Comment

Reflecting on our new CPD guidance

Professor Sir Peter Rubin, chair of the General Medical Council, explains the role of doctors and employers in the new CPD guidance.

We have recently published new guidance to help doctors across the UK keep their knowledge and skills up to date throughout their working life.

‘Continuing professional development: guidance for all doctors’ aims to help doctors as they reflect on their practice and prepare for revalidation.

It doesn’t tell doctors what CPD they need to do or how much, but guides them in planning, carrying out and evaluating their CPD.

Responsibility

Our guidance makes it clear that doctors must take responsibility for identifying and addressing their own CPD requirements and in doing so they must consider the needs of their patients and the teams and service in which they work. In other words, CPD cannot be just a private matter: it must be relevant to a doctor’s professional practice and focused on improving the quality of care given to patients and the public, now or in the future.

By emphasising the needs of patients and the service, our guidance also highlights the importance of appraisal, personal development plans (PDPs) and job planning when it comes to identifying CPD needs and supporting doctors in meeting those needs. This should help employers and contractors to plan and coordinate the CPD needs of their staff and monitor the effectiveness of doctors’ CPD activities.

Doctors are accountable to us for keeping their knowledge and skills up to date, but employers are responsible for making sure their workforce is competent, up to date and able to meet the needs of the service and the requirements we set. This means facilitating access to the resources – including the information systems and time to learn – that will support this.

The current economic climate makes this a challenge, but doctors will be better able to maintain and improve their performance, and that of the service in which they work, where employers create a culture of learning. This applies whether a doctor is a consultant, staff grade, specialty or associate specialist doctor, sessional GP, locum or trainee.

It helps that the new guidance tries to move the CPD story on from the idea that professional development is all about attending courses and conferences, and accumulating hours and credits. While acknowledging the importance of these things, the guidance points out that CPD covers any learning that helps a doctor maintain and improve their performance. It notes that opportunities for learning and reflection about performance will arise spontaneously from day-to-day practice. This can be one of the most fruitful and relevant forms of CPD because it links directly with everyday work.

And when it comes to appraisal and revalidation, the appraiser will be interested in how a doctor’s CPD inputs are intended to enhance the quality of their practice and how they plan to develop or change their practice as a result of learning and reflecting on their performance.

Providing a framework for CPD discussions and encouraging reflection

CPD is intended to be developmental. We have not set a mandatory minimum number of CPD hours per year for doctors, nor do we want to set a regulatory minimum requirement for participation.

That doesn’t mean doctors can simply ignore our guidance and stop doing CPD. Far from it. Our guidance states clearly that doctors must remain competent and up to date in all areas of their practice and be able to show, through revalidation, that they are doing so and following recognised best practice in their speciality. Our view is that we are not close enough to the circumstances of every doctor’s practice to know how much CPD, or what type of CPD, is appropriate for every individual.

The place where individual developmental needs are more usefully discussed is in the workplace, in light of the best practice for the specialty described by the relevant college, faculty or specialist association.

What our guidance does is provide the framework within which those discussions about CPD can take place and the key element is reflection.

‘Good Medical Practice’ requires doctors to reflect regularly on their standards of medical practice. There is evidence that reflection drives change in performance and is key to effective CPD.1 The difficulty, however, is knowing whether your CPD is effective.

We acknowledge that it is often not possible to measure directly the effect of a particular CPD activity on patient outcomes. But this need not diminish the value of the activity. The point is to identify CPD activities aimed at improving the quality of care provided for patients and the public.

To help us better understand the impact of CPD activity, and supplement the new guidance, we have commissioned research into how participation in CPD affects doctors’ practice and performance and contributes to improvements in patient or service outcomes. The research will also try to identify examples of innovative practice in CPD that have resulted in demonstrable changes in the way care is provided. The results are expected later in the summer.

Our facilitative role in CPD

Our new guidance and research reflects our expanding interest in the subject of doctors’ CPD as a key component of revalidation. Now that the guidance is published, we are starting to develop a more facilitative role in CPD. In broad terms, this means we are using our position as regulator, and using the data that we hold, to provide better information about trends in medical practice and professionalism that may be relevant to doctors’ reflections on their CPD needs.

Until recently the GMC held very little information about either individual doctors or trends across the profession as a whole. That is changing. For example, research shows that doctors pose a higher regulatory risk at key transition points in their careers. International medical graduates are more likely to face challenges in making the cultural transitions necessary for medical practice. The GMC has a role in promoting the sort of good practice which will help doctors make these transitions and highlighting areas where individuals may need to reflect on their own practice and learning needs.

Two studies we commissioned on prescribing errors2 demonstrated, in the different environments of primary and secondary care, that human factors (that is, the interaction between doctor and system), rather than educational deficits as such, are the principal cause of prescribing errors. Understanding that, and reflecting on how to address it within a doctor’s own practice, is potentially enormously powerful.

All this does not mean that we have plans to step in and become a provider of CPD. In most cases it will be others, such as the medical royal colleges’ faculties and specialist associations, who have the relevant expertise to do this. Nor does it mean we will be specifying certain CPD activities for doctors to undertake. But, particularly for those doctors who are not affiliated with particular professional organisations, we will be able to highlight issues so that they can reflect on their individual CPD needs with their appraisers. The new guidance will help them to do that.

The importance of lifelong learning

Continuous advances in medical science mean that all doctors need to ensure they are always at the leading edge of medical practice.

Lifelong learning is the key to ensuring that doctors keep up to date and this new guidance will support doctors in their efforts to achieve this and in their preparation for revalidation. We hope they will use it to reflect on how their learning and development improves the quality of care they provide for patients and for the service in which they work.

Tell us what you think – have your say below, or email us directly at [email protected]