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Ophthalmologist, Continuing medical education, Qualitative research, IntroductionHuman resources are known as the most important source of health system, and performance of health care systems highly depends on the knowledge, skills, and motivation of those staff who are responsible for providing care services. Accordingly, training is a key investment tool for the obsolescence of old skills as well as the emergence of new technologies in the provision of care ( 1, , 2, ).Nowadays, lifelong learning has become an integral part of human life. In this regard, the United Nations Educational, Scientific and Cultural Organization (UNESCO) has emphasized it at the beginning of the 21st century ( 3, , 4, ). Continuous learning, along with updating information and skills on health issues that also deal with community health status, is of especial important ( 5, , 6, ).Owners of medical sciences, and especially physicians, are among the people mostly suffering from the loss of information in the scientific field for themselves and the people in the community who benefit from their care services ( 5, ).CME refers to a specific form of the continuing education (CE) that helps those in the medical field who maintain, develop, or increase their competence and relationships in order to provide better services for patients ( 5, - 7, ). The first CME programs worldwide and in Iran were reported in 1935 and 1991 ( 8, , 9, ), respectively.For several years, the traditional form of CME has been holding conferences, symposiums, or workshops. However, there are many other activities that can be added to this form such ::as char::t audit and feedback, and simulated experiences ( 7, ). However, the CME programs must be designed in a way to meet the needs of the learners ( 10, - 12, ). According to articles published in other fields of medical science, the CME programs do not actually meet the needs of their learners ( 13, - 15, ). In fact, qualitative research is known as a valuable approach used to describe life experiences, which can help to better understand human experiences. In the study, qualitative data consists of the participants&apos, perceptions and opinions ( 16, ). The aim of the CME programs in the medical community is to improve the knowledge of practitioners and cause a change in their performance ( 17, ). Previous studies ( 5, , 18, - 19, ) showed that the CME provided minimum changes in physicians&,rsquo behaviors, so it is important to pay attention to the viewpoints of this group.Up to now, no study has been conducted on continuing ophthalmology education in Iran, and most of the studies performed on general practitioners are quantitative. On the other hand, most experts believe that performing qualitative research to understand the real needs of teaching and learning, the subjects&,rsquo experiences, and mental phenomena is considered as a unique solution ( 20, ). Therefore, continuing ophthalmology education was selected to be investigated in the current study. This qualitative study aimed to explain the Iranian Ophthalmologists&,rsquo perceptions and experiences regarding the implementation of the CME Programs in Iran.MethodsThis study was designed and implemented using a qualitative content analysis method ( 21, ). Participants In this qualitative study, a total of 18 ophthalmologists, including 10 professors of ophthalmology and 8 ophthalmologists with a mean age of 45&,plusmn 9 years old and a mean duration of 14&,plusmn 9 years in ophthalmic practice were enrolled and then interviewed. The participants were selected using purposeful sampling. The inclusion criteria including the participants in this study were continuous presence in programs, a background in policymaking and program implementation with the maximum variation in terms of job title (Professors of ophthalmology, Assistant professors of ophthalmology, Associate professors of ophthalmology, and Nonacademic ophthalmologists), and educational degree (Fellowship or General Ophthalmologist). Those cases who were unwilling to participate in the interviews were excluded from the present study. Ethical consideration The present study was approved by the Ethics Committee of Ophthalmic Research Centers, Shahid Beheshti University of Medical Sciences with the approval number of IR.SBMU.ORC.REC.1396.21. Firstly, the objectives of the study were explained to the participants prior to the data collection, and the interviews were recorded with their consent. Informed written consent was taken from all the included subjects. All the participants had the right to continue or withdraw from the study. Of note, the studied cases&,rsquo information was kept confidential. Data collection The required data were collected directly from the experiences of the study participants by holding semi-structured and in-depth individual interviews. Interviewing is a qualitative research technique that involves intensive individual conversations with a small number of respondents, with the purpose of exploring their perspectives on a particular idea, program, or situation ( 22, ). Data collection was conducted from April 2018 to Feb 2019. A member of the research team (MK) who had the experience of conducting qualitative research, was interviewed. She had participated in some ophthalmology continuing education programs and had interactions with participants, lecturers, and program providers to better understand the phenomenon of the continuing ophthalmology education. Purposive sampling was continued until data saturation, meaning that no additional information was obtained for the concept. Subsequently, categories and themes were repeated. The length of each interview varied from 40 to 60 minutes depending on the interviewee&apos,s circumstances and their agreement. We have planned to perform data collection from each participant by a single interview visit, but in some cases, there was a need to arrange additional interviews. It is noteworthy that three participants were interviewed twice. Overall, a total of 21 interviews were conducted. The interview guide was a short list consisting of some general questions such as ",Please explain your experience in continuing ophthalmology education programs?", or ",Describe the last time you participated in a continuing education program?",. Following the interviews, follow-up questions, including ",Please give an example in this case?", and ",Explain more",, were asked based on the participants&apos, statements and the provided information in order to clarify the concept under the study. The following questions were based on the participants&,rsquo answers. The interviews were listened to by MK until the researcher understood their content and main ideas, and the ambiguities were clarified immediately after holding the interview through referral to the interviewee. Data were collected in those environments where this phenomenon occurred. Thus, each interview was conducted in medical universities (Shahid Beheshti University of Medical Sciences, Tehran University of Medical Sciences, Iran University of Medical Sciences, Baqiyatallah University of Medical Sciences) eye research centers and the ophthalmology departments, offices, and operating rooms of public and private hospitals. Data analysis The content analysis method suggested by Graneheim and Lundma (2004) ( 21, ) was used at this stage. After each interview, its record was immediately transcribed by MK. Thereafter, the whole text of each interview was considered as the unit of analysis. Afterward, each unit was abstracted and named with a code by two researchers (MK, AF). To find similarities and differences, MK and AF read the preliminary codes several times and then compared them. In case of any disagreement, a third researcher (SA) was involved. The sub-categories were categorized based on the similarities. Finally, the categories were developed and integrated to the themes. Of note, we used no software for analyzing the data. Trustworthiness To ensure the trustworthiness of the obtained data, Credibility, Confirmability, Dependability, and Transferability criteria were used as the criteria of scientific accuracy in the qualitative research, which were firstly presented by Guba and Lincoln ( 23, ).For credibility, the researcher spent a long time immersing in the data and transcripts, and enough time was allocated for collecting and then analyzing the information. For credibility, the researcher spent a long time on the data using note taking during the semi-structured interviews. The Dependability of the data was evaluated by the observers&,rsquo review (peer-check) and external review (member check). The initial findings of the current study were presented to some participants in the form of the codes and categories, and their comments were received (member checking) as well. Some parts of each interview were analyzed by the colleagues who were not present in the study (peer-checking), and thereafter, the findings were confirmed based on their analyses also, the findings were repeatedly evaluated by the supervisors (expert checking). Additionally, in a meeting with the ophthalmology experts, the findings of this study were presented and then approved.Moreover, as to the Dependability of the findings, they were presented and approved in a meeting with the ophthalmology experts and quality experts as a specialized panel.Other evidence obtained from other studies, as well as opinions and ideas of the researchers and documentation of the study&apos,s findings helped to prove the confirmability of the data. Finally, by providing a comprehensive description of the concepts, contributors, content, data collection and analyses, methods used, and the study limitations, the transferability of the data was confirmed, so that other researchers can follow the research process employed by the researchers of this study.ResultsThe results of this study are based on the experiences and perceptions of the participants of the four main themes, including ",growth and development of the ophthalmology&apos,s CME program over time",, ",challenges of the ophthalmology&apos,s CME program",, ",reasons for the participation of the ophthalmologist in the CME program",, and ",strategies for improvement,&,rdquo which are described below, respectively ( Table 1,).NO.Categories Sub-CategoriesCode1Growth and development Gradual maturity of ophthalmology&apos,s CME program over timePlanning for job promotionImproving the quantity and quality of programs |