1. Continuing Professional Development Knowledge Market
Designing CPD for Better Practice and Outcomes
Evidence, Practice and Debate 9th May 2013

2. Overview: Evidence base for CPD
Literature on CPD influencing practice and outcomes.
Evidence-based CPD methods.
Combining CPD and improvement to translate knowledge into practice.

3. The Challenge

4. Knowledge-Practice Gap (1)
40-45% defect rate in healthcare system – patients not receiving care as recommended in guidelines.
Grol, 2001;
McGlynn et al, 2003;
NHS Atlas of Variation, 2012
17 years to get research recommendations into practice (Balas et al 2000)
Institute of Medicine, 2001

5. Knowledge-Practice Gap (2)
Information overload- “Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up?”
Bastian, H. et al 2010
2. Practice vs research: Overestimation of impact in research studies compared with real-life contexts.
Ioannidis, 2011.

6. Continuing Professional Development: Bridging the Knowledge-Practice Gap?

7. The Literature Can CPD change practice and healthcare outcomes?
How can we design CPD for maximum impact?

8. The evidence base
Fragmented, partial and complex evidence base on CPD methods and theories - healthcare, education, sociology, psychology, management, organisational change.
A stronger evidence base is needed – metrics, research, evaluation.

9. Key evidence sources
Marinopoulos 2007: Overview of reviews and primary studies. Overall CPD approaches were effective in acquiring and sustaining knowledge, attitudes and skills, changing behaviours, and improving clinical outcomes.
Institute of Medicine 2010: 62 evaluations; 20 systematic reviews. Evidence that CPD works, in some cases, to improve clinical practice and patient outcomes.

10. Effective CPD approaches
Interactive learning
Patient/Service
Need
Multiple methods;
Time to assimilate and reflect.
Practice orientation:
Embedding & Feedback

11. Examples Use of clinical pathways Audit and feedback
Interactive education – meetings, workshops, online communities.
Educational outreach visits (“academic detailing”)
On-screen, point of care computer reminders
Local opinion leaders
Printed educational materials
Rapid-response educational technologies – access to new knowledge.
Cochrane Effective Practice and Organisation of Care Group

12. Pathman-PRECEED Model
Individual
Pathman-PRECEED Model
Intervention
Awareness
Agreement
Adoption
Adherence
Predisposing
Print materials
Journals
Lectures
Enabling
Opinion leaders
Small group sessions
Small group sessions.
Educational detailing.
Patient education.
Reinforcing
Small group audit and feedback.
Reminders
Multiple interventions
System
Davis et al 2003

13. CPD Outcomes Chain
HEALTHCARE OUTCOMES: the resulting impact on patients and communities.
PERFORMANCE……application of knowledge in practice.
COMPETENCE…..demonstrated in educational setting.
KNOW-HOW……learners acquire skills and procedural knowledge.
KNOW-WHAT …… learners acquire new knowledge about interventions.
SATISFACTION …… learners react in these ways.
PARTICIPATION….reaches learner.
Moore et al 2009

14. Knowledge Translation: Combining CPD and Improvement

15. Transformative Learning: Bridging the Knowledge-Practice Gap
Individual change
Clinical competency
Healthcare performance
Translating
Knowledge
Into
Practice
and
Quality
Outcomes
Continuing
Professional
Development
Adult learning principles
Policy
Other partners
System and process
System change
Implementation
Person-Centred Values
Safety
Systems Improvement
& Systems Learning Principles

16. Educational Bridge to Quality
Institute of Medicine (2003)
5 educational themes central to quality and safety in all professions:
Person-centred care.
Interprofessional team working.
Evidence-based practice.
Continuous quality improvement.
Health informatics - combining data and evidence to support decisions and improve quality of care.

17. Summary
Transformative learning to bridge the knowledge-practice gap calls for a combination of:
CPD – education as intervention.
Systems improvement – implementation, patient safety and quality improvement methods.
Clinical knowledge and “improving quality” knowledge.
Opportunity for NES to contribute through research and evaluation to the evolving evidence base for CPD contributing to improvement in practice and outcomes.

18. Discussion and debate
How can NES develop its leadership role in CPD, combining clinical knowledge and improvement knowledge, to improve practice and patient outcomes?
How can NES help to build the evidence base for continuing professional development?

19. Continuing Professional Development Knowledge Market
Combining Education, Improvement and Knowledge
for Better Practice and Outcomes
Evidence, Practice and Debate 9th May 2013