#KEYLIMEPODCAST 363: CPD – good in theory, not in practice?

Reference

Weise, A et al Doctors\’ attitudes to maintenance of professional competence: A scoping review. Med Educ. 2022;56:374–386.

Reviewer

Linda Snell (@LindaSMedEd)_

Background

CME -> CPD -> Maintenance of Professional Competence (MPC) programs are supposed to facilitate doctors\’ lifelong learning thus leading to high-quality, safe patient care. Many formats are included under the umbrella: knowledge self-assessments, examinations, quality improvement projects, appraisal, peer and patient feedback and continuing professional development activities. Some, like interactive CPD, appraisal, review of patient complaints and multisource feedback, impact doctors\’ knowledge, skills, attitudes or behaviors.

As they have become mandatory (and are called many things now regulators are involved: revalidation, recertification, relicensing, maintenance of licensure), the requirements can be perceived as bureaucratic and irrelevant, leading to disengagement, frustration, cynicism. This might lead to doing CPD as a ‘a tick-box exercise, creating an impression of compliance without learning or behavior change’

Doctors\’ attitudes and beliefs about MPC are critical to translating regulatory requirements into committed and effective lifelong learning.

Purpose

We aimed to summarize knowledge about doctors\’ attitudes to MPC to inform the development of MPC programs and identify under-researched areas.’  Of interest, the research team included a range of stakeholders: the regulator, the training bodies who administer the program, the health service and patients.’

Key Points on the Methods

Scoping review following Arksey and O\’Malley, looking at evidence about doctors\’ attitudes to MPC in the United States, the United Kingdom, Canada, Australia, New Zealand and Ireland.

Broad search of original research papers, commentaries and letters containing empirical data, and government or organization reports and consultation documents, in English.

Used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)

A clear description of search terms and strategy, eligibility criteria, selection and collation given.

Key Outcomes

125 papers included – 102 peer-reviewed publications, 23 reports.

Most were from the past 20 years; from UK, USA; involved 1 or more disciplines / specialties; and used quantitative (47) mixed methods (46) or qual (32).

There was ‘agreement across jurisdictions (despite differences in formats) that MPC is a good idea in principle but doubt that it achieves its objectives in practice.’

Purposes: development and regulation: ‘help improve the good, pick up the bad’

Mixed attitudes to the processes of MPC, and their impact on learning and practice. A recurring theme: lack of connection between MPC and practice.  This despite some evidence to the contrary.

Doctors valued some aspects especially those that were formative and developmental, like self-assessment, significant event analysis and personal development plans, knowledge updates, multisource feedback, formative feedback, portfolios and self-directed learning.

Barriers to participation were lack of time and resources, complexity of the requirements, bureaucracy, and a lack of flexibility in addressing doctors\’ personal and professional circumstances.