{"title":"Graduate Medical Education in Lebanon: Challenges, Support, and Adaptation Amid the Compounding Crises.","authors":"Fatima Msheik-El Khoury, Carine Zeeni, Halah Ibrahim, Frida Atallah, Salah Zeineldine","doi":"10.5334/pme.1721","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Graduate Medical Education (GME) systems often face disruptions. In Lebanon, repeated crises over the past several years, including political instability, economic collapse, the COVID-19 pandemic, and military conflict, raise questions about institutional support, clinical residents' preparedness, and the resilience of the GME system. This study aims to examine clinical residents' perceived preparedness and competency at graduation, the challenges they faced during compounding national crises, and how training institutions supported them and adapted GME to maintain training and well-being.</p><p><strong>Methods: </strong>In June 2024, we conducted a cross-sectional survey of graduating clinical residents including fellows and residents, in a large academic medical center in Lebanon. Thirteen questions were developed by a group of program directors from different specialties. Quantitative data assessed residents' self-perceived preparedness across six ACGME core competencies. In parallel, qualitative data explored the challenges residents faced, institutional interventions, and residents' recommendations. Descriptive statistics were used to analyze quantitative data. Qualitative analysis of open-ended survey responses was guided by Maslow's Hierarchy of Needs to understand residents' challenges, while inductive thematic analysis was used to synthesize the institutional strategies.</p><p><strong>Results: </strong>127 of 133 (95%) residents and fellows across a wide range of specialties, including medical-surgical specialties, completed the survey. Despite ongoing training disruptions, most residents felt well-prepared in core competencies, including 67% for patient care, 54% for medical knowledge, 57% for systems-based practice, 69% for communication skills, 72% for professionalism, and 61% for Practice-Based Learning and Improvement. Open-ended responses revealed that the crises provided opportunities for residents to develop their skills in the systems-based practice competency domain. Five themes on residents' challenges emerged: meeting basic needs, ensuring well-being, maintaining family and social life, fostering professional growth and clinical experience, and fulfilling career aspirations. Institutional strategies, particularly through the provision of essential financial support, structured emotional and psychological support programs, faculty and program leadership social support, sustained career support and supervision amid crisis, and career mentorship and support, helped maintain continuity in resident training despite severe challenges. Some challenges were beyond the institution's resources and control.</p><p><strong>Discussion: </strong>The unique resilience of Lebanese GME programs despite multiple external disruptions highlights the strengths and vulnerabilities of institutional support systems. While the study identified several significant challenges faced by residents and fellows, it underscored the importance of prioritizing their well-being, fostering a supportive learning environment, and developing crisis-relevant competencies to ensure the continued success of medical education in the face of future challenges.</p>","PeriodicalId":48532,"journal":{"name":"Perspectives on Medical Education","volume":"14 1","pages":"549-559"},"PeriodicalIF":3.9000,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12428328/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perspectives on Medical Education","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5334/pme.1721","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Graduate Medical Education (GME) systems often face disruptions. In Lebanon, repeated crises over the past several years, including political instability, economic collapse, the COVID-19 pandemic, and military conflict, raise questions about institutional support, clinical residents' preparedness, and the resilience of the GME system. This study aims to examine clinical residents' perceived preparedness and competency at graduation, the challenges they faced during compounding national crises, and how training institutions supported them and adapted GME to maintain training and well-being.
Methods: In June 2024, we conducted a cross-sectional survey of graduating clinical residents including fellows and residents, in a large academic medical center in Lebanon. Thirteen questions were developed by a group of program directors from different specialties. Quantitative data assessed residents' self-perceived preparedness across six ACGME core competencies. In parallel, qualitative data explored the challenges residents faced, institutional interventions, and residents' recommendations. Descriptive statistics were used to analyze quantitative data. Qualitative analysis of open-ended survey responses was guided by Maslow's Hierarchy of Needs to understand residents' challenges, while inductive thematic analysis was used to synthesize the institutional strategies.
Results: 127 of 133 (95%) residents and fellows across a wide range of specialties, including medical-surgical specialties, completed the survey. Despite ongoing training disruptions, most residents felt well-prepared in core competencies, including 67% for patient care, 54% for medical knowledge, 57% for systems-based practice, 69% for communication skills, 72% for professionalism, and 61% for Practice-Based Learning and Improvement. Open-ended responses revealed that the crises provided opportunities for residents to develop their skills in the systems-based practice competency domain. Five themes on residents' challenges emerged: meeting basic needs, ensuring well-being, maintaining family and social life, fostering professional growth and clinical experience, and fulfilling career aspirations. Institutional strategies, particularly through the provision of essential financial support, structured emotional and psychological support programs, faculty and program leadership social support, sustained career support and supervision amid crisis, and career mentorship and support, helped maintain continuity in resident training despite severe challenges. Some challenges were beyond the institution's resources and control.
Discussion: The unique resilience of Lebanese GME programs despite multiple external disruptions highlights the strengths and vulnerabilities of institutional support systems. While the study identified several significant challenges faced by residents and fellows, it underscored the importance of prioritizing their well-being, fostering a supportive learning environment, and developing crisis-relevant competencies to ensure the continued success of medical education in the face of future challenges.
期刊介绍:
Perspectives on Medical Education mission is support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices.
Official journal of the The Netherlands Association of Medical Education (NVMO).
Perspectives on Medical Education is a non-profit Open Access journal with no charges for authors to submit or publish an article, and the full text of all articles is freely available immediately upon publication, thanks to the sponsorship of The Netherlands Association for Medical Education.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.
Perspectives on Medical Education positions itself at the dynamic intersection of educational research and clinical education. While other journals in the health professional education domain orient predominantly to education researchers or to clinical educators, Perspectives positions itself at the collaborative interface between these perspectives. This unique positioning reflects the journal’s mission to support and enrich collaborative scholarship between education researchers and clinical educators, and to advance new knowledge regarding clinical education practices. Reflecting this mission, the journal both welcomes original research papers arising from scholarly collaborations among clinicians, teachers and researchers and papers providing resources to develop the community’s ability to conduct such collaborative research. The journal’s audience includes researchers and practitioners: researchers who wish to explore challenging questions of health professions education and clinical teachers who wish to both advance their practice and envision for themselves a collaborative role in scholarly educational innovation. This audience of researchers, clinicians and educators is both international and interdisciplinary.
The journal has a long history. In 1982, the journal was founded by the Dutch Association for Medical Education, as a Dutch language journal (Netherlands Journal of Medical Education). As a Dutch journal it fuelled educational research and innovation in the Netherlands. It is one of the factors for the Dutch success in medical education. In 2012, it widened its scope, transforming into an international English language journal. The journal swiftly became international in all aspects: the readers, authors, reviewers and editorial board members.
The editorial board members represent the different parental disciplines in the field of medical education, e.g. clinicians, social scientists, biomedical scientists, statisticians and linguists. Several of them are leading scholars. Three of the editors are in the top ten of most cited authors in the medical education field. Two editors were awarded the Karolinska Institute Prize for Research. Presently, Erik Driessen leads the journal as Editor in Chief.
Perspectives on Medical Education is highly visible thanks to its unrestricted online access policy. It is sponsored by theThe Netherlands Association of Medical Education and offers free manuscript submission.