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Continuing Professional Development Integration of Formal CME and Quality Improvement Initiatives
Conditions for starting integrated CPD interventions	Previous    Contents    Next

1. Pre-course needs should be assessed

QI provides methods for pre-course needs assessment. Needs perceived by patients or other partners eg patients can be detected. Clinical audit can reveal areas needing attention. Evaluation of physician performance (according to stated indicators) can be the starting point for detecting areas requiring improvement.

2. Start from a need in the practice

Personal engagement can be encouraged by allowing individuals to choose their own outcome topics. However patient, society and health care needs should also be addressed.

CME topics should focus on specific, well defined, problem-based topics, where improvement is possible and readily applicable in practice. CME topics should be suitable for Q work.

Formal CME programmes should not only consist of credit collection to fulfil the demands set by authorities etc, but be based on assessment of needs.

3. Personal development plans and portfolio learning helps the individual professional to plan CPD

A personal development plan is based on the results of an appraisal meeting (interview), which discovers the areas most suitable to further professional development. The process covers the personal needs of the doctor and the needs of the service. The Personal Development Plan (PDP) must be a comprehensive document that records the outcome of the appraisal. The PDP describes the proposed CPD activities, how the need was identified, how CPD will be reinforced or disseminated and how effectiveness will be shown.

A learning portfolio is a comprehensive record of learning events, along with evidence of outcomes. It may content logbooks, research of practice, research proposals, clinical data, “jottings” (ideas, thoughts, insights, challenges) and a reflective commentary in which the individual identifies what has been learned.

The portfolio provides a way of assessing professional development.

4. Include practice enabling and reinforcing strategies in formal CME programmes

Figures about performance data on the subject of CME and reinforcing strategies may have considerable impact on implementation of guidelines. Well-structured feedback techniques may improve the quality of certain clinical procedures (cervical smears, laboratory requests).

Box 8 Effect of routine individual feedback, over nine years general practitioners requests for tests Methods: The Diagnostic Coordinating Centre Maastricht has provided feedback continuously since 1985, resulting in a more rational use of tests and fewer requests. They report the effects of nine years of feedback. They also investigated its effects on requests for tests that were not advised but had a recommended alternative. Written feedback is given twice a year, with comments on inappropriate requests and suggestions for more rational testing. Rationality can be assessed because forms contain clinical data on patients. Results: Annual data were analysed for each test and each doctor from 1983 to 1993. The effects of feedback are assessed by comparing trends in the number of requests for 44 common tests in our region and a control region. From 1984 to 1993 the mean annual decrease in the number of requests in the Maastricht region was 3.5%, leading to a total decrease of 29% from 1984 values in 1993. A transient increase occurred in 1989. Requests for individual tests decreased by up to 98%. The number of requests for the 44 common tests decreased by 45% between 1984 and 1993 (mean annual decrease 6%) in the Maastricht region, but it increased continuously in the control region (mean annual increase 3.2%) (P<0.001, Mann-Whitney U test). If the trend in the Maastricht region had been the same as that in the control region the number of requests in 1993 would have been about double.