Table 2.
Examples of extracting codes, categories and themes from raw data
| Meaning unit | Code | Category | Theme |
|---|---|---|---|
|
“Retraining program is to promote the doctors; when he/she is not considered, when their opinions and suggestions are not mentioned, when their requests and ideas do not put into the practice, surely it won’t be ever successful.” “I’ve never seen a university sends forms to ask what programs you’d like us to hold for you.” |
Lack of attention to doctors’ views and suggestions prior to designing the program; Lack of interaction with regard to choice of topics; Lack of compilation of doctors’ views and reflecting them in the program Not communicating with doctors prior to program. |
Insufficient interaction with trainees prior to planning the programs | Insufficient interaction in CME programs |
| “The instructor would go there, without attracting attention, very strict. He didn’t care about the audience, just showing his slides. Maybe in around 80% of sessions we attended, we were just listeners”. |
Instructors’ inattention to the audience while instructing; Instructors’ Lack of communication with the audience |
Insufficient interaction between instructors and trainees during the course of program | |
|
“It might be the case that a participant, twenty years older than me, asks some questions that I might find them funny, or vice versa, I ask some questions that he might find them funny because of having more experiences.” “In a lecture with 100 to 200 attendants, the audience had the feeling no one could interact with that doctor or lecturer.” |
Heterogeneous mass hindered communication between instructors and trainers | ||
| “Doctor, wish we had an archive system; wish we collected doctors’ prescriptions, so that my prescription from 20 years ago could be compared with that of the present to tell me what I’ve done. I wish I’d received feedback, and I’d change my behavior better accordingly. | Lack of giving feedback after the program | Lack of interaction after executing or implementing the programs | |
| “They should take exams, should not to leave us on our own, or we will be illiterate” | Need for evaluating the doctors after the program | ||
| “In CME the trainees are left on their own; it does not bring about durability needed to update doctors. You get acquainted, then you’re on your own till the next program. Because you won’t get a chance to use it now, the use is made for couple of months later. CME should be the way that evaluates my performance." |
Leaving the doctors on their own after the program until further notice not creating durability needed to update doctors; doctors’ reluctance to utilize the content after the program |
||
| “A director of an insurance company takes a seat here, a doctor with an office comes; family physician comes; this is just a heterogeneous environment. All have to learn the same thing. Every physician should be trained in his/her own field of work.” | Providing content regardless to individual differences and fields of work | Presenting the same content for everyone | Undifferentiated approach in CME programs |
| “Just because of being a general practitioner, one can join in all types of a relevant program, even though being not related to their own work fields.” | Administrators’ lack of criteria for participating of learners | Undifferentiated approach recruiting trainees regardless of their work | |
| “Early on, there used to be classes. Yet, even since then the debate was whether 25 annual credits is really enough for a doctor whose knowledge goes back to 20, 30 years ago, or for a doctor just graduated a year ago. Are they the same? Well, looks like they failed to some extent to get it trough. | Making no distinction for doctors in designing a program since the beginning of program holding nationwide | Lack of a special or tailored approach in educational design | |
| “Most of CME programs I’ve taken part in by now were all lecture-based. Look, we are a bunch of people with different needs, different interests in learning; but in consecutive years, only a specific and similar method by the presenters …this exactly cannot be matched. This just reduces the efficiency of the program.” | Presenting programs with the same method in consecutive years | Lack of a special or tailored approach in educational instruction | |
| “There was an educational seminar on crisis management. Once I entered the hall, I saw a dentist, a general doctor, a midwife, a nurse … being there. I thought that might God save the speakers’ soul. What is he going to say? Each of these folks has their own positions.” | Holding combined programs participated by various groups; making no distinction between those groups in terms of experience, scientific level, and working status in the program | ||
| “When a doctor is in the society, they are facing familial, economic, cultural, social, and many other issues. You can’t go and teach them separately.” | Ignoring non educational issues in designing the program | Non comprehensive educational design | |
| “…The doctor feels whether he takes part or not he can keep going his own business.” | Feeling of detachment between doctors’ performance and the program | Inconsistency between CME and Doctors professional needs | Unreal and abstract CME |
| “…It is only effective in extending their license for practice and nowhere else, neither in their work or their vision.” | Ineffectiveness in their job, vision, and professional destiny | ||
| “Apparently, the whole debate was a theoretical one instead of being practical to let the trainee learners in practice.” | Offering theoretical and unpractical instruction | Inapplicability in clinical practice | |
| “Well, the slides weren’t actually applicable in the doctor’s office. You could see that’s the mentioned case, yet they never fully explained its management.” | Insufficient issue instruction. not being practice guiding in doctors’ offices | ||
| “Now, what I know is performed like a cliché. The instructors speak of their own points. We’re not lacking in terms of content and richness of material presented. But is that really of any use to a general practitioner. We used to view it with suspicion.” |
Stereotypical style of conducting the program Doubt in applicability of the content for general practitioners |
||
| “One of the most discussed matters is that friendly get-together of doctors and friends see each other” | Contribution to social interactions between doctors as a participating motivation | Motivating factors | Reasons to participate in CME |
|
“Most of the friends and colleagues with office only have eyes for the scores.” “First of all, to tell my interests: I’m personally interested in participating.” |
Getting credits as a motivation for participating Personal interest as an impetus for participation |
||
| “I don’t take part for the sake of scores; I do it for scientific aspects.” | Scientific aspect highlighted as a motivation for participation | ||
| “Look, the problem with the program is its compulsory nature. I’m obliged to credit 25 each year to extend my license. I think, based on discussions I had with my friends, this is somewhat discouraging among on our colleagues.” | Compulsory nature of the programs serving as the effective factor for participating | Legal framework | |
| “Our trainee looks on CME more as a legal requirement than as an actual feeling of need. I mean I have to take the course at long last if I’m to practice. There is no conviction that taking it is beneficial or enabling.” | Feeling no real need for participation; taking part based on legal requirement; obligatory participation to be authorized to practice |