Building recommendations for Mandatory Continuing Medical Education in developing countries: A nominal group study of regional experts.

Introduction: 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. Methods: Following the development of 31 recommendations through a review of the literature of 33 countries in Southeast Asian and Eastern Mediterranean regions regarding the status of CME, a narrative review of five of these countries that have implemented mandatory CME, and in-depth exploration of the experiences and practices of CME providers in Pakistan, we used a nominal group technique with regional experts to identify those that are most crucial. An online meeting was held to establish recommendations for implementing CME in developing nations using a hypothetical developing country. Two rounds of discussion occurred during this consensus-building process. Results: The expert panel identified eight recommendations within the themes of educational design, delivery, and CME governance as the most relevant for implementing mandatory CME in developing nations. These include topics of national significance determined by a central body as desirable components of a CME programme, a combination of online and face-to-face methods, support for developing institutions that are currently active in providing CME in rural settings, accrediting a wide range of CME providers, forming a national CME committee under the national physician regulatory body, a predetermined phase-in period before full implementation of mandatory CME, developing guidelines to regulate and control commercial sponsorship of CME events, and broadening the definition of full disclosure. Discussion: These eight recommendations are likely to benefit developing nations that may be attempting to implement or revamp mandatory CME.