From CME to CPD: getting better at getting better?

Individual learning portfolios may bridge gap between learning and accountability

See also p 432

Continuing medical education is part of the process of lifelong learning that all doctors undertake from medical school until retirement and has traditionally been viewed by the medical profession in terms of updating their knowledge. However, all career grade doctors need skills that extend beyond updating their medical knowledge in order to practise effectively in the modern NHS. Such skills include management, education and training, information technology, audit, communication, and team building. These broader skills are embraced by continuing professional development, which, in a welcome move last year, was endorsed by the Academy of Royal Colleges. Thus the colleges have now accepted responsibility for both continuing medical education and professional development of hospital doctors (with parallel arrangements for general practitioners1). The task is now to establish schemes and develop methods that both achieve the desired outcomes and are seen to do so.

The royal colleges are responsible for providing a framework for continuing professional development; setting educational standards; and monitoring, facilitating, and evaluating activities for their members. Their professional development schemes need to be flexible so that doctors can participate and be recognised for what they do in the context of their professional practice.2 At the same time individuals should be able justify their activities when subjected to external scrutiny. This will become increasingly important in relation to clinical governance,3 revalidation,4 and poor performance procedures, which are providing the impetus for continuing professional development to become mandatory.5

In the United Kingdom continuing professional development schemes are currently based on acquiring credits. The advantage of this system is that time devoted to continuing professional development can be measured and recorded. The disadvantage is that it encourages a “bums on seats” approach by both participants and providers of education. It should be the quality and relevance of the activities that is important, not the quantity.6 The undifferentiated pursuit of credits provides a false security blanket that may bear little or no relation to the real outcomes of activities aimed at professional development.

There needs to be a shift away from credit counting towards a process of self accreditation and reflection, recording learning that has occurred and applying it to practice. There is no single correct or best way of doing continuing professional development, and the methods chosen will depend on personal preference and appropriateness. They may range from self assessment multiple choice questions and journal reading to case discussions and visiting other departments or practices.7 Learning that occurs in the context of the daily workplace is far more likely to be relevant and reinforced, leading to better practice.8

No matter how innovative and flexible the schemes become, the greatest challenge is to manage the interface between the requirements of professional bodies and those of employers, managers, and patients in trusts and primary care groups. The process of professional development needs to be managed.7 The vast majority of doctors are good learners and have always just got on with their own continuing medical education and professional development—that is what being a professional means. However, the changing political climate and need to be more accountable mean that doctors now have to demonstrate that they are developing professionally and that their activities are educationally and cost effective and improve their practice.

One practical way of achieving this is through individual learning portfolios. Portfolios are not a panacea, but they are a useful tool which can be used to plan and record learning and incorporate personal development plans to form the basis of appraisal or peer review. They have been shown to be effective and efficient in primary care when compared with the traditional activities that enable general practitioners to claim educational payments.9 The portfolio can be subjected to external review and provide documentary evidence to support revalidation and, if necessary, contribute to assessment of performance. The portfolio can also provide a framework for individual doctors to identify both their own personal learning needs and those related to the organisation for which they work. Meaningful dialogue between trusts, managers, primary care groups, professional bodies, and the General Medical Council is needed to take this forward.

Individual doctors have a corporate responsibility through clinical governance and a personal responsibility through revalidation to maintain clinical standards and performance. Participation in effective continuing professional development underpins these layers of accountability. As a profession we need to be self confident enough to embrace a culture where continuing education and development, peer review, appraisal, and revalidation are not threatening concepts. The recent structural changes leading to the formation of primary care groups has provided an impetus for such change. It will be more difficult to embed the cycle of identifying learning needs; delivering learning structure; and reinforcing, disseminating, and reviewing outcomes in acute trusts. Increasing clinical workloads mean that it is difficult for many doctors to find time for professional development in the working week, let alone to reflect or use a portfolio. But unless we start to prioritise our tasks and make the time to build professional development into our practice we will not be able to show to the public that we are getting better at getting better.