The importance of continuing professional development in family medicine

Weng-yee Chin 陳穎怡

HK Pract 2015;37:81-82

This issue of The Hong Kong Practitioner highlights the diverse range of problems that family doctors in Hong Kong are called to deal with, from common eye conditions and tropical infection to acute cardiac events requiring defibrillation and resuscitation. Maintaining such diverse skills and competencies is an enormous challenge, and as highlighted in Dr Donald Li’s 26^th Dr Sun Yat Sen Oration,“Doctors have to work harder than ever before to stay at the forefront of their fields and to earn trust from their patients…..”.

We all want to be familiar with the latest developments in medicine and be able to offer our patients excellent and informed care. The role of Continuous Professional Development (CPD) is to keep doctors updated to help them remain competent throughout their career. This process of continuous learning also helps to improve our discipline as a whole. In many countries, such as the United States, Canada and the United Kingdom, CPD is mandatory for the revalidation of a doctor’s practicing license. The United Kingdom General Medical Council (GMC) launched mandatory revalidation for all medical professionals in 2012, a process by which all licensed doctors must demonstrate regularly that they are up to date, fit to practice, and providing quality care. United Kingdom doctors are now required to maintain a portfolio of supporting information that provides evidence on how they are meeting the profession’s values.1 Within the region, Singapore implemented compulsory Continuing Medical Education (CME) programme in 2003.² In Hong Kong, non-specialist doctors are encouraged to join a CME programme, whilst mandatory CPD is imposed for specialists.

Whilst participating in CPD activities is generally accepted as an important component of being a medical professional, demonstrating the impact of complex interventions such as CPD within a real world setting remains a significant challenge. To date, most of the evidence for the impact of CPD activities has typically been based on evaluations which report the changes in doctor’s perceptions or attitudes, or on their satisfaction with the learning process. Whilst many studies have found a positive correlation between reading and attending courses and subjective coping or job satisfaction, there is an ongoing debate about what types of CPD activities are more effective in enhancing quality of care and patient outcomes.³

Some believe that continuous medical education should not be viewed as separate from patient care. Rather, questions about patient care should provide the context for learning. It is important therefore that bodies who regulate CME and CPD accreditation understand how primary care doctors might wish to receive credit for self-directed learning and support doctors to maintain their competencies by allowing them easy access to high-quality resources, teaching them how to use it, and giving them credit for doing so.⁴ Over the last decade doctors in Norway have spent less time on attending courses and more time on medical reading. This changing pattern of professional self-learning may reflect a more general individualistic trend in society.⁵

Recent research suggests that CPD tends to be more effective when it is integrated with appraisal, linked to personal development plans and aligned with organisational objectives.³ CPD is more effective when time is provided for individuals to reflect on their learning after its completion. It is also more effective when organisational support is provided to facilitate changes to the way doctors practice following completion of such activities.³ Audits have been shown to be an effective strategy for creating behaviour change in doctors especially if they include targeted feedback.6 Group and peer review type interventions have also been shown to be feasible and effective.⁶

As family doctors we must always strive to improve outcomes for our patients. Well-designed CPD activities are important in helping clinicians maintain their competencies so that they can deliver high quality care. Careful consideration needs to be made about what a CPD programme entails, to ensure that the efforts made in fulfilling CPD requirements are effective in enhancing patients’ health outcomes.