accreditation that have not achieved this recognition would no longer be recognised by SCFHS.
Build a Support Program for CPD Educators
(a) To promote the identification and support of CPD educators, the SCFHS improved educational quality through the professionalisation and education of CPD educators; provided virtual consulting services; supported and built an educational home model; and expanded the CPD provider base by evolving eligibility criteria and creating a timeline to expand capacity.
(b) A new online education platform, CPD Academy, was developed and launched for CPD professionals to promote self-directed learning and provide life-long learning opportunities; to support CPD providers through the accreditation process and enable them to achieve excellence and quality in performance; and to provide a learning community that supports exchanging experiences and inspires creativity in CPD.
(c) The SCFHS launched a CPD Champions programme to continue building the capacity of the evolving accreditation system in the KSA. A 7-month education programme was designed to help the CPD Champions develop skills for leading and disseminating the values and practices of accredited CPD within the SCFHS framework. Throughout the programme, CPD Champions worked in small groups to create an “Action Plan”. At the beginning of the programme, participants engaged in needs assessment activities to identify areas for developing CPD in the KSA. These need assessments formed the basis of the Action Plans with the goal to create a plan that would impact CPD at participants’ organisations or the CPD system as a whole in the Kingdom.
(d) The SCFHS established an annual CPD providers forum to create a CPD community of practice by providing unified common ground and networking space for CPD discussions to take place in the Kingdom.
Deploy a Grant and Research Infrastructure
The SCFHS established a research advisory committee to learn about the CE landscape in the region, the range and capabilities of the CE provider community, and some key challenges being faced there; to develop a core set of recommended research priorities; to select grantees for an initial set of pilot projects; to have each committee member advise approximately one grantee or project leader on his or her project.
Join the International Community of CPD Accreditors
The SCFHS is becoming integrated into the international community of CPD accreditors through a variety of channels. CPD champions are being mentored by internationally renowned researchers to establish an ongoing research agenda for the KSA. Current and ongoing achievements (research, scholarship, leadership) of the SCFHS will be shared through international collaboration [Citation10,Citation11]. The Commission is developing a strategic plan outlining steps to establish and build the reputation and standing of SCFHS worldwide and create new introductions to global accreditors who may consider recognising SCFHS accredited activities. International accreditors who might recognise SCFHS credits in their country will be identified and approached. And applications for equivalency determinations with peer international accreditors will be submitted.
Results
Survey of Educational Providers
Of the 321 accredited CPD providers that were contacted, 136 (42%) organisations responded. Respondents rated the ease or difficulty of implementing new accreditation requirements. Median responses indicated that maintaining attendance and activity records, and digital learner data management were considered easiest (1 on 6 point scale), ensuring commercial sponsors or faculty biases did not influence content were considered straightforward (2 on 6-point scale), while training educators, preventing payments and reimbursements to attendees, obtaining financial disclosures from faculty, and assessment of change were all considered more moderately challenging (3 on 6-point scale). When asked about the key obstacles being faced, the fraction of respondents indicating underinvestment was highest (19%), while evolving the culture of learning (14%), navigating the accreditation process (11%), managing activity logistics (9%), and staff education (6%) were considered the most meaningful. No respondents considered accreditation fees a barrier. When asked about activities the accreditor could do to support a provider’s CPD program, improving the accreditation process, providing educational support for CPD staff, and improving accreditor communication and website were the most frequently cited. No respondents objected to a provider accreditation model.
Development of Mission and Responsibilities for the Accreditor
The purposes of the SCFHS CPD accreditation department was established to identify, develop, and promote standards for continuing professional development (CPD) utilised by healthcare professionals in their maintenance of competence and incorporation of new knowledge; to improve quality medical care for patients and their communities; to apply these principles, policies, and standards in the accreditation of institutions and organisations offering CPD through a voluntary system for accrediting CPD providers that is responsive to changes in medical education and the health care delivery system; to deal with such other matters relating to CPD as are appropriate. The responsibilities of SCFHS CPD accreditation department were defined as follows:
(a) To serve as the body accrediting institutions and organisations offering CPD;
(b) To develop criteria for evaluation of both educational programmes and their activities by which the SCFHS CPD accreditation department shall accredit institutions and organisations and be responsible for assuring compliance with these standards;
(c) To develop educational programmes to support the evolution of the CPD community and the quality of their educational activities;
(d) To manage data about its accredited providers, their activities, and the learners who participate in those programmes in a central repository;
(e) To maintain international recognition of its accreditation system;
(f) To review periodically its standards, processes, and its role in CPD, to ensure it remains responsive to public and professional needs.
Development of CPD Standards
Through an integrative process, evolving standards for both provider and activity accreditation were finalised, adopted, and published. The final standards included provider eligibility standards, content validity expectations, appropriate identification, mitigation, and disclosure of financial relationships of faculty and planners, standards for appropriate use of commercial support, use of accreditation statement, communication and retention of learner records, as well as expectations for identification of learner needs, programme and outcome assessment. Appropriate forms, templates and processes were created. A committee of community faculty was recruited and trained.
Training Accreditation Staff
The ACCME then created and executed an 8-month education and training programme aimed at helping SCFHS staff build accreditation skills, competencies, and expertise. Three SCFHS staff participated, and several attended accreditation review committee meetings of the ACCME in the United States.
Training of CPD Community of Educational Providers
In collaboration with ACCME, SCFHS made level 1 (fundamentals of CPD), 2 (CPD Basics Capsules), 3 (CPD Re-accreditation Competency), and 4 (CPD Empowerment: practice and ethics) courses available virtually and by 2023 these were completed by 2523, 1016, 96 and 21 individuals, respectively.
CPD Champions Training
Approximately 100 unique individuals participated in the first training programme. The coursework for this training programme included six online courses produced in the ACCME Academy; four webinars led by ACCME staff, for a total of 6 hours of interactive training; and one, 1.5-day live meeting covering topics including educational theory, curriculum development, teaching, assessment, scholarship, and leadership (See Appendix).
Education and support for CPD leaders in the KSA continued with the development of online learning modules and webinars around the following content areas and support their dissemination and deployment to the community via the ACCME Academy online learning platform: evidence-based educational design practices; assessment and mastery learning; educational research design and analysis; building faculty development programmes for CE faculty; data collection and measurement for CE outcomes; quality improvement for healthcare; and learning health systems, implementation science and design thinking in healthcare (See Appendix).
In addition, the SCFHS is training additional CPD champions and continuing the “Champion Certificate Program” to develop skills for leading and disseminating the values and practices of accredited CPD within the SCFHS framework. To address quality assurance for accreditation decisions, SCFHS is supporting the CPD Specialists in the Commission and the accreditation review committee in maintaining and improving their quality controls. This effort aims to achieve consistent and accurate decision-making that is aligned with international standards (See Appendix).
Current Status of Providers and Their Activities and Programs
SCFHS now recognises 396 providing organisations (providers) who have been determined as being eligible and having necessary structure, capacity, and expertise to implement CPD for physicians and healthcare professionals. The current makeup of the accredited providers by organisation type is hospitals (26%), societies (23%), training centres (21%), administrative directorates (9%), universities and colleges (10%), and e-learning centres (11%). Criteria to identify e-learning CPD providers were implemented in 2017. In 2023, there are 44 approved eLearning Centres in the KSA.
The number of CPD accredited activities produced in the KSA and approved by the SCFHS has grown steadily since the introduction of the system, and in the past 2 decades has expanded nearly 10-fold, from 1,000 activities in 2002 to 5,600 in 2010 and at 9,700 in 2018 to 10,500 in 2022. The SCFHS began recording the total hours of CPD produced in 2009. During the years since, the number of CPD hours has grown commensurate with the growth of the number of activities reaching 95,700 hours in 2018 and 115,190 hours in 2022. The number of Specialised Professional Programmes (SPP) that accredited by SCFHS has grown from 8 programmes in 2020 to 26 programmes in 2022. Some 464 activities were produced by e-learning centres in 2023.
SCFHS realised the importance of promoting diversification in the learning and educational journey for healthcare professionals and therefore embraced SPPs under their umbrella of CPD regulations of governance. SPPs differ from CPD activities in being a long-duration programme that can extend up to one year. HCPs receive a more advanced level of training with more focused and specialised competencies for upskilling the professional. In mid-2023, SCFHS decided to govern the empowering of providers and HCPs by introducing “Certificates of Competence” as an outcome of passing SPPs and for it to be added to their professional registration profile as an official means of recognition.
Recognition of International Certificates and Self-Directed Learning Activities
Beyond the SCFHS-accredited activities, healthcare professionals can submit their international learning credits for recognition. SCFHS takes into consideration the quality of the learning, learning method, and the main CPD accrediting body, such as ACCME or the Royal College of Surgeons in Canada, and international accrediting agencies that have achieved substantial equivalency status with each other or with the International Academy for CPD Accreditation. In 2023, the SCFHS recognised almost 31,203 self-reported activities (courses, symposia, conferences, and SDL).
Finally, in addition to international involvement by SCHFS, the organisation is establishing a research infrastructure to establish SCFHS as a thought leader in CPD research and innovation. And a new annual meeting for CPD for the Middle East will offer a forum for continuous learning and ensure the viability of the CPD system for years to come.
Discussion
An empowered CPD programme, with its multi-professional scope and educational expertise, can contribute to initiatives focused on both clinical and nonclinical areas, such as quality and safety, professionalism, team communication, and process improvements [Citation4]. Engagement in the learning journey of health care professionals as they seek to improve their competence and expertise is an investment in people. Accredited CPD can be one of the key resources that supports this lifelong pursuit and is particularly needed in a large and diverse nation such as Saudi Arabia with its distinct health education priorities and challenges [Citation5,Citation7,Citation8,Citation12]. Quality accreditation standards can ensure that CPD is relevant, evidence based, and responsive to learners’ needs; designed according to adult learning principles; evaluated for its effectiveness; and independent of commercial interests [Citation8,Citation13,Citation14].
Our experience in the Kingdom of Saudi Arabia demonstrates that healthcare leaders who recognise the strategic value of education and engage their people in education can expect a meaningful return on their investment – not only in terms of the quality and safety of their clinicians’ work but also in the spirit and cohesiveness of the clinicians who work at their institution [Citation3,Citation5]. To optimise the benefits of education, clinical leaders need to think of accredited CPD as the professional development vehicle that can help them drive change and achieve goals, in consort with quality improvement efforts, patient safety projects, and other systems changes [Citation4]. Our experience suggests that the development of quality CPD accreditation standards that are implemented with reliability and with accountability serve not only the country and its healthcare professionals but the patients we serve.
Disclosure Statement
No potential conflict of interest was reported by the author(s).
References
- Health Sector Transformation Program. Vision 2030. 2021. Available from: https://www.vision2030.gov.sa/media/x3jbf45y/2021-2025-health-sector-transformation-program-delivery-plan-en.pdf
- About the Saudi Commission. Saudi commission for health specialties. Available from: https://www.scfhs.org.sa/en/about-us
- McMahon GT. The leadership case for investing in continuing professional development. Acad Med. 2017;92(8):1075–8. doi: 10.1097/ACM.0000000000001619
- Dave Davis DA, McMahon GT. Translating evidence into practice: lessons for CPD. Med Teach. 2018;40(9):892–895. doi: 10.1080/0142159X.2018.1481285
- Al-Muhanna FA. Challenges to Saudi medical education in the third millennium. J Family Community Med. 2009;16(2):67–69. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23012193
- Algahtani H, Shirah B, Alshawwa L, et al. Factors to be considered in designing a faculty development program for medical education: local experience from the Western region of Saudi Arabia. Yeungnam Univ J Med. 2020;37(3):210–216. doi: 10.12701/yujm.2020.00115
- Alotaibi A, Saleh W, Abdulbaqi A, et al. Health research priority agenda for ministry of health, Kingdom of Saudi Arabia from 2020 to 2025. J Epidemiol Glob Health. 2022;12(4):413–429. doi: 10.1007/s44197-022-00061-5
- Alsabban W, Kitto S. Bridging continuing medical education and quality improvement efforts: a qualitative study on a health care system in the Kingdom of Saudi Arabia. J Contin Educ Health Prof. 2018;38(4):255–261. doi: 10.1097/CEH.0000000000000226
- Griebenow R, Campbell C, McMahon GT, et al. Roles and responsibilities in the provision of accredited continuing medical education/continuing professional development. J Eur CME. 2017;6(1):1314416. doi: 10.1080/21614083.2017.1314416
- Regnier K, Campbell C, Griebenow R, et al. Standards for substantive equivalency between continuing professional development/continuing medical education (CPD/CME) accreditation systems. J Eur CME. 2021;10(1):1874644. doi: 10.1080/21614083.2021.1874644
- McMahon GT, Aboulsoud S, Gordon J, et al. Evolving alignment in international continuing professional development accreditation. J Contin Educ Health Prof. 2016;36(Suppl 1):S22–6. doi: 10.1097/CEH.0000000000000075
- Davis DA, Thomson MA, Oxman AD, et al. Evidence for the effectiveness of CME. A review of 50 randomized controlled trials. JAMA. 1992;268(9):1111–1117. Available from: https://www.ncbi.nlm.nih.gov/pubmed/1501333
- McMahon GT. Advancing continuing medical education. JAMA. 2015;314(6):561–562. doi: 10.1001/jama.2015.7094
- McMahon GT. What do I need to learn Today? — the evolution of CME. N Engl J Med. 2016;374(15):1403–1406. doi: 10.1056/NEJMp1515202