title: Adapting continuing medical education for post-conflict areas: assessment in Nagorno Karabagh - a qualitative study.
abstract: BACKGROUND
  One of the major challenges in the current century is the increasing number of post-conflict states where infrastructures are debilitated. The dysfunctional health care systems in post-conflict settings are putting the lives of the populations in these zones at increased risk. One of the approaches to improve such situations is to strengthen human resources by organizing training programmes to meet the special needs in post-conflict zones. Evaluations of these training programmes are essential to assure effectiveness and adaptation to the health service needs in these conditions.
  
  
  METHODS
  A specialized qualitative evaluation was conducted to assess and improve a post-conflict continuing medical education (CME) programme that was conducted in Nagorno Karabagh. Qualitative research guides were designed for this post-conflict zone that included focus group discussions with physician programme participants and semi-structured in-depth interviews with directors of hospitals and training supervisors.
  
  
  RESULTS
  Saturation was achieved among the three participating groups in the themes of impact of participation in the CME and obstacles to application of obtained skills. All respondents indicated that the continuing medical education programme created important physician networks absent in this post-conflict zone, updated professional skills, and improved professional confidence among participants. However, all respondents indicated that some skills gained were inapplicable in Nagorno Karabagh hospitals and clinics due to lack of appropriate medical equipment, qualified supporting human resources and facilities.
  
  
  CONCLUSIONS
  The qualitative research methods evaluation highlighted the fact that the health care human resources training should be closely linked to appropriate technologies, supplies, facilities and human resources available in post-conflict zones and identified the central importance of creating health professional networks and professional confidence among physicians in these zones. The qualitative research approach most effectively identifies these limitations and strengths and can directly inform the optimal adjustments for effective CME planning in these difficult areas of greatest need.
authors.affiliation: Fund for Armenian Relief of America (FAR), Healthcare Department, #22 Khorenatsi Street, Yerevan, Republic of Armenia. arinbalalian@gmail.com.
authors.forename: Arin A
authors.initials: AA
authors.lastname: Balalian
authors.forename: Hambardzum
authors.initials: H
authors.lastname: Simonyan
authors.forename: Kim
authors.initials: K
authors.lastname: Hekimian
authors.forename: Byron
authors.initials: B
authors.lastname: Crape
mesh_terms: D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003695:Delivery of Health Care; D004502:Education, Medical, Continuing; D005260:Female; D017144:Focus Groups; D006295:Health Resources; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010820:Physicians; D015397:Program Evaluation; D036301:Qualitative Research; D014154:Transcaucasia; D014857:Warfare
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