WORKING AND LEARNING IN THE SERVICE Managing continuing professional development Professor Janet Grant Centre for Medical Education in Context [CenMEDIC] Open University University College London Medical School United Kingdom
WHAT IS CPD? Postgraduate Continuing Basic medical (specialty) professional education training development Maintenance Continuing Continuing of professional medical competence development education (North (Europe) (USA) America) Continuous………
CONTINUING PROFESSIONAL DEVELOPMENT For regulation For patient For cost- and licensing safety and effectiveness of the ethics profession For personal and For improvement professional of the healthcare development and service satisfaction To meet All should international contribute to standards improvement of the service
HOW CAN WE MAKE CPD DELIVER THESE BENEFITS? Collection of credits for activity is the most common system
IS COLLECTING CPD CREDITS EFFECTIVE? No Doctors can No rationale No evidence systemic participate for award of of effect on relationship just for ease credit practice to need or the meal….. Offers Indicates BUT… opportunities that CPD is Good for the for CPD important bureaucracy
THE CENTRAL PROBLEMS: Collecting credits is an isolated process, not systematically linked with personal or service need Credit recognition systems do not recognise actual effective ways of learning at senior level Learning is a process, not an event Credits can be offered for an effective learning process HOW!?
WHAT DO WE KNOW? From literature review, educational psychology and experience … . • A stated reason for the CPD to be done • An identified learning An effective CPD method process has: • Some follow-up AND>>>>>
Individual doctors vary considerably in their Much actual CPD is not preference for different credit bearing learning methods Changes to practice are CPD does make a more satisfying if they have difference, but programme arisen from personal planners must pay attention incentive rather than from to the circumstances under external pressures which it does CPD must be relevant to the Prevalence of self-directed individual in their own learning context
SO HOW CAN CPD BE…… Transparent and Regulated? accountable? Relevant to the Relevant to the interests of health care service? the individual clinician? Based on effective Cost effective? learning methods?
A SIMPLE 4-STEP PROCESS USE the LEARN learning to HOW reinforce will it be and apply learned? it WHAT will be learned?
BUT FIRST……… How do senior doctors learn? Research and experience tell us….
SITUATED LEARNING The process of professional education depends on immersion in practice It is from immersion in practice that effective CPD arises
THIS DOCTOR LEARNS IN HIS OWN WAY…….. There is no best method of learning. There is no widely shared preference. How people like to learn depends on context, culture and purpose. That is a challenge for credit-based systems that set different values on different ways of learning.
IS CPD AN ISOLATED EVENT? CPD is an integral part of a doctor’s professional life – it is not a separate stream
FACILITATING EFFECTIVE LEARNING Doctors learn effectively in many ways already There is no ‘best’ learning method: people vary Effective learning can be: specifically needs related for the doctor’s general professional development
SO WHAT WILL BE LEARNED IN THIS INDIVIDUAL WAY? Although sometimes there will be a need to teach health care professionals about a developing condition e.g. HIV, swine ‘flu……………. In general,……..
THERE IS NO CPD CURRICULUM And there should not be one that is pre- specified It must arise from the practice and judgment of doctors and from emerging health service needs.
ENSURE THAT LEARNING IS RELATED TO PRACTICE Doctors are unlikely to share many common learning needs: CPD needs arise from practice and judgment
DO WE NEED TO TEACH DOCTORS THE SKILLS OF EFFECTIVE LEARNING? The Good CPD Guide Can they identify their 48 methods of learning learning needs? needs assessment Do they meet the needs Planning CPD in relation of the health care to the development of the service? service Do they continue to 40 methods of learning learn? Do they show 41 ways of showing effectiveness & reinforce effectiveness and learning in practice? reinforcing learning
ALL WE NEED TO DO IS…… Build all this into a managed system for CPD
A SIMPLE 4-STEP PROCESS USE the LEARN learning and show HOW effects will it be learned? WHAT will be learned?
STEP METHOD EFFECT Ensures that intended learning • Reflection derives from: • Peer appraisal 1. IDENTIFY • personal need, • Context factors W H AT TO • professional [service needs] LEARN developments, • QA processes • needs of the health service
THE UK APPRAISAL PROCESS Peer review of doctor’s performance Personal reflection Consider doctor in the local healthcare service Set out development needs Agree learning plan Seek support for the learning
STEP METHOD EFFECT A rational and • Personal 2. PLAN transparent development HOW TO record is plan, or LEARN created other record
PERSONAL DEVELOPMENT PLAN An action plan, based on awareness, reflection, goal-setting and planning learning for personal development in the context of a career, the job, education, or self-improvement
STEP METHOD EFFECT In any way that is appropriate Learning is 3. LEARN to the need, personally the person, effective and the context
EFFECTIVE PROFESSIONAL LEARNING METHODS Academic Learning from Meetings activities colleagues Technology- Management Learning from based and quality practice learning and processes media Specially arranged educational events
STEP METHOD EFFECT Learning is • Dissemination 4. USE THE carried back to others LEARNING to the • Incorporation AND SHOW workplace and EFFECTS into practice service • Further learning
TAKING LEARNING BACK TO THE WORKPLACE Reviewing Teaching practice others Confirming Changing current practice practice
MANAGED CPD IN PRACTICE … You no longer need to count CPD hours. Instead: Reflect on your practice and identify your learning and development needs Plan how to address your needs and knowledge gaps Record and evaluate your activities, using downloadable templates http://www.sra.org.uk/solicitors/cpd/tool- kit/continuing-competence-toolkit.page
THE PROCESS Information How to How to reflect plan How to How to address record learning and needs evaluate
TEMPLATES
DECLARATION Appraisal or peer conversation Annual Declaration: I have reflected on my practice and addressed any identified learning and development needs Regulatory monitoring
CAN THE QUALITY OF CPD BE MEASURED BY OUTCOMES? Too many intervening and uncontrollable variables between learning and patient outcomes NO because The conditions of practice sometimes stop new learning being used Doctors must acquire new knowledge that may not be predictably used e.g. If patients do not require it
THE EVIDENCE IS POOR QUALITY They frequently fail to use Statistical analysis of control groups or data is often randomisation inadequate Issues of validity are frequently ignored Many studies are correlational and/or retrospective (and are thus unhelpful in terms of increasing the understanding of causal processes) Fail to isolate the Inadequate influences of particular measurement of activities from those of outcomes intervening variables
RESEARCH DESIGN IS DIFFICULT Too many uncontrolled, intervening, unmeasurable variables All different Learners CPD activity All different Changes in learners All different Changes in professional practice All different Changes in the outcomes of All different practice
The key to effective CPD is in how the process is managed: USE LEARN HOW ? WHAT?
MANAGED CPD CAN IMPROVE THE HEALTHCARE SERVICE BY: Deriving from health service needs Being tailored to the individual doctor's needs and practice Assuring return to practice Allowing a personal learning plan that suits the individual Transparent and monitorable Allowing targeted CPD when healthcare service development requires that
FORMAL RECOGNITION OF THIS PROCESS IS REQUIRED For credit or certification
Process Documentation Certification For the For the doctor For the service profession For transparency For regulation and accountability
USE the LEARN learning and HOW show effects will it be learned? WHAT will be learned? To help the profession to do better what it does well already.
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