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Redesigning Continuing Education in the Health Professions (2010)

Chapter: Appendix C: International Comparison of Continuing Education and Continuing Professional Development

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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Appendix C
International Comparison of Continuing Education and Continuing Professional Development

Examining international models and trends in continuing education (CE) and continuing professional development (CPD) for health professionals has been, and continues to be, an area of interest for the global community of health professionals and education theorists. A 1999 report prepared for the Organisation for Economic Co-operation and Development (OECD) emphasizes the importance of internationally comparable data for advancing the study of CE. Cross-fertilization of innovative education models provides comparative formative and summative evaluations to validate and improve best practices while leading the way toward international coherence on the training, registration, and continual assessment of health professionals (Merkur et al., 2008b).

This comparative synthesis, which primarily includes examples from Canada, Australia, the United Kingdom, and other European countries,1 reviews the development of and current practices in medical, nursing, dental, and pharmacy CE and CPD. The paucity of descriptive literature available made it necessary to limit this review to these selected professions.

This review aims to address three questions:

  1. Do definitions and mechanisms of CE and CPD differ, and to what extent are they tied to revalidation and licensure?

1

For the purposes of this review, the United Kingdom is examined separately from the rest of Europe.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×
  1. Have countries changed or adapted their CE or CPD systems to improve content or learning methods, and how have they dealt with pharmaceutical support for CE?

  2. What can the United States learn from the experiences of other countries?

The literature search, performed in December 2008, included the EBSCO, OVID, Academic Search Premier, and Medline databases. Keywords included continuing professional development, European learning, international, continuing education, nursing, pharmacy, medicine/medical, dental/dentistry, accreditation, revalidation, and competence. This review indicates requirements for training, types of training, and the mechanisms by which the requirements are enforced. However, much about the effectiveness of many of these models remains unknown.

The diverse definitions and terminologies associated with CE and CPD systems complicate comparative analyses. While CE credits or hours are the currency by which regulatory bodies often assess competence, these regulatory bodies have a myriad of purposes and synonyms, including licensure, certification, credentialing, and revalidation. For example, Merkur and colleagues (2008a) define revalidation as aiming to “demonstrate that the competence of doctors is acceptable.” These regulatory processes may include periodic application forms, fees, and required participation in activities, such as CE, CPD, and peer assessment, to maintain and improve competence.

Just as CE requirements within professions vary by state in the United States, Canadian licensing bodies, for example, which differ between jurisdictions of practice (i.e., provinces, territories), do not agree on requirements for CE and CPD as part of their processes for ensuring the competence of health professionals. The degree of inclusion of CE credits in revalidation and relicensure systems varies between and within countries.

In the early 1990s, Australia, Canada, and the United Kingdom gradually shifted from CE to CPD. Whereas CE serves to update and reinforce knowledge (e.g., management of heart attacks, how to diagnose HIV), CPD deals with personal, communication, managerial, and team-building skills in addition to content (Merkur et al., 2008a; Peck et al., 2000). Limitations in the traditional methods of CE (e.g., educational courses, lectures) led to the development of the more self-directed and self-reflective approach, which is believed to encourage lifelong learning and better meet the educational needs of health professionals (Evans et al., 2002). For example, in 1997 the government of the United Kingdom stressed the role of CPD in

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

ensuring quality and encouraged professional bodies to strengthen systems for self-regulation and lifelong learning (UK Department of Health, 1997). This process of CPD, defined by Davis and colleagues as an “umbrella for all sorts of interventions,” including CE, ties learning more closely to practice (Davis et al., 2003, p. 11). Compared to CE, which is frequently based on acquiring credits, CPD relies on processes of self-accreditation and reflection via personal portfolios.

COMPARATIVE EXAMPLES OF CONTINUING MEDICAL EDUCATION

In a series of articles in the British Medical Journal exploring how the United States can improve its health care system, Quam and Smith (2005) argue the United States could improve its continuing medical education (CME) system by more closely mirroring the United Kingdom’s guidelines for CPD. A brief historical survey provides the background in which CE systems can adapt and change based on international models presented in Table C-1.

Although methods of CE are continually evolving around the world, CE models may be classified into two distinct categories: the learning model, seeking to improve clinical competence, and the assessment model that emphasizes both performance and competence (Merkur et al., 2008a). These CE models are presented in Table C-2. The majority of countries use the learning model only. While some countries (e.g., Austria, France, the Netherlands, United Kingdom) screen all physicians for competence, no countries included in the 2008 comparative survey used more selected, targeted screenings to ensure competence.

Maintenance of Certification in Canada

Through the latter half of the twentieth century, Canadian concepts of CME developed alongside those in the United States until patient advocacy, government regulation, and an increase in medical knowledge led the Royal College of Physicians and Surgeons of Canada (RCPSC) to explore new frameworks for continued competency. The framework, known as CanMEDS, was adopted in 1996 and outlines essential physician competencies with the aim of improving patient care. A program of mandatory professional development, called the Maintenance of Certification (MOC) program was mandated by the RCPSC beginning in 2000 (Royal College of Physicians and Surgeons of Canada, 2008). At this time, fellows of the college

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

TABLE C-1 Continuing Medical Education—An International Comparison

Country

Ways of Ensuring Competence

Compulsory

CME or CPD

Peer Review

Australia

CPD

No

No

Austria

CME

Yes

Yes

Belgium

CME & CPD

Yes

No

Canada

CPD

Yes

No

France

CME

Yes

Yes

Germany

CME

No

Yes for government employees

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Incentives

Regulating Authority

Requirements

+

 

Financial disincentives for noncompliance

Respective medical colleges and faculties (professional bodies)

Cycle varies between 3 and 5 years. Mandatory components vary by college

 

Legal requirement

Austrian Medical Chamber (professional body)

150 1-hour credits over 3 years

Financial incentive (4% salary increase)

 

Minister of Public Health (government body)

20 hours every year OR accreditation (requires 200 credit hours over 3 years and participation in two peer reviews per year)

Participation awards

 

Royal College of Physicians and Surgeons (professional body)

400 credits over 5 years (some activities worth more credits based on content)

 

Lawsuits by regional councils

National Councils for Continuing Medical Education (professional bodies)

 

 

Reduced reimbursement; accreditation withdrawn

Regional chambers of physicians (professional bodies)

250 45-minute credits over 5 years

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Country

Ways of Ensuring Competence

Compulsory

CME or CPD

Peer Review

Italy

CPD

No

Yes

The Netherlands

CME & CPD

Yes for specialists

Yes

New Zealand

CPD

No

Yes

Spain

CME (9 of 17 regions)

No

No

United Kingdom

CPD

Yes: 360° feedbacka

Pending

United States

CME

No

Yes

NOTE: CME = continuing medical education; CPD = continuing professional development.

a 360° feedback is a process whereby colleagues (including nursing and administrative staff) evaluate a physician’s performance. The process was initially developed in the commercial sector as a means of highlighting an employee’s strengths as well as areas in need of improvement.

SOURCES: Merkur et al., 2008a,b; Peck et al., 2000.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Incentives

Regulating Authority

Requirements

+

None

 

Continuing Medical Education Commission of the Ministry of Health (government body)

150 1-hour credits over 5 years

 

Removal from medical registry

Committees of specialists and primary care physicians (professional body)

200 hours of credits over 5 years; peer visitation every 5 years (only for specialists)

 

Forced work supervision; loss of registration

Medical colleges and faculties (professional bodies)

Variable by region and college

Variable by region

Spanish Medical Association (professional body)

Variable by region

 

 

 

Forced work supervision

Department of Health (government)

Parallel requirements:

(1) relicensure every 5 years and

(2) recertification (variable by college)

Variable by state

 

 

Variable by state

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

TABLE C-2 Synthesis of Models for Assessing Continuing Competence

Models for Assessing Continuing Competence

Pros

Cons

Countries Using the Model

Learning Model: CE seeks to improve clinical competence

Seeks to improve clinical competence

Does not identify poorly performing professionals

Australia

Austria

Belgium

Canada

France

Germany

Italy

The Netherlands

New Zealand

Spain

United Kingdom

United States

Assessment Model: emphasizes both performance and competence

Responsive Assessment: assessment when a complaint or problem occurs

Potential to identify poor performers

Cannot identify all poorly performing professionals and requires centralized complaint system

None

 

Periodic Assessment: full assessment of all domains of competence for all physicians

Potential to identify poor performers

Very ambitious and potentially unfeasible

None

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

 

Screening Assessment for All: identifies incompetence using peer review and patient questionnaires

Potential to identify poor performers

No single screening test has been developed that reliably and practically indicates poor performance

Austria

France

Hungary

Ireland

The Netherlands

Slovenia

United Kingdom

 

Screening Assessment for High-Risk Groups: assesses poorly performing professionals (e.g., based on patient outcomes or prescribing patterns) or targeting groups using other known qualities (i.e., older doctors)

Potential to identify poor performers

May contravene privacy laws and requires a database of physician performance measures

None

SOURCE: Merkur et al., 2008a.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

(approximately 90 percent of certified physicians in Canada are fellows of the RCPSC) were mandated to assess their professional needs and record participation in CPD, as well as learning outcomes achieved for their practice. The MOC program aims to make CPD an educational initiative to improve practice as opposed to an administrative burden (Campbell, 2008). Box C-1 describes how technology is used to decrease the administrative burden placed on health professionals.

Maintenance of Professional Standards in Australia and New Zealand

In 1994, alongside Canada, the Royal Australasian College of Physicians (RACP)2 broke ground in CME by implementing a strategy to promote CPD. This CPD scheme, known as the Maintenance of Professional Standards (MOPS) program, included the accumulation of credit points and the recording of those points in a diary system. In consultation with the Royal College of Physicians and Surgeons of Canada, RACP is now phasing out MOPS and moving toward a fully electronic system. Between May 2008 and 2010, all RACP fellows will transition to an e-folio CPD system. This system will enhance opportunities for prospective learning by facilitating individual CPD plans tailored to individually identified needs and competencies (Royal Australasian College of Physicians, 2008).

Continuing Professional Development in the United Kingdom

While participation in CPD has long been a condition of employment in the National Health Service (NHS), a string of unfortunate, and perhaps preventable, incidents spurred changes in the United Kingdom’s CPD system (Wall and Halligan, 2006). Most notably, a 2001 government inquiry into pediatric cardiac surgeries performed at Bristol Royal Infirmary focused attention on poor clinical teamwork, a severe lack of performance data, and an absence of reflective practice. The government and the public demanded competent health professionals; thus, the CME system in the United Kingdom is composed of three interrelated yet separately monitored and administered parts, each of which requires CPD: (1) mandatory recertification, (2) annual appraisal (for doctors in England), and (3) mandatory revalidation.

2

In Australia, individual medical colleges, of which RACP is one, regulate CME requirements.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

BOX C-1

An Integrated System for CE

The College of Family Physicians of Canada (CFPC), which accredits activities in which family physicians participate, has an integrated system for CME, called Maintenance of Proficiency (known as Mainpro). Mainpro is based on the principle that physicians should plan and manage their own programs of self-directed, practice-based, lifelong learning (College of Family Physicians of Canada, 2003). Both the MOC program and Mainpro utilize online tools to aid physicians in tracking their learning objectives and participation in learning events. Individual learning portfolios can be a useful tool for planning and recording learning and incorporating personal development plans. The portfolio can then form the basis for peer or external review, providing documentation necessary for revalidation while also encouraging the individual professional to identify his own learning goals (du Boulay, 2000).

The General Medical Council (GMC) has defined the competencies needed by all doctors, while professional organizations, including for example the Royal College of General Practitioners, have defined the extra competencies needed for their specialties (Quam and Smith, 2005). Like most of the CE systems discussed in this report, the royal college systems depend on the accrual of hours related to credits. To be recertified, a doctor must meet the CPD standards set by his royal college before being said to be “in good standing.”

In 2001, the NHS made annual appraisal compulsory for all doctors in England. This process requires the formation of a personal development plan with identified learning needs relevant to the competencies developed by their respective specialist associations. An appraisal process evaluates how the doctor has worked toward meeting those learning needs (Quam and Smith, 2005). This system hinges on the training and competence of its appraisers, all of whom are employed and trained by the NHS.

In 2004, the NHS introduced standards for moving the health care system toward patient-centered care, preventive medicine, and local decision making. Of 37 standards, 3 specifically relate to updating skills and training and participating in peer review and appraisal (UK Department of Health, 2004). The Commission of Healthcare Audit and Inspection has responsibility for the implementation of these standards at an organizational level. In 2008, the Department of Health gave the royal colleges a key role by making the Academy of the Royal Medical Colleges a clearinghouse for funding of

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

CE development (see Box C-2 for the role of industry funding). For example, “e-Learning for Healthcare” provides cash to individual royal colleges for the development of online learning programs. In sum, the royal colleges develop content, set standards, provide examinations, and accredit the content of events and online courses provided by commercial competitors (Hawkes, 2008).

Disparate Continuing Education Systems in Select European Countries

European countries face a mosaic of CE and CPD stakeholders and incentives for and mechanisms of revalidation (Table C-2). In Belgium, participation in CME yields higher salaries; in the Netherlands, CME is mandatory and failing to participate can result in a physician’s removal from the medical registry; and in Italy, mandatory interprofessional training with other professionals such as nurses and medical technicians is the norm (Braido et al., 2005). Professional medical bodies tend to regulate CME in most Western European countries, sometimes within legal frameworks established by national governments; in other countries, however, insurers may require physicians with whom they contract to fulfill specific CME requirements (Merkur et al., 2008a). A patchwork system of funding, including physician self-payment, professional associations or governments subsidizing costs, and pharmaceutical companies contributing to CME, further entangles the CME process.

The European Union, predicated on principles of free movement across borders, has a vested stake in ensuring the mobility of health care professionals. This requires mutual recognition of professional qualifications, but this principle is difficult to uphold because the legal framework in certain countries does not require training beyond initial education whereas other countries make this mandatory. Until 2005, France, for example, did not require any training beyond receipt of a medical diploma. Despite efforts to encourage CE through the use of incentives, physicians did not embrace it; thus, the French government passed a law making CME mandatory. A parallel law made the evaluation of professional practice mandatory for all doctors. While control of these processes was placed under the responsibility of an independent organization, compliance with the requirements is yet unknown (Segouin et al., 2007).

The European Commission [sic] recognized in 2006 the need for minimal standards for CPD for physicians and nurses (European Commission High Level Group on Health Services and Medical Care, 2006). Despite this acknowledgment, a directive was never placed on

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

BOX C-2

The Role of Industry Funding

Despite the differences in CPD and CE, the UK, Canadian, and U.S. systems of CME face similar challenges, one of which is the role of industry-subsidized learning opportunities. A 2008 editorial in the Canadian Medical Association Journal called the pharmaceutical industry’s role in funding CME in Canada “unacceptable” (Hebert, 2008, p. 179). Although there are no reliable data on the percentage of accredited CME activities in Canada funded by pharmaceutical and medical device manufacturers, there are widely held beliefs that the situation is similar to that in the United States, where $1.21 billion (48 percent of all money spent on accredited CME) in 2007 came from commercial support (ACCME, 2008; Spurgeon, 2008). For example, while online CME is an important approach to CPD in Canada, much online CME is currently funded directly or indirectly by industry. As a result, in January 2008, the Canadian Medical Association convened a meeting of national specialty societies and related medical organizations to discuss issues related to online CME, particularly how the sources of funding might be identified.

A study published in 2003 by a team of Scottish researchers found that the pharmaceutical industry funded approximately half of CME in the United Kingdom. Since that time, the Association of the British Pharmaceutical Industry has introduced a code of conduct, including a ban on gifts worth more than 6 pounds sterling and a guideline that companies do not pay for “key opinion leaders” to attend conferences abroad (Hawkes, 2008).

Because pharmaceutical companies, in particular, generally target prescribers as their clients, conflicted funding sources are not nearly as prominent an issue in CE for nurses, dentists, and pharmacists as they are for physicians.

the agenda to develop these standards. Harmonized systems of CME still need to be developed, potentially by the European Accreditation Council for Continuing Medical Education (Braido et al., 2005).

COMPARATIVE EXAMPLES OF CONTINUING NURSING EDUCATION

A systematic review of nursing education and regulation stresses the importance of Europe’s harmonizing nursing education systems to minimize problems with nursing retention and recruitment (Robinson and Griffiths, 2007). The review of 18 countries including the United States acknowledges difficulties in obtaining accurate information on CE requirements for nurses and documents disparate examples of nursing CE systems.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

The United Kingdom, which has acknowledged the need for a functioning system of CE for nurses since the mid-1990s (Nolan et al., 1995), has a system in which nurses must register with the Nursing and Midwifery Council. This registration requires triannual renewal dependent on evidence that CPD was performed. Similarly, advanced degree nurses in Japan (as categorized by their level of education) must apply for certificate renewal every 5 years, a process requiring participation in designated CPD events and the development of a practice report. Nurses with advanced degrees (postbaccalaurate) do not, however, need to renew their certifications or engage in CE (Harayama, 1994).

To further illustrate the vast differences that exist in nursing regulation, licensure, and CE, Swedish nurses must register with the National Board of Health and Welfare but are not regulated once licensed (Josefsson et al., 2008). In Denmark, to deal with specific local education needs, the Branch Boards of the Denmark Nursing Organisation offers study days and seminars on topical issues (Vejlgaard, 2003). Similarly, Italian universities, health care institutions, and CE agencies offer courses for speciality nurses, allowing them to choose among relevant training (Robinson and Griffiths, 2007).

COMPARATIVE EXAMPLES OF CONTINUING DENTAL EDUCATION

In order to build a culture of professional competency, the Association for Dental Education in Europe (ADEE), an organization that promotes high standards of dental education to its membership of European dental schools, specialist societies, and national dental bodies, has emphasized that undergraduate education should “act as a springboard which engenders the concept of continuing professional development and life long learning” (Cowpe et al., 2008, p. 20). In its Profile and Competencies for the European Dentist (2008), the ADEE states that upon graduation, a dentist must seek CE on an annual basis and demonstrate this through the use of a logbook or e-folio. Additionally, graduating dentists must prove competency in using information technology for documentation of participation in CE.

The Commonwealth Dental Association, a trade association comprised of 53 countries currently or formerly associated with the British crown, conducted a review of its dental workforce in 2007. Mandatory CE for dentists was limited to eight of the surveyed nations, including Canada, New Zealand, the United Kingdom, and the Victoria region of Australia (Table C-3). Of these, only New

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

TABLE C-3 Continuing Dental Education—An International Comparison

 

Compulsory

Requirements

Australia

No, except in one state (Victoria)

Unknown

Canada

Yes

Variable by province

New Zealand

Yes

160 hours over 4 years

United Kingdom

Yes

75 hours of formal courses and 250 hours of nonformal education over 5 years

United States

Yes (in 49 states)

Variable by state

SOURCE: Kravitz, 2007.

Zealand and the United Kingdom have countrywide mandates for CE for dentists.

The United Kingdom’s General Dental Council instituted its CE program in 2002, preceeding New Zealand’s countrywide CE program for dentists by 12 months. In addition to completing CE courses, all dentists contracted with the NHS must complete 15 hours of peer review every 3 years. A systematic survey of 2,082 dentists in three regions of England examined the effectiveness of the NHS mandate for CE for dentists based on the frequency and types of CE activities in which a dentist participated (Bullock et al., 2003). The review concluded that dentists have little personal incentive to engage in activities other than CE courses and discussion with colleagues because the mandate permits dentists to choose the methods of CE activities in which they engage and does not, for example, require peer review. Mandated professional development plans are one means of reflection and thus may be an appropriate vehicles of CE for dentists.

COMPARATIVE EXAMPLES OF CONTINUING PHARMACEUTICAL EDUCATION

A report prepared for the International Pharmaceutical Foundation (FIP) acknowledges a breadth of new knowledge relevant to the field of pharmacy and the important role CE plays in maintaining and updating pharmaceutical skills and knowledge (International Pharmaceutical Federation, 2006). The FIP initially stressed the link between the development of pharmacy skills and quality improvement when, in 2001, it established the International Forum for Quality Assurance of Pharmacy Education to develop a set of principles

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

for CE programs (Rouse, 2008). Furthermore, the FIP’s Statement of Professional Standards on Continuing Professional Development includes a provision about a pharmacist’s individual responsibility to ensure his own competency through “systematic maintenance, development, and broadening of knowledge, skills, and attitudes” (International Pharmaceutical Federation, 2002). The FIP differentiates CPD from CE by stressing that CPD requires pharmacists to take personal responsibility for planning for their own development, meeting these needs, and subsequently evaluating their success in doing so.

The Pharmacy Workforce Survey, administered in 2005, surveyed 37 countries representing each of the six World Health Organization regions: 9 of the 37 countries had mandatory CE for individual pharmacists (International Pharmaceutical Federation, 2006). Information on the regulatory boards and the CE systems is presented in Table C-4. CE courses for pharmacists, provided by professional associations, pharmacy boards, universities, teaching hospitals, and pharmaceutical companies, vary widely in their scope and breadth of content, and only a few countries (e.g. France, Iraq, Japan, Kenya, Singapore, Zambia) have mandatory accreditation of providers of CE for pharmacists.

APPLICABLE LESSONS FOR THE UNITED STATES

CE, which serves a variety of purposes, may improve quality of care and patient safety while minimizing risks and containing costs. The notion that the acquisition of a qualification is an adequate measure of lifelong competence (Merkur et al., 2008b) has been challenged in recent decades. As a result, many countries are in the process of reforming their CE systems (Braido et al., 2005). Overall, this literature review suggests that the definitions and mechanisms of ensuring competence vary significantly across countries. While divergence exists in monitoring and enforcement, similarities exist as well: most systems rely on professional self-regulation (Peck et al., 2000); a principal barrier for improving and implementing CE systems at the organizational level is lack of financial resources (Merkur et al., 2008a); and the most demanding systems incorporate peer review or practice audit. Although no CE system is obviously superior, considerable scope exists to learn from experiences in other countries.

Increasingly, professional associations and regulatory bodies encourage health professionals to learn together with other professional groups. As an example, health professionals in Italy engage

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

TABLE C-4 Continuing Pharmaceutical Education—An International Comparison

 

Compulsory

Incentives

Regulating Authority

Requirements

+

Canada

Yes (in most provinces)

 

Potential for refusal to renew license

Provincial pharmacy boards

Variable by province

France

Yes

Certificate for completion

 

Ordre National des Pharmaciens and the Social Affairs Ministry

Currently being considered

Germany

No (ethical obligation stated in law)

Certificate for completion

 

N/A

150 45-minute credits over 3 years

United Kingdom

Yes

 

Potential for removal from pharmacy register

Pharmacy profession (subnational pharmaceutical associations)

CPD not measured (guidelines advise one CPD entry per month)

United States

Yes

 

Potential for license revocation

State boards of pharmacy

Most common (varies by state) is 30 hours over 2 years

NOTE: N/A = not applicable.

SOURCE: International Pharmaceutical Federation, 2006.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

in interprofessional CE in a system that aims to ensure the impact of education on practice quality (Braido et al., 2005). The Learning Opportunities for Teams (LOTUS) program, facilitated by the European Commission, furthered the advancement of Italy’s teambased CE by linking 214 primary care professionals at four sites across Europe. This pilot program, which began in 1997 and has now ended, highlighted the relevance of multidisciplinary facilitation and technology for organizational and individual growth (Mathers et al., 2007). Furthermore, Canada’s well-established system of interprofessional education serves as a model for the further development of interprofessional education (Ho et al., 2008) and has recently been adopted by the Royal Dutch Medical Association (Wigersma et al., 2009).

The 2005 examination of CE by the British Medical Journal acknowledges widespread acceptance that systems to ensure competence should be nonpunitive, with efforts focused on professional development (Kmietowicz, 2005). Professional organizations could take the lead in this by introducing a system rewarding physicians who participate in CE and CPD. The United States has the opportunity to understand the current challenges in CE both nationally and internationally and to use the platform of CPD as a means to address deficiencies in the current CE system. International CE and CPD systems are vehicles from which the United States can learn, gleaning best practices and offering solutions and leadership.

REFERENCES

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Braido, F., T. Popov, I. J. Ansotegui, J. Gayraud, K. L. Nekam, J. L. Delgado, H. J. Mailing, S. Olson, M. Larche, A. Negri, and G. W. Canonica. 2005. Continuing medical education: An international reality. Allergy: European Journal of Allergy and Clinical Immunology 60(6):739-742.

Bullock, A., V. Firmstone, A. Fielding, J. Frame, D. Thomas, and C. Belfield. 2003. Participation of UK dentists in continuing professional development. British Dental Journal 194(1):47-51.

Campbell, C. 2008. Maintenance of certification: Back to the future. http://rcpsc.medical.org/news/documents/MOCCraig_e.pdf (accessed December 15, 2008).

College of Family Physicians of Canada. 2003. Mainpro background information. http://www.cfpc.ca/English/cfpc/cme/mainpro/ (accessed January 23, 2009).

Cowpe, J., A. Plasschaert, W. Harzer, H. Vinkka-Puhakka, and A. D. Walmsley. 2008. Profile and competencies for the European dentist, update 2008. Dublin, Ireland: Association for Dental Education in Europe.

Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
×

Davis, D., B. E. Barnes, and R. D. Fox, eds. 2003. The continuing professional development of physicians: From research to practice. Chicago, IL: American Medical Association.

du Boulay, C. 2000. From CME to CPD: Getting better at getting better? British Medical Journal 320:393-394.

European Commission High Level Group on Health Services and Medical Care. 2006. Report on the work of the high level group in 2006. HLG/2006/8 FINAL European Commission Health and Consumer Protection Directorate-General.

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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Suggested Citation:"Appendix C: International Comparison of Continuing Education and Continuing Professional Development." Institute of Medicine. 2010. Redesigning Continuing Education in the Health Professions. Washington, DC: The National Academies Press. doi: 10.17226/12704.
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Today in the United States, the professional health workforce is not consistently prepared to provide high quality health care and assure patient safety, even as the nation spends more per capita on health care than any other country. The absence of a comprehensive and well-integrated system of continuing education (CE) in the health professions is an important contributing factor to knowledge and performance deficiencies at the individual and system levels.

To be most effective, health professionals at every stage of their careers must continue learning about advances in research and treatment in their fields (and related fields) in order to obtain and maintain up-to-date knowledge and skills in caring for their patients. Many health professionals regularly undertake a variety of efforts to stay up to date, but on a larger scale, the nation's approach to CE for health professionals fails to support the professions in their efforts to achieve and maintain proficiency.

Redesigning Continuing Education in the Health Professions illustrates a vision for a better system through a comprehensive approach of continuing professional development, and posits a framework upon which to develop a new, more effective system. The book also offers principles to guide the creation of a national continuing education institute.

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