| A Framework
for Continuing Professional Development of Vocationally Trained
General Practitioners and Specialists
An Overview (December
2003)
A Summary of the Framework Developed from a
Project funded by the Commonwealth Department of Health and Ageing
(DHA) and Conducted by the Royal Australian and New Zealand College
of Obstetricians and Gynaecologists on Behalf of the Committee
of Presidents of Medical Colleges.
Dr
Eleanor Long
Chief Executive Officer
RANZCOG
|
 |
Dr
Peter White
Project Manager |
Index
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INTRODUCTION
This document describes a framework for Continuing
Professional Development (CPD) of medical practitioners in Australia.
In the context of the framework, medical ‘practitioners’ are
considered to be doctors who have completed a prescribed period
of postgraduate vocational training and are certified as possessing
recognised expertise in a specific area of medical practice.
Thus, the document is considered to have relevance to General
Practitioners as well as specialists from other disciplines.
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BACKGROUND
Recent international developments in continuing
education for medical practitioners evidences a shift away from
the relatively narrow focus of maintenance of skills programs
or continuing medical education (CME) to the broader concept
of CPD that acknowledges the wider range of skills, knowledge
and attributes now considered to be part of professional practice.
Practitioners are expected to engage in activities to maintain
or develop abilities that enable them to function as safe and
effective medical professionals who can provide high quality
health care in their area of expertise across a range of domains.
Developments in Australia in the areas of medical registration,
accreditation of specialist medical college training and professional
development programs, medical indemnity insurance, increasingly
aware health care consumers and the motivation of the profession
to undertake continuous improvement have also resulted in an
increased awareness of the need for medical practitioners to
be involved in effective, on-going CPD programs in this country.
As a result, the area of CPD has become an increasingly important,
complex and debated component of practice for medical practitioners.
An ad hoc or spasmodic approach to CPD can no longer be considered
acceptable, and a uniform approach to this issue across the different
specialties would appear desirable and logical. The framework
outlined in this document is one such approach.
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DEVELOPMENT
AND SUMMARY
The framework described in this document was
funded by The Commonwealth Department of Health and Ageing (DHA)
and conducted by the Royal Australian and New Zealand College
of Obstetricians and Gynaecologists (RANZCOG) on behalf of the
Committee of Presidents of Medical Colleges (CPMC). A Project
Reference Group comprising representatives from a range of interest
groups was convened to advise and support the project. Members
of the Project Reference Group are listed in Appendix
A.
The overall purpose of the work described in this document was
the design and development of a framework that can be considered ‘best
practice’ in the field of specialist medical CPD, based
on the data and information collected throughout the duration
of the project, and which could be applicable to a wide variety
of medical specialities. To that end, the project was informed
by available literature and consultations with a variety of stakeholders
in the health care field, including medical boards, medical defence
organisations, health complaints organisations, specialist medical
colleges and practitioners Overwhelmingly the primary purpose
of practitioners participating in ongoing CPD was, according
to the consultations, the maintenance, development and improvement
of skills that enable consumers of health care to be confident
of the level of care that they receive, while recognising the
need for CPD in the wider context of professional practice.
Within this climate of a developing acceptance of the need for
ongoing learning in areas beyond traditional medical and clinical
knowledge, the term continuing professional development is understood
in this project to encompass other terms, such as CME and Maintenance
of Professional Standards (MOPS). Coupled with the acknowledgment
that the practice of medicine is a profession, and all that this
implies (see later discussion on Medical Professionalism), a
succinct definition of CPD for medical practitioners can be developed
as:
| The ongoing maintenance, acquisition and development of
knowledge, skills and attitudes to enable a medical practitioner
to constantly improve as a practising professional. |
The framework uses the concept of medical professionalism as
its theoretical platform, acknowledging the increasing awareness
of a patient-focused medical workforce. Three main areas (strands)
of medical professionalism are identified: Clinical Expertise,
Risk Management, and Professional Values and Responsibilities.
These strands are further divided into ten areas (components)
as outlined below. The theoretical platform is shown in Appendix
B; descriptions of each of the ten components are described in
Appendix C.
| Clinical Expertise |
|
Medical Expertise
Clinical Judgement
Medical Informatics (Clinical) |
| Risk Management |
|
Communication
Practice Management
Medical Informatics (Practice)
Personal Management and Insight |
| Professional Values and Responsibilities |
|
Relationships and Accountability
Advocacy and Equity
Education |
The purpose of constructing this theoretical platform was to
enable practitioners across disciplines and settings to identify
areas of practice that encompass their CPD needs and activities
within these ten components. It is not the intention of the framework
to communicate the perception that all practitioners should recognise
facets of their practice or undertake CPD activities in all ten
areas. The theoretical platform is an acknowledgement of the
wider range of skills, knowledge and attitudes now being accepted
as constituting the role of a medical practitioner.
The framework advocates the recognition of a wide range of activities
as valid for medical practitioner CPD and recognises the existence
of three levels of CPD activities: those that focus on increasing
knowledge and skills; those that can facilitate changes in practice
and health outcomes; and those where changes in practice and
health outcomes are evaluated. Common CPD activities currently
undertaken by medical practitioners that can be grouped according
to those three levels are shown in Appendix
D. The crux of the
framework thus becomes a matrix of ten components of medical
professionalism and three levels of CPD activities, as shown
in Appendix E.
In addition the framework specifically acknowledges general
adult education principles, as well as the literature relating
to the ways in which medical practitioners learn and that relating
to the effectiveness of CPD. As such, the framework advocates
the prospective identification of learning and, thus, CPD, needs
by individual practitioners, as well as an evaluation of what
has been achieved by the CPD undertaken by a practitioner throughout
a defined CPD cycle. As far as possible and practicable, this
evaluation should address changes that have occurred at the levels
of specialist practice and behaviour, as well as health outcomes.
These components are outlined in Appendix
F.
It is recognised that these aspects of the framework need to
be addressed and conducted in such a way that is manageable for
the practitioners involved, as well as for individual medical
colleges from the perspective of infrastructure and capacity.
The construction of the framework described in this document
has been done with an attempt to achieve rigour and effectiveness
in medical practitioner CPD programs, with a view to what is
practical and achievable at the practitioner and institutional
level.
The framework has been designed to be broad ranging and flexible
in its application and operation. It is possible to construct
a CPD program around the framework that can operate on the basis
of a participant portfolio, or on the basis of a requisite number
of hours or credit points, or a combination of the two approaches.
The framework is considered to be flexible enough to meet all
current statutory requirements currently operating in Australasia,
and to be capable of accommodating any changes in this respect
that may be introduced in the short- to medium-term future. For
example, the framework is designed to be used easily by professional
bodies other than specialist medical colleges that are members
of the CPMC, and could be adapted for use as a framework on which
a revalidation process such as that currently being introduced
in the United Kingdom could operate.
As an adjunct to the framework, the creation of a universal
system of recognising the participation of medical practitioners
in appropriate CPD is advanced. Such a system (based upon the
issuing of what has been called a Certificate of Continuing
Medical Professionalism [CCMP] by participating bodies) could offer a
mechanism to indicate to statutory bodies, as well as consumers
and other stakeholders, that individual practitioners are participating
and in good standing in a CPD program sanctioned by the issuing
body. The practical issues and difficulties associated with this
initiative are recognised and acknowledged; however it would
appear to be associated with sufficient advantage to merit consideration.
The framework has been constructed on the premise that participation
by medical practitioners, or any other health professional, in
CPD can help to maintain and increase the knowledge, attitudes
and skills associated with practice; i.e. contribute to an individual’s
ability to practise in a manner that is considered ‘professional’ in
modern medicine. The framework has taken a wide view of medical
professionalism, akin to the ‘new professionalism’ that
has underpinned reform of the health system in the United Kingdom.
It acknowledges the obligation for individuals to take responsibility
for their own professionalism development, without mandating
compulsory participation, and makes no claim as to the existence
of an absolute causal link between participation in CPD and a
guarantee of competence. CPD is seen as a means of helping a
self-regulating profession to maintain and improve standards.
The framework is an instrument that attempts to facilitate that
process.
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FUTURE
DIRECTIONS
The framework for CPD for medical practitioners
and the associated issues outlined in this report represent a
timely opportunity for stakeholders involved in ongoing specialist
medical education and registration in Australia to move forward
in collaborative ways to develop integrated processes aimed at
improved health care outcomes. Participation in CPD is an aspect
of practice for medical practitioners that is increasingly being
recognised as a basic professional expectation of and by all
involved in the profession and it is appropriate that dialogue
ensue to enable agreed attitudes toward, and standards of, CPD
to be developed across the medical specialties in this country.
Those involved in the work described in this document hope that
the framework as outlined is able to make a significant contribution
to the on-going process and debate relating to CPD for medical
practitioners and look forward to any progress made as a result
of its publication.
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APPENDICES -
PDF files
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CREDITS,
ACKNOWLEDGEMENTS & COPYRIGHT NOTES
This project was funded by the Commonwealth
Department of Health and Ageing (DHA) and conducted by the Royal
Australian College of Obstetricians and Gynaecologists (RANZCOG)
on behalf of the Committee of Presidents of Medical Colleges
(CPMC). The project was
developed, managed and reported by Dr Peter White, Manager, Assessment
Services, RANZCOG, with project
design and oversight by Dr Eleanor Long, CEO and Director of
Education, RANZCOG.
The College expresses it gratitude for the contribution made
to the project by the Project Reference Group chaired by Dr Jack
Sparrow.
© 2003 The Royal Australian and New Zealand
College of Obstetricians and Gynaecologists.
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