Redesigning Continuing Education in the Health Professions (2010) / Chapter Skim
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Appendix C: International Comparison of Continuing Education and Continuing Professional Development
Appendix C: International Comparison of Continuing Education and Continuing Professional Development
Pages 233-252
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From page 233... ...
emphasizes the importance of internationally comparable data for advancing the study of CE. Cross-fertilization of innovative education mod els provides comparative formative and summative evaluations to validate and improve best practices while leading the way toward international coherence on the training, registration, and continual assessment of health professionals (Merkur et al., 2008b)
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The literature search, performed in December 2008, included the EBSCO, OVID, Academic Search Premier, and Medline databases. Keywords included continuing professional development, European learning, international, continuing education, nursing, pharmacy, medicine/medical, dental/dentistry, accreditation, revalidation, and competence.
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COMPARATIVE EXAMPLES OF CONTINUING MEDICAL EDUCATION In a series of articles in the British Medical Journal exploring how the United States can improve its health care system, Quam and Smith (2005) argue the United States could improve its continuing medical education (CME)
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236 REDESIGNING CE IN THE HEALTH PROFESSIONS TABLE C-1 Continuing Medical Education -- An International Comparison Ways of Ensuring Competence Country CME or CPD Peer Review Compulsory Australia CPD No No Austria CME Yes Yes Belgium CME & CPD Yes No Canada CPD Yes No France CME Yes Yes Germany CME No Yes for government employees
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Lawsuits by National Councils regional councils for Continuing Medical Education (professional bodies) Reduced Regional 250 45-minute credits reimbursement; chambers of over 5 years accreditation physicians withdrawn (professional bodies)
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238 REDESIGNING CE IN THE HEALTH PROFESSIONS TABLE C-1 Continued Ways of Ensuring Competence Country CME or CPD Peer Review Compulsory Italy CPD No Yes The Netherlands CME & CPD Yes for specialists Yes New Zealand CPD No Yes Spain CME (9 of 17 No No regions) United Kingdom CPD Yes: 360° Pending feedbacka United States CME No Yes NOTE: CME = continuing medical education; CPD = continuing professional development.
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body) Forced work Medical colleges Variable by region supervision; loss of and faculties and college registration (professional bodies)
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TABLE C-2 Synthesis of Models for Assessing Continuing Competence 240 Countries Using Models for Assessing Continuing Competence Pros Cons the Model Learning Model: CE seeks to improve clinical competence Seeks to improve Does not identify poorly Australia clinical competence performing professionals Austria Belgium Canada France Germany Italy The Netherlands New Zealand Spain United Kingdom United States Assessment Model: Responsie Assessment: assessment when a Potential to Cannot identify all poorly None emphasizes both complaint or problem occurs identify poor performing professionals performance and performers and requires centralized competence complaint system Periodic Assessment: full assessment of all Potential to Very ambitious and None domains of competence for all physicians identify poor potentially unfeasible performers
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Screening Assessment for All: identifies Potential to No single screening test Austria incompetence using peer review and identify poor has been developed that France patient questionnaires performers reliably and practically Hungary indicates poor performance Ireland The Netherlands Slovenia United Kingdom Screening Assessment for High-Risk Groups: Potential to May contravene privacy None assesses poorly performing professionals identify poor laws and requires a (e.g., based on patient outcomes or performers database of physician prescribing patterns) or targeting groups performance measures using other known qualities (i.e., older doctors)
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. Most notably, a 2001 government inquiry into pediatric cardiac surgeries performed at Bristol Royal Infirmary focused attention on poor clinical teamwork, a severe lack of performance data, and an absence of reflective practice.
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To be recertified, a doctor must meet the CPD standards set by his royal college before being said to be "in good standing." In 2001, the NHS made annual appraisal compulsory for all doctors in England. This process requires the formation of a personal development plan with identified learning needs relevant to the competencies developed by their respective specialist associations.
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. Professional medical bodies tend to regulate CME in most Western European countries, sometimes within legal frameworks established by national governments; in other countries, however, insurers may require physicians with whom they contract to fulfill specific CME requirements (Merkur et al., 2008a)
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As a result, in January 2008, the Canadian Medical Association convened a meeting of national specialty societies and related medical organizations to discuss issues related to online CME, particularly how the sources of funding might be identified. A study published in 2003 by a team of Scottish researchers found that the pharmaceutical industry funded approximately half of CME in the United Kingdom.
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, an organization that promotes high standards of dental education to its membership of European dental schools, specialist societies, and national dental bodies, has emphasized that undergraduate education should "act as a springboard which engenders the concept of continuing professional development and life long learning" (Cowpe et al., 2008, p.
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Mandated professional development plans are one means of reflection and thus may be an appropriate vehicles of CE for dentists. COMPARATIVE EXAMPLES OF CONTINUING PHARMACEUTICAL EDUCATION A report prepared for the International Pharmaceutical Foundation (FIP)
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The Pharmacy Workforce Survey, administered in 2005, surveyed 37 countries representing each of the six World Health Organization regions: 9 of the 37 countries had mandatory CE for individual pharmacists (International Pharmaceutical Federation, 2006)
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SOURCE: International Pharmaceutical Federation, 2006.
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. The 2005 examination of CE by the British Medical Journal acknowledges widespread acceptance that systems to ensure com petence should be nonpunitive, with efforts focused on professional development (Kmietowicz, 2005)
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2000. Continuing medical education and continuing professional development: International comparisons.
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British Medical Journal 336:742-743. UK Department of Health.
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