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Continuing Professional Development Integration of Formal CME and Quality Improvement Initiatives
How to implement CPD?	Previous    Contents    Next

1. Financial incentives

Financial incentives must be available for both formal CME and QI initiatives. A better planned and managed system of CPD means visualising what resources are needed.

2. Accreditation procedures

Accreditation procedures must integrate both formal CME and QI initiatives. CME courses must be attended and specific goals in QI attained. Therefore CPD time should be used for both QI and formal CME.

A flexible system of accreditation is needed, covering re-certification (competency evaluation) and both practice and doctors accreditation (performance evaluation). The system should be designed to account for the diversity of adult learning and knowledge and acknowledge the doctor as a self-directed learner.

The system of accreditation has to be supportive, transparent and checked with the national authorities, the professional organisations and the scientific organisations. Transparency will encourage public trust. CPD should be constantly evaluated, prioritised and guided at a national level on efficiency, potentiality, acceptability, etc.

Any point system using credits has to include the broad range of CPD interventions. Thus the organisers of formal CME/CPD become less obsessed with the control aspect and more focussed on real learning needs and how these can be met.

The legal consequences of various systems of mandatory re-certification for all specialists need clarification before introducing new systems.

3. Formal CME and QI Initiatives organisers must work together

Colleges, universities, local authorities etc. involved in the organisation of formal CME meetings and those who organise QI must combine their efforts in organising effective interventions. The organisation of effective integrated interventions on this level has to be stimulated by knowledge and stepped planning. The establishment of a clinical task force with numerous areas of competence to produce theoretical, practical and situational knowledge is one way of achieving this.

Doctors themselves have to take the lead, using methodological guidance provided by experts.

Box 6 Peer group learning based on performance data improves practice Carlsen T, Bratland SZ, Claudi T, Cooper J, Telje J, Waaler HM Method: Between 1995 and 1998 the Norwegian Medical Association carried out a project to develop and to assess a quality improvement tool for use in general practice (SATS). This method combines self-directed learning, documentation of practice and peer group support. SATS defined performance indicators for registration of practice by means of the computerised patient record. Groups of 4-10 general practitioners used their own consultation data as a basis for learning cycles. The participants saw the possibility to compare their own practice with that of others as a good origin for learning. The group discussions gave support and constructive criticism, which are both important to the learning benefit. The participants discussed what were actually doing with patients, not what they assumed that they did. The strength of the method seems to be that it is linked to own data, that it is woven into the clinical everyday work, that it is discussed with colleagues and that the use is relatively simple. The participants provide the data themselves, independent of external support. This gives flexibility. The method presupposes full openness about data inside the group, but gives protection against the observation from outside. It is seen as crucial that the participants “own” their data and that they remain confident that the aim is professional development, not external control. Results: The practice evaluations indicate significant improvement in clinical work. The confrontation with own-recorded practice in a supportive peer environment is found to be a major force for change. The participants reported satisfaction with the method, and expressed an interest in trying out new topics. However, the project demonstrated the need for simplification of terminology, further development of group process methods and computer software. There is furthermore a need for strong local support of peer review groups.

4. The organisation of peer review groups should be promoted

The organisation of peer review groups should be promoted as a useful structure as long as it is organised as a secure and open environment for adult learning. Small- group work offers the opportunity for interactive education in a trusting environment. Establishing a peer review network would facilitate these actions. A tutor-training program enhances the facilities of the individual groups.

5. Start with simple and effective procedures

Clinical incident analysis, audit on prescription patterns of antibiotics, care for the diabetic patient and evaluation of organisational aspects of practice care are usually good starting points.

Box 7 Diabetic care and quality assurance: project in Israel Margalit Goldfracht

6. Education

Skills for integrated effective interventions should be acquired in undergraduate teaching and during vocational training. A positive attitude towards lifelong learning, evidence- based practicing, and the undergraduate and vocational training curriculum should encourage cost-effective outcome orientation.

7. Research

Establishing national research centres for CPD, working together in an international network, should support research on effective CPD.

EPOC: the Cochrane Effective Practice and Organisation of Care Group

The results and outcomes of CPD should be recorded and analysed.