The Good CPD Guide A Practical Guide to Managed

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The Good CPD Guide
A practical guide to managed continuing
professional development in medicine

Second Edition

Janet Grant
Professor of Education in Medicine
Centre for Education in Medicine
The Open University

Foreword by
Thomas Zilling
Associate Professor of Surgery, Lund University, Sweden
President, Swedish Association of Senior Hospital Physicians
Vice President, European Association of Senior Hospital Physicians

Radcliffe Publishing
London • New York
CRC Press
Taylor & Francis Group
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Boca Raton, FL 33487-2742

© 2012 by Janet Grant

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    v

Contents

Foreword vii
About the author ix
Acknowledgements x

INTRODUCTION: WHAT IS MANAGED CONTINUING

PROFESSIONAL DEVELOPMENT? 1
Background 1
What is managed CPD? 2
How does managed CPD fit into professional and regulatory 
environments? 4
Managed CPD, clinical governance and regulation 7
The effectiveness of continuing professional development 9
Effectiveness and the individual doctor 10

IMPLEMENTING MANAGED CPD 12

STEP ONE: IDENTIFY WHAT TO LEARN 13

How can learning needs be identified? 14
Should all CPD be based on specific learning needs? 15
How do doctors identify their learning needs? 15
Needs assessment based on the clinician’s own experiences in 
direct patient care 16
Interactions within the clinical team and department 20
Needs assessment based on the clinician’s non-clinical activities 22
Formal approaches to quality management and risk assessment 25
Specific activities directed at needs assessment 27
Peer review 31

STEP TWO: PLAN HOW TO LEARN − DOCUMENTATION 36

STEP THREE: LEARN 39

Learning in a profession 39
vi   CONTENTS

Right and wrong assumptions about doctors’ learning 42

Professional learning methods 44
Academic activities 44
Meetings 46
Learning from colleagues 49
Learning from practice 54
Technology-based learning and media 58
Management and quality processes 64
Specially arranged events 66

STEP FOUR: USE THE LEARNING AND SHOW ITS EFFECT 69

Reinforcing learning 69
Disseminating the CPD locally 70
Measuring the effectiveness of CPD: The challenges 70
Who benefits from CPD? 72
Types of change resulting from CPD: How can they be appreciated? 72
Showing the effectiveness of CPD 73
Methods of using CPD and showing its effects 74
The methods 76

Appendices
Appendix 1: Overview of the literature 106
Appendix 2: Appraisal record form template 157
Appendix 3: Methods of needs assessment 160
Appendix 4: A study leave application form 162
Appendix 5: Methods of professional learning 164
Appendix 6: Methods of using the learning and showing its effects 166
Appendix 7: A personal development plan 168

References 169
Index 172
 Foreword

CPD for change

Continuing professional development is unquestioned in modern-day society.
Knowledge-intensive organisations have to invest in their employees in order to
survive. This is especially important for the medical profession. Once specialist
certification has been achieved, the continuing process of lifelong learning is
in many countries unspecified. Cutbacks in funding for healthcare and a short-
age of doctors have brought into focus medical productivity and given ongoing
development and training of staff a lower priority. At the same time, one of
the most important challenges for doctors today is to raise the competencies
needed to increase patient safety and improve healthcare. With this in mind,
we are entering a political arena where CPD, in its limited form sometimes
still called Continuing Medical Education (CME), is used by some governments
and authorities to regulate mandatory learning standards for doctors. Today
there is a diversity of CPD systems worldwide, ranging from entirely voluntary
to mandatory by law. These are usually based on collecting credit points, as
an indicator of CPD activity. In some countries mandatory systems involve a
revalidation or recertification process run by either government authorities or
professional bodies.
A structure and process for CPD is necessary but not always at hand. Thus, the
new expanded second edition of The Good CPD Guide by Professor Janet Grant is
such an important contribution and fills the much needed gap, especially since
this comprehensive guide is based on evidence from current literature studies,
along with practical experience from the United Kingdom.
The Good CPD Guide includes all aspects of CPD such as quality improvement
– the actual process of CPD or managed CPD – quality assurance – a system for
physicians to prove to the public that they are capable of delivering top-notch
healthcare – and, finally, quality control – in the meaning of recertification as
applied in some countries.
The Good CPD Guide gives examples of how to introduce and follow up
CPD, and challenges countries with mandatory CPD systems based only on
CME-credit points to broaden and enhance their offerings. Professor Grant’s
recommendations advocate integrated learning, uniting theory and practice, in
an educationally friendly environment.
The development of CPD in the USA can also serve as an example for change
where systems for recertification and revalidation were introduced during the

vii
viii   FOREWORD

seventies. The Americans have gradually changed from CME towards CPD. A
good example is the ‘General Competencies’ from The Accreditation Council
for Graduate Medical Education (www.acgme.org) which include: 1 Patient
care, 2 Medical knowledge, 3 Practice-based learning and improvement, 4
Interpersonal and communication skills, 5 Professionalism, and 6 Systems-based
practice. Professor Grant’s CPD guide goes deeper and beyond these areas.
CPD is the key to excellent healthcare. Professional ethics should drive the
system and there should be adequate resources for the development of the
structure and process of CPD. This second edition of The Good CPD Guide is the
roadmap to where we stand today and where we are heading. This guide will
inspire not only physicians but also administrators, government officials and
healthcare organisations. This book is a must for everyone engaged in CPD for
the medical profession.

Dr Thomas Zilling MD, PhD

Associate Professor of Surgery, Lund University, Sweden
President, Swedish Association of Senior Hospital Physicians
Vice President, European Association of Senior Hospital Physicians
September 2011
 About the author

Janet is an educational psychologist and Professor of Education in Medicine

at the UK Open University Centre for Education in Medicine (OUCEM). Her
special interest is in how students, trainees and experienced doctors develop
knowledge and skill, and on the relationship between medical education and
clinical practice.
Janet works both nationally and internationally on medical education devel-
opment and regulation. She is an honorary member of three medical Royal
Colleges.

ix
 Acknowledgements

This new edition of The Good CPD Guide owes a lot to the work of those who
developed the first edition (1999). Subsequent research and policy develop-
ment have shown that the guidance and the conclusions of that edition remain
unchanged, even though the details of context have altered.
We would, therefore, like to acknowledge the work of the following key
players:

Ellie Chambers Mr Peter Milton

Dr Gordon Jackson Mr Vincent O’Neill
Mr Robert Atlay Prof Trudie Roberts
Dr Peter Bourdillon Dr Frank Smith
Dr Claire du Boulay Mr Adrian Steger
Dr Shelley Heard Mr Paul Thomas
Dr Mike Isaac Dr Alistair Thomson
Dr Doug Justins Dr Peter Toghill
Dr Gay Kingsley Mr Denis Wilkins
Dr Peter Luce Dr Helen Mulholland

x
 Introduction: What is managed
continuing professional
development?
Background
The role of continuing professional development (CPD) is now centre-stage in
the minds of regulators, educationalists and the profession. In terms of contin-
ued fitness to practise and patient safety, as well as maintaining professional
standards, a more thoughtful and transparent approach to CPD has gradually
become the accepted aim.
There are many competing and complementary definitions of CPD, depend-
ing on the main perspective; thus, for example, CPD can be:
‘A continuing process, outside formal undergraduate and postgraduate training,
that allows individual doctors to maintain and improve standards of medical
practice through the development of knowledge, skills, attitudes and behaviour.
CPD should also support specific changes in practice.’1

Or it is:
‘… a continuing learning process that complements formal undergraduate and
postgraduate education and training. CPD requires doctors to maintain and
improve their standards across all areas of their practice … CPD should also
encourage and support specific changes in practice and career development.’2

There is some debate about exactly how CPD can be mindful of its various
imperatives.
➤➤ How can CPD be transparent and accountable?
➤➤ How can CPD be regulated?
➤➤ How can CPD be relevant to the needs of a developing healthcare service?
➤➤ How can CPD be relevant to the needs of the individual clinician?
➤➤ How can CPD be cost effective?
➤➤ How can a CPD system ensure that the method of learning is effective?

The Good CPD Guide attempts to answer these pressing questions. We will do so
by presenting:
➤➤ An overview of CPD practice
➤➤ An overview of CPD policy
➤➤ An analysis of the evidence about the effectiveness of CPD.

Presentation of a system of managed CPD that answers the questions put above.

1
2   the good cpd guide

We also present management tools and documentation for CPD, as well as

describing ways of identifying learning needs, undertaking related learning and
reinforcing that learning.

What is managed CPD?

Managed CPD is a systematic approach to continuing learning and development
for medical practitioners which will:
➤➤ Relate CPD to the needs of the changing and developing healthcare service
➤➤ Ensure the personal and professional development of the individual doctor
➤➤ Provide an accountable and transparent system which can be used for
regulatory, quality assurance, revalidation and relicensure purposes.

The approach to managed CPD presented is based on the published literature,

the professional and regulatory environment, and on the established practice of
doctors who have integrated their own continuing learning and development
with the provision of patient care. We have no reason to believe other than that
the vast majority of doctors are already lifelong learners who take their own
current knowledge and skill very seriously indeed.
It is those good doctors to whom we turned to determine how they do, actu-
ally, keep themselves up to date.
The Good CPD managed process can be seen as the stages of What? How?
Learn Use:

Figure 1: The Good CPD managed process

This process of managed CPD is described further in Figure 2. The process out-
lined is based on the:
 INTRODUCTION: WHAT IS MANAGED CONTINUING PROFESSIONAL DEVELOPMENT?   3

➤➤ published literature on the effectiveness of CPD

➤➤ need for CPD to be incorporated into the regulatory process
➤➤ actual approaches of doctors in keeping themselves up to date.

Managed CPD not only responds to the demands of the regulatory system, but also
recognises that doctors have different learning needs, learn in different ways and in different
contexts.

Figure 2: The system of managed CP

Each of these components is discussed in the following chapters.

4   the good cpd guide

How does managed CPD fit into professional and regulatory

environments?
Lord Patel’s 2010 report to the UK General Medical Council3 states that:
‘Once outside formal training programmes, the onus is on doctors to demon-
strate that they are maintaining appropriate professional standards. The role
of the regulator is to support them in doing this and to monitor that it is done.

Good Medical Practice requires doctors to keep their knowledge and skills up to
date and encourages them to “take part in educational activities that maintain
and further develop” their competence and performance. In future, revalidation
will provide a focus for that formative activity. These elements will be brought
together through appraisal and continuing professional development (CPD) and
through each doctor’s Personal Development Plan.’

This picture is rapidly becoming the norm in a number of countries. CPD

is closely involved in professional development, service development, self-
regulation and external regulation. As such, it must be a transparent process
that is amenable to record. Some believe that the increasing regulatory burden
of revalidation will bring about positive changes in CPD itself.4 There are many
variations in CPD policy between countries in terms of:
➤➤ Whether CPD is mandatory or not
➤➤ Which authority regulates CPD
➤➤ The way in which compliance is counted and monitored (CPD credits which
tend to be counted as hours are the most common framework)
➤➤ The implicit model of learning
➤➤ What activities are recognised for CPD purposes
➤➤ Whether CPD providers and events are accredited or formally approved
➤➤ The consequences of complying or not complying with any CPD targets
➤➤ Relationship to relicensure or revalidation of registration.

These variations occur because of a relatively poor evidence base, different regu-
latory régimes, different ownership of the process and different purposes. The
design of CPD systems is therefore open to local judgment and context.
Although there are such variations between countries in the way CPD (also
still called continuing medical education, or CME, in many countries, including
the USA) is conducted, there are some commonly occurring themes.

The measurement of participation in CPD by accumulation of credits, or hours, is perhaps the

most commonly applied framework. Evidence would suggest that it is probably not effective in
ensuring that CPD has an impact on practice. Managed CPD addresses this issue.

Common themes, internationally, relate to regulation of the profession, reli-

censure of the individual doctor, quality assurance, and accreditation of CPD
 INTRODUCTION: WHAT IS MANAGED CONTINUING PROFESSIONAL DEVELOPMENT?   5

events, as well as the specification of recognised learning methods that will

accrue CPD credits. Found within these broad headings are a number of specific
entities such as portfolios, appraisal, and other forms of recorded activity. These
themes and entities are presented in Figure 4, in relation to the ability of a man-
aged CPD system to cope.
The process of managed CPD described here takes advantage of existing
mechanisms within the service and the profession: audit, critical incident meth-
ods, peer review, appraisal and other quality assurance measures can not only
contribute to needs assessment5, but also to learning itself, and reinforcement of
that learning. Current proposals for appraisal to be at the heart of revalidation6
ensure harmony between managed CPD and professional relicensing. In this
context, four influences on continuing medical education (as the authors term
it) have been identified7, as follows (Figure 3), which managed CPD likewise
takes into account:

Figure 3: Social, political, professional and service influences on CPD

Schostak et al.8 (2010) concluded that:

‘… CPD is valued and is seen as effective when it addresses the needs of indi-
vidual clinicians, the populations they serve and the organisations within which
they work.’

Managed CPD does all of these things.

6   the good cpd guide

The World Federation for Medical Education has set out global standards for
continuing professional development.9 These recognise the factors identified in
Figure 4.

Figure 4: How does managed CPD support the major features of CPD internationally?