Annals of PIMS-Editorial Board

In the United Kingdom (UK), Continuing Professional Development (CPD) is an accepted part of professional life. It is mandatory for all those in career grade posts, including part-time doctors and those wholly in private practice. Non-Members of some Royal Colleges, e.g. the Royal College of Obstetricians and Gynaecologists (RCOG) can participate in the CPD Programme as CPD Associates. Those practicing outside the UK may participate in the programme on a voluntary basis. CPD is defined as ‘a continuing process, outside formal undergraduate and postgraduate training, that enables individual doctors to maintain and improve standards of medical practice through the development of knowledge, skills, attitudes and behavior. CPD should also support specific changes in practice’.

The Academy of Medical Royal Colleges (AoMRC) has developed core principles to assist Royal Colleges and Faculties to develop appropriate CPD programmes.¹ The ten principles for College/Faculty CPD schemes are:

1. An individual’s CPD activities should be planned in advance through a personal development plan, and should reflect and be relevant to his or her current and future profile of professional practice and performance. These activities should include continuing professional development outside narrower specialty interests.

2. CPD should include activities both within and outside the employing institution, where there is one, and a balance of learning methods which include a component of active learning. Participants will need to collect evidence to record this process, normally using a structured portfolio cataloguing the different activities. This portfolio will be reviewed as part of appraisal and revalidation.

3. College/Faculty CPD schemes should be available to all members and fellows and, at reasonable cost, to non-members and fellows who practice in a relevant specialty.

4. Normally, credits given by Colleges/Faculties for CPD should be based on one credit equating to one hour of educational activity. The minimum required should be an average of 50 per year. Credits for un-timed activities such as writing, reading and e-learning should be justified by the participant or should be agreed between the provider(s) and College/Faculty directors of CPD.

5. a) Self-accreditation of relevant activities and documented reflective learning should be allowed and encouraged. b) Formal approval/accreditation of the quality of educational activities for CPD by Colleges/Faculties should be achieved with minimum bureaucracy and with complete reciprocity between Colleges/Faculties for all approved activities. The approval/accreditation process and criteria should be such as to ensure the quality and likely effectiveness of the activity.

6. Self-accreditation of educational activities will require evidence. This may be produced as a documented reflection. Formal CPD certificates of attendance at meetings will not be a requirement, but evidence of attendance should be provided, as determined by each individual College or Faculty.

7. Participation in College/Faculty based CPD schemes should normally be confirmed by a regular statement issued to participants which should be based on annually submitted returns, and should be signed off at appraisal.

8. In order to quality assure their CPD system, Colleges/Faculties should fully audit participants’ activities on a random basis. Such peer-based audit should verify that claimed activities have been undertaken and are appropriate. Participants will need to collect evidence to enable this process.

9. Until alternative quality assurance processes are established, the proportion of participants involved in random audit each year should be of a size to give confidence that it is representative and effective. This proportion will vary according to the number of participants in a given scheme. 10. Failure to produce sufficient evidence to support claimed credits will result in an individual’s annual statement being endorsed accordingly for the year involved and the individual subsequently being subject to audit annually for a defined period. Suspected falsification of evidence for claimed CPD activities will call into question the individual’s fitness for revalidation, and may result in referral to the General Medical/Dental Council (GMC/GDC). CPD will be a central component for recertification, which allows doctors to continue to enjoy the privileges associated with entry on the medical register. Recommendation for recertification will be the responsibility of the Responsible Officer, subject to satisfactory confirmation from Royal Colleges/Faculties that the doctor has met the requirements of the relevant CPD Programme.

The Chief Medical Officer (CMO) of England published his report: Trust, assurance and safety – the regulation of health professionals in the 21st century in February 2007.² In the following year there was a report Medical Revalidation - Principles and Next Steps: the report of the Chief Medical Officer for England’s working group.³ Under the proposals, medical revalidation is to have two components: relicensure and specialist recertification. Relicensing will rely primarily on information derived from a revised and strengthened annual appraisal, which will include evidence from multi-source feedback from patients and colleagues. Recertification will be based on standards for specialist practice set by the Medical Royal Colleges, working with the specialty associations, and approved by the General Medical Council (GMC). Each College/Faculty is developing detailed CPD programmes.

The RCOG CPD programme has been revised to meet the challenges of recertification to ensure that clinicians stay up-to-date in their current areas of practice and develop in the areas they wish to progress. Therefore clinicians will need to bring their CPD activities in line with their job plans and professional aspirations, as well as their wider activities for the benefit of their specialty and of the NHS. The CPD categories have been redefined as follows:

• Local - job-plan related clinical and non-clinical educational activities (in the UK most of these would be discussed locally through the appraisal process).

• National/International - contribution to the national or international agenda or learning from the national or international scene.

• Personal/Professional -activities that develop the individual professionally or specialty-related activities which derive from a personal interest.

• Knowledge-based assessment (KBA) - this is a new category that will become mandatory once revalidation comes into operation. There will be a minimum requirement of 250 CPD credits during a five-year cycle. There are mandatory minimum credits within each of these categories and a significant increase in flexibility between the categories has been introduced. The RCOG has adopted an approach that will support the large number of doctors who are committed to the goals of lifelong learning and continuous improvement that are the hallmarks of professionalism. The process should also identify those doctors who pose a risk to their patients.(Table-I) The RCOG has established a Recertification Committee to implement the recommendations of the Working Group report in relation to revalidation and to ensure that the RCOG process remains relevant and in line with new policies and developments.

The CPD guide for the RCOG is downloadable from http://www.rcog.org.uk/files/rcog-corp/uploaded-files/CPDGuide0509.pdf. The CPD programmes will continue to evolve so that individuals remain upto date for their clinical practice and support positive change so that patients receive the best care available. Those practicing in Pakistan will be able to access the relevant CPD programmes within the UK relevant to their specialty. They will be able to register as overseas CPD participants and if appropriate to maintain their license to practice with the UK General Medical Council. Even those that are non-members of the relevant Royal College in the UK will be able to register as CPD associates with prescribed benefits. The College of Physicians and Surgeons in Pakistan (CPSP) could establish similar programmes which would benefit practitioners.

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