Discussion Forum From CME to CPD 12th December 2006

Setting the Scene Exponential growth in knowledge, need to read 20 papers /day to keep updated (Grol & Grimshaw, Lancet 2003;362: ) Expectation to keep updated Translating research evidence into practice Effective means Barriers to change in practice Health care outcomes changed?

CME Vs CPD

Definition of CME Educational activities which serve to maintain, develop, or increase the knowledge, skills, and professional performance and relationships that a physician uses to provide services for patients, the public, or the profession. ACCME: Accrediting Council Continuous Medical Education

Definition of CPD Development of competencies relevant to the practice profile of a practitioner that may change over the years, and professional development endeavours are directed at enhancing his quality of care and the delivery of safe standard of practice Tang G. CPD-A surrogate for recertification. Ann Acad Med Singapore 2004;33:711-4

CME versus CPD CMECPD Educator centredLearner focused Little direct impact on improving professional practice Good for quality management in terms of changes Passive learningActive learning Dr KW Chan Medical education: From continuing medical education to continuing professional development Asia Pacific Family Medicine 2002; 1: 88–90

CMECPDKnowledge translation SettingsTeaching settingsAny learning settingsPrimarily practice settings ToolsPrimarily educational methods (lectures, print materials) Wide variety of learning methods Methods for overcoming barriers to changee.g. prompts, reminders, patient mediated methods TargetsIndividual doctors; CME credits Doctors, other health professionals, groups; CPD credits, learning portfolio, self directed learning Clinicians, teams, health systems, patients, populations, policy makers ContentMostly clinicalClinical plus other practice related areas As in CME and CPD, possible focus on evidence based information Guiding model(s) Primarily educational; CME credits and accreditation important Self directed learning; CPD credits and accreditation important Holistic: incorporates clinician- learner and educational delivery system; Evidence based: from content of activity to testing of interventions Relevant disciplines Medicine, education, educational psychology As for CME Plus organisational learning theory, social psychology As for CME and CPD Plus systems management, health services research, social marketing, patient education, bio-informatics, and others Dave Davis et al. The case for knowledge translation: shortening the journey from evidence to effect. BMJ 2003;327:33-35

Effectiveness of CME Lectures Traditional didactic lectures at CME Ineffective or negligible impact on clinical practice (Davies et al, JAMA 1995;274:700-5, Davies et al, JAMA 1999;282:867-74, Grimshaw et al, Med Care 2001;39 Suppl 2:I12-45) Not individualised to individual learner or relevant to ones practice (Sectish et al, Pediatrics 2002;110:152-6) Barriers to implementation after message received Knowledge seeking behaviour

Selecting Appropriate Change Strategy 4 types / traits Seeker Actively reads, appraises scientific journals and changes practice Receptive clinician Actively reads, relies on authorities judgment to change practice Traditionalist clinician Focus on clinical skills, experience, relies on advocates to change practice and with less concern with scientific arguments. Pragmatist Busy. Any call to change practice be placed amongst other competing demands from patients, colleagues, employees etc Wyszewlanski et al, The Journal of Family Practice 2000;49:461-4

Principles of CPD CPD allows doctors to demonstrate that they are maintaining their skills in their practice. It also allows doctors to develop professionally and to learn from more informal experiences CPD encourages and motivates doctors to learn. It should be closely related to each doctors individual needs, ambitions and personal learning styles. This focus on the doctors learning needs will support changes and improvements in practice.

The ultimate purpose of CPD is to contribute to high-quality patient care whilst taking into account the needs and wishes of patients. CPD also helps doctors to improve their professional effectiveness, career opportunities and work satisfaction. CPD should also include public and patient involvement. Principles of CPD (contd)

Encourage active participation in CME/CPD activities, which is more effective in changing ones behaviour/practice, and discuss and review their CPD with others Let Fellows adopt the CPD programme that is most appropriate for their practices Provide flexible and wider choices of learning to Fellows Why implement CPD?

Current Types of CME/CPD Activities Self study Publication Active Participation Passive Participation Research Postgraduate Course Development of CME/CPD materials Development of New Technologies or Services Conducting Examinations Quality Assurance and Audits Activities for Improvement of Patient Cares Grand Rounds in Training Units Mortality and Morbidity Meetings Reviewer of HKMJ and Indexed Journals

Moving towards CPD

Moving from CME to CPD Expanding definition of CME Encouraging Fellows to play an active role in CME/CPD activities Duty to keep up-to-date Focusing on quality assurance and medical audits activities which are important for improving healthcare for patients

CME/CPD Continuous life-long learning process maintain, develop or increase the knowledge, skills and competencies relevant to the practice of Fellows that may change over the years enhance professional performance to enable the delivery of quality professional care and safe standard of practice to the patients, and public that Fellows serve ensure that Fellows will remain competent throughout their professional career

From CME to CPD: Milestones 1 st Jan 2008 – Capping of 75 points maximum for passive CME to encourage Fellows to do other activities 1 st Jan 2011 – Further capping of participation as attendee of meetings – Certain activities become mandatory ( QA, Audit, M&M and those activities that would improve patient care)

Major Changes of CME/CPD for 2011 Mandatory component - Fellows must obtain some points in activities like quality assurance, medical audits, mortality and morbidity meetings, or those activities involving improvement of patient care

Major Changes of CME/CPD for 2011 Wider Choices of Learning - Contents will be expanded to cover other non-medical professional development activities such as knowledge and skills relating to relevant laws, information technology, clinic management and interpersonal communication

Recommended Types of CME/CPD Activities for Participation as an Attendee in FCAA 2.Chairing/Presenting at FCAA 3.Self study 4.Publications 5.Research 6.Development of New Technologies or Services 7.Conducting Examinations 8.Quality Assurance and Medical Audits

Recommended Types of CME/CPD Activities for 2011 (2) 9.Mortality and Morbidity Meetings 10.Postgraduate Course 11.Development of CME/CPD or Knowledge- Translation materials 12.Activities for Improvement of Patient Cares 13.Grand Rounds in Training Units 14.Reviewer of HKMJ and Indexed Journals 15.Other Non-medical Professional Development Activities 16.Hands-on Clinical Attachment Programme 17.Others ……..

Role of HKAM on CME/CPD Provide general and specified principles and guidelines Approve CME/CPD programmes established by Colleges Ensure compliance with CME/CPD requirements, and the programme is practicable and achievable

Role of HKAM on CME/CPD (2) Discussion Forums Discussed at EC for a year 1st Forum: 30th Sept 2006, more to come Discussion with private hospitals Opinion collected from web CMECPD Newsletter

Comments received Support CPD, on right track, get down to do it Public expects all professionals to commit to CPD CPD points to be kept minimum at start

Questions received Why need to cap, should allow fellows free to choose Posing difficulties for fellows in solo practice or in private hospital practice Is capping at 75 practical or achievable?

Questions received (2) Evidence that CPD is better? Depends on determination of individual fellow to improve. If there is determination, CME didactic lectures will be useful, why need CPD? QA, audits etc may be good on paper, but not practical for private practitioners

Questions received (3) Application of CPD activities have to be much defined Precise definitions for QA or activities involving improvement of patient care? Does it have to be the project officer or presentation officer to attract the CPD points in the 15-point category? Fellows should not have problems meeting 15 CPD points requirement. Many Fellows in the private sector worried because did not know apart from passive CME what could be counted as CPD. Fellows do not know how to do CPD; e.g. Can we attend M & M meeting in HA hospitals? M & M meetings can be considered passive participation and there may need some clarification on the level of participation

Questions received (4) Will the individual college decide on CPD points to be awarded or will Academy decide for Colleges? How can we assess the quality and nature of the CPD activities (e.g. quality assurance meeting) in order to grant CPD? Those meeting involving more than one discipline, difficult to gauge the participation of each. Can pathologists claim credits on QA, audits etc. when med. Techs and nurses are also part of the team doing such activities? What about community medicine fellows? Fellows making oversea/ China/Macau lectures a CME (as guest lecturer or clinical consultant may gain CPD/CME points) if application to college for this activity is granted. The college should encourage local member to participate in the international arena and CPD should be given. Overseas courses? Pain Medicine- unrecognised specialty- under which specialty?

Questions received (5) CPD should be delayed till facilities are ready. CPD points should be kept to mini- max at start. Will the college be able to provide/organise courses for the CPD?

Questions received (6) Doctors not interested in attending clinical audits/M&M meetings not related to their specialty areas. Individual hospitals may not have sufficient number of cases for clinical audits and M&M meetings, especially when these meetings should be specialty specific Would data collected for clinical audits be used against the Fellows themselves. Doctors in private practices not familiar with clinical audits. Doctors in solo practices not have chance to attend M&M and audit meetings.

Support for Fellow FAQ Q&A contact point: CME/CPD Office of the Academy

Q & A