Continuing Professional Development
I have become very concerned over recent times that medical college CPD programs are becoming more prescriptive and less flexible for their members.
These programs ask doctors to spend a number of hours at the beginning of each year developing a professional development plan to determine what CPD goals and activities are of personal relevance to the doctor. That seems fine in that the resultant CPD plan is salient for the doctor. But these same CPD programs now mandate that the doctor do a significant number of hours per year of one type of CPD activity – practice improvement activities – irrespective of whether the doctor believes they are relevant to the doctor’s needs.
These coercive directives were introduced around 2017. Asking a doctor to make choices about what CPD activities are relevant to their needs but then mandating a particular type of CPD that may not be of any benefit to the doctor (compared with other more relevant CPD activities) seems to suggest that medical colleges devalue the decision making capacities of their members.
I have been fortunate in my career to spend substantial time in public and academic medical practice and now over the last fourteen years I have spent considerable time in private practice.
In all these settings I have valued CPD and participated enthusiastically in it. But I consider CPD must be reflective of the specific needs of the particular doctor, not some mandated ‘top-down’ approach by those who believe they ‘know better’ than the rank and file members of medical colleges.
This lack of flexibility in CPD programs affects all doctors, but has particular relevance to those in private practice.
There are substantial differences in compliance costs for CPD between public and private practice. In public positions most CPD is done during working hours in paid salary time with no income lost by the psychiatrist. In private practice most CPD is done after hours with no reimbursement, and if done within working hours the private doctor must put aside patient consultation time thus incurring a loss of income. It seems to me that the medical colleges have not taken these differences into account seriously enough.
Some might argue that the medical colleges need to take into account the expectations of regulatory bodies like the Medical Board of Australia in devising the type of CPD demanded of their members. While the Medical Board of Australia in its 2017 report on revalidation proposed a strengthening of CPD requirements, the strengthening mentioned in this report did not demand the coercive model of CPD introduced by some medical colleges in 2017.
In my view, before a medical college introduces a mandatory form of specific CPD activity into its CPD program that overrules the personally relevant CPD activities chosen by the individual doctor, it should be convinced that this coerced activity has robust replicated evidence that it is more effective than other forms of CPD activities on improving doctors’ knowledge and skills, and patient welfare. I am not convinced that medical colleges have this evidence.
I believe that medical colleges need to undertake a thorough review of their CPD programs to encourage more flexibility and to make their programs more sensitive and suitable to the needs of colleagues in both public and private practice. The emphasis of the review should be on the amount of robust evidence that one form of CPD has over others in order for it to be made compulsory, and how the CPD program differentially affects doctors practicing in different clinical and economic environments. I would call for submissions from public, academic, and private practice doctors and ask the medical college CPD program committees to come up with revised programs.
Dr Philip Morris