Continuing Professional Development for Health Professionals

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Continuing Professional Development for Health
Professionals

• Khalid Bin Abdulrahman, MD, DPHC, ABFM, MHSc
  (MEd)
• Associate Professor of Family PhysicianDirector
  of Medical Education Center
• College of Medicine , KSU

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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 discovery
• which time or attention has brought to light. 
  But it is
• well known that the greatest part of those who
  are
• engaged in the actual prosecution of this art,
  have
• neither leisure nor opportunity for very
  extensive
• reading.
• Sr. Andrew Duncan,
• 1773, Medical and Philosophical
• Commentaries

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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?

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

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• What are the obstacles to participation in CME?

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What is CPD
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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.

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What is CPD?
Continuing - life long learning, an ongoing
process regardless of your age or the stage of
your career
Professional - focused on your personal /
individual competence at work / in a
professional role
Development - improve your personal skills to
improve patient care and your career progression
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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

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• 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

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

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What is CME
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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

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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

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Why physicians change their performance?
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What are the factors that affect decision making
to participate in formal CME ?
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Decision-making model

• Context of medical practice
• Awareness of needs
• Attitudes toward education
• Goals and expectations
• Opportunities and barriers
• Decision to attend

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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

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• To reduce the possibility of malpractice
• To get away from busy practice
• To get fun and recreation
• To returning back to academic medicine

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What are the obstacles to participation in CME?
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Obstacles to Participation

• Constrains of practice
• Heavy patient load
• Conflict with family and community
  responsibilities
• Cost of CME and loss of patient income

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

• Time
• Motivation
• Lack of understanding of whats involved / how to
  do it
• Money / resources (people)
• Lack of mentors / facilitators
• Lack of administrative support

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• 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

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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
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Does CME make a different in medical practice and
patient care?
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Reviews of the evidence
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• 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.

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• 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 1282(9)867-74

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Emerging evidence supports complex interventions
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• 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
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• 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
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What content and how to update?

• Of 217 drug therapy guidelines developed or
  endorsed by Canadian organizations in the period
  199498, 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
  2001165(2)141, 143

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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 Jun15(3)211-5

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PCDQ Learning from your own clinical data

• www.pcdq.org

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• Online CME Family Practice
• Last Updated April 25, 2004.
• http//www.cmelist.com/family_practice.htm

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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

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The CPD cycle
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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

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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

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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?

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Ways of meeting your development needs

• Lectures Audit
• Action learning sets
• Study days Meetings Reading
• Computer assisted learning

Overhead 6
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Action

• Do what you have planned and record it

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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

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Evaluation

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

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• Consider
• Have you achieved your intended outcomes?
• How has your practice changed as a result?
• If it hasnt, what are the reasons? Are you How
  might you use / apply the knowledge / skills in
  the future?

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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

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Challenges for CME

• relevance to practice
• changes physician behavior
• based on current best scientific evidence

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CME has value when it results in.

• quality patient care
• state-of-the-art patient care
• evidence-based patient care

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Usefulness Equation

• Usefulness Relevance x Validity Work
• --Allen Shaughnessy, David Slawson, 1994

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Thank you