1. Continuing Professional Development for Health Professionals Khalid Bin Abdulrahman, MD, DPHC, ABFM, MHSc (MEd) Associate Professor of Family Physician Director of Medical Education Center College of Medicine, KSU

2. Keeping Up "No one, who wishes to practice medicine, either with safety to others, or credit to himself, will incline to remain ignorant of any discovery which time or attention has brought to light. But it is well known that the greatest part of those who are engaged in the actual prosecution of this art, have neither leisure nor opportunity for very extensive reading. Sr. Andrew Duncan, 1773, Medical and Philosophical Commentaries

3. By the end of this session you will be able to: Define what is CPD and CME? Recognize why physicians change their performance? Understand how physicians change their performance? How physicians learn? Recognize does CME make a different in medical practice and patient care?

4. What are the factors that affect decision making to participate in formal CME ?

5. What are the obstacles to participation in CME?

6. What is CPD

7. What is CPD? CPD is a process of lifelong learning for all individuals and teams which meets the needs of patients and delivers the health outcomes and healthcare priorities of the health sector and which enables professionals to expand and fulfill their potential.

8. Continuing - life long learning, an ongoing process regardless of your age or the stage of your career Professional - focused on your personal / individual competence at work / in a professional role Development - improve your personal skills to improve patient care and your career progression What is CPD?

9. Another definition of CPD: CPD is a systematic, ongoing, cyclical process of self directed learning It includes everything you learn which enables you to do your job (current or future) more effectively

10. It is a partnership between the individual and the organisation The main responsibility for your development lies with you. The organisation for whom you work has a responsibility for helping you to meet the development needs which relate to performance in your current job

11. CPD is a general concept and can be used by everyone (pharmacists, technicians, assistants and other support staff)

12. What is CME

13. Definition CME is a continuing process that involves practicing physicians, practice environments, learning resources, and interventions designed to improve the ability of physicians to provide better medical care to patients Davis DA, Fox RD. The Physician as Learner: Lining Research to Practice. American Medical Association, Chicago, Ill, 1994

14. The Broader Definition Attendance at formal CME activities is part of a broader search for information The search includes not only participation in formal conferences, but reading, consulting with peers & experts and other form of SDL

15. Why physicians change their performance?

16. What are the factors that affect decision making to participate in formal CME ?

17. Decision-making model Context of medical practice Awareness of needs Attitudes toward education Goals and expectations Opportunities and barriers Decision to attend

18. The Purpose of Participation To keep up with advances in medicine To validate previous learning To review or refresh previous learning To prepare for board examinations To obtaining CME credits

19. To reduce the possibility of malpractice To get away from busy practice To get fun and recreation To returning back to academic medicine

20. What are the obstacles to participation in CME?

21. Obstacles to Participation Constrains of practice * Heavy patient load Conflict with family and community responsibilities Cost of CME and loss of patient income

22. What might make it difficult for you to practise CPD and document it? Time Motivation Lack of understanding of what’s involved / how to do it Money / resources (people) Lack of mentors / facilitators Lack of administrative support

23. Unwillingness to include personal information in portfolio? Lack of knowledge of benefits Lack of a formal appraisal / performance review system Perceptions of others’ (e.g. senior managers’) roles

24. Shift towards learner-centred education Old think –Passively listening to lectures –Educator decides topic –Read a journal or text book –Errors should be forgotten / denied New think –Actively participate in learning –You decide the topic –Problem solving, simulated cases –Errors are a learning experience Wyatt JC. Clinical Knowledge… in the Information Age London: RSM, 2001

25. Does CME make a different in medical practice and patient care?

26. Reviews of the evidence :

27. “Our data show some evidence that interactive CME sessions that enhance participant activity and provide the opportunity to practice skills can effect change in professional practice and, on occasion,health care outcomes.

28. Based on a small number of well- conducted trials, didactic sessions do not appear to be effective in changing physician performance.” Davis D et al. Impact of formal continuing medical education: do… continuing education activities change physician behaviour or health care outcomes? JAMA 1999 Sep 1;282(9):867-74

29. Emerging evidence supports complex interventions

30. the complex educational intervention exemplified the best form of knowledge translation (the integration of knowledge into practice), moving the practitioner from Davis D. Clinical practice guidelines and the translation of knowledge: the science of continuing medical education. CMAJ 2000; 163 (10 ):1278-9

31. –awareness of new guidelines –to agreement with the guidelines and –finally to adoption and adherence, following well-defined patterns of adoption and based on principles of adult learning applied to CME. Davis D. Clinical practice guidelines and the translation of knowledge: the science of continuing medical education. CMAJ 2000; 163 (10 ):1278-9

32. What content and how to update? “ Of 217 drug therapy guidelines developed or endorsed by Canadian organizations in the period 1994 – 98, only 15% met half or more of the authors' criteria for rigour in the developmental process, and only 7% were rated by independent reviewers as sound ” Time to weed the CPG garden CMAJ 2001;165(2):141, 143

33. How to interact? A critical mass of practitioners can benefit from a virtual community. Roberts C, Fox N. General practitioners and the Internet: modelling a 'virtual community'. Fam Pract 1998 Jun;15(3):211-5

35. PCDQ – Learning from your own clinical data www.pcdq.org

36. Online CME: Family Practice Last Updated April 25, 2004. http://www.cmelist.com/family_practice.htm

38. How do you go about it? The CPD cycle The CPD cycle is very important and underpins and provides a framework for all CPD activities

39. The CPD cycle

40. Reflection Identify your development needs Reflect or think about what you have done, how you did it and how you could do it better or differently, or apply that insight in the future Takes practice to develop

41. How might you do this? Critical incident analysis (positive and negative) Personal SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis With your line manager during your appraisal

42. Planning How will you meet the development needs you have identified? What level of competence do you need to achieve? What is your preferred style of learning? How important are these needs in relation to each other? What style of learning will you use?

43. Ways of meeting your development needs Overhead 6 Lectures Audit Action learning sets Study days MeetingsReading Computer assisted learning

44. Action Do what you have planned and record it

45. How might you record your CPD? In any way that suits and works for you Computer Notebook Portfolio – whatever documentation you use is your portfolio May use resources and portfolios already available

46. Evaluation This is a very important stage to complete the cycle where you assess how effective your learning has been

47. Consider –Have you achieved your intended outcomes? –How has your practice changed as a result? –If it hasn’t, what are the reasons? Are you How might you use / apply the knowledge / skills in the future?

48. Evaluation/ action form When did you last participated in educational event: What messages did you take home? Have you acted on them? Issues studied today: (1) (2) (3) What did you like? What did you dislike? What would you act on? Reflection is the “mantra” through the entire process

49. Challenges for CME  relevance to practice  changes physician behavior  based on current best scientific evidence

50. CME has value when it results in…. –quality patient care –state-of-the-art patient care –evidence-based patient care

51. Usefulness Equation Usefulness = Relevance x Validity Work -- Allen Shaughnessy, David Slawson, 1994

52. Thank you