Continuing Professional Development

for Health Professionals

Khalid Bin Abdulrahman, MD, DPHC, ABFM, MHSc (MEd)

Associate Professor of Family Physician

Director of Medical Education CenterCollege of Medicine , KSU

Keeping Up"No one, who wishes to practice medicine,either with safety to others, or credit to himself,will incline to  remain ignorant of any discoverywhich time or attention has brought to light.  But it iswell known that the greatest part of those who areengaged in the actual prosecution of this art, haveneither leisure nor opportunity for very extensivereading.

Sr. Andrew Duncan, 1773, Medical and Philosophical Commentaries

By the end of this session you will be able to:

• Define what is CPD and CME?• Recognize why physicians change their

performance?• Understand how physicians change their

performance? How physicians learn?• Recognize does CME make a different in

medical practice and patient care?

• What are the factors that affect decision making to participate in formal CME ?

• What are the obstacles to participation in CME?

What is CPD

What is CPD?

CPD is a process of lifelong learning for all individuals and teams which meets the needs of patients and delivers the health outcomes and healthcare priorities of the health sector and which enables professionals to expand and fulfill their potential.

Continuing - life long learning, an ongoing process regardless of your age or the stage of your career

Professional - focused on yourpersonal / individual competence at work / in a professional role

Development - improve your personal skills to improve patient care and your career progression

What is CPD?

Another definition of CPD:

• CPD is a systematic, ongoing, cyclical process of self directed learning

• It includes everything you learn which enables you to do your job (current or future) more effectively

• It is a partnership between the individual and the organisation

• The main responsibility for your development lies with you. The organisation for whom you work has a responsibility for helping you to meet the development needs which relate to performance in your current job

• CPD is a general concept and can be used by everyone (pharmacists, technicians, assistants and other support staff)

What is CME

Definition• CME is a continuing process that involves

practicing physicians, practice environments, learning resources, and interventions designed to improve the ability of physicians to provide better medical care to patients

Davis DA, Fox RD. The Physician as Learner: Lining Research to Practice. American Medical Association, Chicago, Ill, 1994

The Broader Definition

• Attendance at formal CME activities is part of a broader search for information

• The search includes not only participation in formal conferences, but reading, consulting with peers & experts and other form of SDL

Why physicians change their performance?

What are the factors that affect decision making to participate in

formal CME ?

Decision-making modelContext of medical practice

Awareness of needs

Attitudes toward education

Goals and expectations

Opportunities and barriers

Decision to attend

The Purpose of Participation

• To keep up with advances in medicine

• To validate previous learning

• To review or refresh previous learning

• To prepare for board examinations

• To obtaining CME credits

• To reduce the possibility of malpractice

• To get away from busy practice

• To get fun and recreation

• To returning back to academic medicine

What are the obstacles to participation in CME?

Obstacles to Participation

• Constrains of practice

* Heavy patient load

• Conflict with family and community responsibilities

• Cost of CME and loss of patient income

What might make it difficult for you to practise CPD and document it?

• Time

• Motivation

• Lack of understanding of what’s involved / how to do it

• Money / resources (people)

• Lack of mentors / facilitators

• Lack of administrative support

• Unwillingness to include personal information in portfolio?

• Lack of knowledge of benefits

• Lack of a formal appraisal / performance review system

• Perceptions of others’ (e.g. senior managers’) roles

Shift towards learner-centred education

• Old think– Passively listening to

lectures– Educator decides

topic– Read a journal or

text book– Errors should be

forgotten / denied

• New think– Actively participate in

learning– You decide the topic– Problem solving,

simulated cases– Errors are a learning

experience

Wyatt JC. Clinical Knowledge… in the Information Age London: RSM, 2001

Does CME make a different in medical practice and patient care?

Reviews of the evidence :

“Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion,health care outcomes.

Based on a small number of well-conducted trials, didactic sessions do not appear to be effective in changing physician performance.”

Davis D et al. Impact of formal continuing medical education: do… continuing education activities change physician behaviour or health care outcomes? JAMA 1999 Sep 1;282(9):867-74

Emerging evidence supports complex interventions

the complex educational intervention

exemplified the best form of knowledge translation (the integration

of knowledge into practice), moving the practitioner from

Davis D. Clinical practice guidelines and the translation of knowledge: the science of continuing medical education. CMAJ 2000; 163 (10 ):1278-9

– awareness of new guidelines

– to agreement with the guidelines and

– finally to adoption and adherence,

following well-defined patterns of adoption and based on principles of adult learning applied to CME.

Davis D. Clinical practice guidelines and the translation of knowledge: the science of continuing medical education. CMAJ 2000; 163 (10 ):1278-9

What content and how to update?

“Of 217 drug therapy guidelines developed or endorsed by Canadian organizations in the period 1994–98, only 15% met half or more of the authors' criteria for rigour in the developmental process, and only 7% were rated

by independent reviewers as sound”

Time to weed the CPG garden CMAJ 2001;165(2):141, 143

How to interact?

A critical mass of practitioners can benefit from a virtual community.

Roberts C, Fox N. General practitioners and the Internet: modelling a 'virtual community'.

Fam Pract 1998 Jun;15(3):211-5

PCDQ – Learning from your own clinical data

www.pcdq.org

Online CME: Family Practice

Last Updated April 25, 2004.

http://www.cmelist.com/family_practice.htm

How do you go about it?

• The CPD cycle

The CPD cycle is very important and underpins and provides a framework for all CPD activities

The CPD cycle

Reflection

• Identify your development needs

• Reflect or think about what you have done, how you did it and how you could do it better or differently, or apply that insight in the future

• Takes practice to develop

How might you do this?

• Critical incident analysis (positive and negative)Personal SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis

• With your line manager during your appraisal

Planning• How will you meet the development

needs you have identified? • What level of competence do you need to

achieve? • What is your preferred style of learning? • How important are these needs in

relation to each other? • What style of learning will you use?

Ways of meeting your development needs

Overhead 6

Lectures Audit

Action learning sets

Study days Meetings Reading

Computer assisted learning

Action

• Do what you have planned and record it

How might you record your CPD? • In any way that suits and works for you

• Computer

• Notebook

• Portfolio – whatever documentation you use is your portfolio

• May use resources and portfolios already available

Evaluation

• This is a very important stage to complete the cycle where you assess how effective your learning has been

• Consider– Have you achieved your intended outcomes? – How has your practice changed as a result?– If it hasn’t, what are the reasons? Are you

How might you use / apply the knowledge / skills in the future?

Evaluation/ action form

When did you last participated in educational event:• What messages did you take home?• Have you acted on them?

Issues studied today: (1) (2) (3)• What did you like?• What did you dislike?• What would you act on?• Reflection is the “mantra” through the entire process

Challenges for CME

relevance to practice

changes physician behavior

based on current best scientific evidence

CME has value when it results in….

–quality patient care

–state-of-the-art patient care

–evidence-based patient care

Usefulness Equation

Usefulness = Relevance x ValidityWork

--Allen Shaughnessy, David Slawson, 1994

Thank you