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Continuing Professional Development Integration of Formal CME and Quality Improvement Initiatives
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Contextual changes

The medical scenery is constantly changing necessitating new concepts, strategies and options concerning services, education and quality. Science and knowledge, especially medical knowledge, change rapidly, leading to a limited lifetime for a "diploma". In each country Governments policies result in changes from "medicine by status" to "medicine by contract".

Modern high technology care, changes in demography, morbidity and social needs, growing expectations of patients, the demand of a humanistic approach and many other issues, as doctors' shift to part-time work, development of electronic communication and free movement between countries are going to have their impact on education and quality as well as on expectations towards the medical profession. In addition, the pharmaceutical industry is also changing its strategies with increasing use of scientific evidence.

Authorities stress the importance of basic knowledge and skills in the field of quality management for professionals in health care. Data should be collected and produced at local, regional and national levels in order to underpin assessment and decisions concerning policy and development.

Continual medical education and quality improvement

Until now, most of the formal Continuing Medical Education (CME)* -programmes have been offered as separate entities. Traditional formal CME programmes have emphasised teaching. Inspiring new approaches to continuing medical education focus on active learning. Quality Improvement (QI) activities have also been developed, and are mainly organised as separate activities.

The emerging requirements of health care systems focusing on outcome and cost-efficiency combined with the new learning paradigms, focusing on knowledge, competence and performance, set the scene for integrating the more traditional options for Continuing Medical Education and Continuous Quality Improvement, and put more and more emphasis on Continuing Professional Development Planning.

General Practice should be open to evaluation. Quality assessment and development is essential, irrespective of the employment status of family physicians. Continuing medical education can be an important instrument in Quality Assurance. (WHO, Regional office for Europe, 1998).

Recent large-scale review work demonstrates that didactic CME lectures don't lead to changes in performance. Broadly defined interventions using practice-enabling or reinforcing strategies are needed. These strategies consistently improve physician performance and in some instances, health care outcomes.

Professional development, continuously striving to enhance the competence necessary to meet the needs of patients and societies served, is a legal and ethical obligation. CPD should be based on the learners experiences. Effective CPD starts from perceived needs of the professional. The doctor should be seen as a self-directed learner (Hans A. Holm).

This document shows several ways to link traditional CME with Quality Improvement initiatives. Quality Improvement is a rapidly evolving discipline using specific methods and instruments. There is a big need for education in Quality Improvement. There is also a big need for evaluation of the quality of current CME.