CPD - Continuing Professional Development of General Practitioners in Europe

PREAMBLE

General Practice enjoys ever greater recognition within health care systems in Europe. In parallel with this, demands for quality in the health care services delivered by General Practice are also increasing.

The continuing professional development (CPD) of General Practitioners is an inevitable prerequisite for the maintenance and development of this quality.

DEFINITION

The term CPD in this document is used to mean the maintenance and development of the professional competence of the individual general practitioner.

CPD should be understood as the activity by which the individual doctor updates his knowledge about, orientation on, and responsible practice of medicine in general practice including management, communication and relationship issues.

Evidence has shown that general practitioners make considerable efforts to maintain their competence in the daily work. Expertise in new competencies grounded in the needs which becomes evident within the daily professional challenge are set in focus while competencies not central to that challenge are set aside.

RESPONSIBILITY

It is the responsibility of the individual general practitioner to make optimal use of resources (time, finance, the profession's taking care of) which in the given national system are set aside for CPD. This is achieved by enabling the GPs themselves explicitly identify their personal learning needs and select their CPD activities accordingly. Explicit evaluation of the success of this process as well as registration of the activities are necessary links in the quality assurance of the CPD process.

It is the responsibility of the professional organizations to cooperate in securing and developing an effective framework for the individual physician's CPD. This includes mutual responsibility for the determination of an annual minimum amount of CPD, which should be reflected in the resources (finances, time, CPD offers), made available nationally for this purpose.

As various teaching methods have different strengths and weaknesses, the broadest possible range of learning opportunities should be offered. The individual doctor must be able to choose the methods which are most relevant for him or her in the context of the identified learning needs to have the skills to be updated or learned, and challenge the attitudes that may impede patient care.

It is the responsibility of all stakeholders – patients, societies and politicians to cooperate in securing the necessary finances and time as well as the establishment of frameworks which can satisfy the requirement for competence that society is generally aiming for.

INDEPENDENCE

The choice of the individual GP of concrete CPD activities must be independent of influence from the financing and regulating authorities - that is, the public authorities, the various insurance systems and the pharmaceutical industry. The individual physician's CPD takes place in his or her zone of mastery; thus, only the individual doctor can evaluate the relevance of his or her choice of CPD.

However, at the same time, GPs must be accountable for the quality of their CPD and for their use of resources. In cooperation with the professional organisations, the process should be organized so that the individual GP is able to develop his or her personal learning plan in the light of external evaluation and audit in order to ensure that unrecognized educational needs are identified. Attendance at CPD activities must be allowed during regular office hours. Financing of CPD provision cannot be the sole responsibility of general practice.

Within this general framework each GP should have access to participation in appropriate CPD throughout his or her professional career.

QUALITY

The assurance of high quality must build upon criteria established by the profession in close cooperation with the academic organizations and universities. The establishment of quality requirements must furthermore involve the other interested parties - patients, public authorities, insurance systems, and politicians.

A broad array of CPD activities both with regard to form and content is a prerequisite for a high quality CPD. Explicit definitions of the content, high teaching standards and the use of recognized educational methods, all help to maximize the quality of the individual CPD activities.

Accreditation in accordance with established criteria of the individual CPD activities for GPs can be a method for securing quality. Obligatory CME does not guarantee quality. The principle of voluntary choice is the only way of ensuring that the individual needs are covered in the best possible manner and that the resources earmarked for CPD are used effectively.

UNDERPERFORMING DOCTORS

Society, through the relevant regulatory authority, may look to a physician's recorded CPD as evidence of his/her continued competence. If this is to be the case then the imposition of measures to ensure competence in general practice requires a legislative framework, the provision of resources to provide the educational structure, an appeals mechanism and a remedial education program for those physicians who ‘fail’ to meet the criteria set. The academic colleges may facilitate their individual G.P. members to satisfy the regulatory authority’s competence assurance measures, but will not act in a surrogate policing role (of their member’s license to practice) on behalf of others.

REGISTRATION

Individual electronic registration or manually maintained logbooks of the individual CPD activities are useful. Such documentation sharpens the individual's attention to his or her own CPD activity and is a prerequisite for an effective personal learning plan. Anonymised registration information held in a central database can provide a basis for the quality assurance of CPD system.

UEMO DECLARATION ON CPD

  1. With this document the UEMO wishes to establish goals and proposals with special relevance for the CPD of general practitioners.
  2. UEMO endorses the content of the CPME policy paper on CME/CPD adopted in 2002.
  3. CPD is a natural part of and must take its starting point in the daily work in general practice. CPD for general practitioners must be conducted on both a theoretical and a practical level and ought to be of direct use in the practitioner's daily work. CPD is a developmental and formative process and must be differentiated clearly from the processes needed to assess and assist GPs who are experiencing problems.
  4. Specifically allocated resources (time, money, professional willingness) is a prerequisite for the quality assurance of structured CPD.
  5. The choice of the individual CPD activities is the responsibility of the individual. The organization and standards of CPD activities is the responsibility of the profession and the academic medical organizations. The frameworks within which the CPD takes place must necessarily include cooperation with the health authorities in general and the financing authorities in particular as CPD must be seen to be a part of the functioning of practice and take place during office hours. As broad an array of CPD offers as possible must be ensured with regard to both content and form in order for the individual GP to fulfill his or her learning needs.
  6. It is necessary to ensure the scientific and educational quality of CPD by:
    • Establishing precise goals and appropriate criteria.
    • Assuring the quality of the CPD activities - for example, by setting accreditation criteria for those who deliver CPD.
    • Establishing formal recognition of doctors who participate in CPD, where such an organization does not already exist. UEMO proposes the establishment of a national organization consisting of representatives from the various interest groups involved in system of CPD.
  7. An attempt to develop methods for continuing to follow the process and result of CPD activities must be supported.
  8. Each GP should be ensured time and money to participate in CPD. The content of the individual physician's CPD is decided upon by him- or herself as the individual doctor should be engaged in coverage of his or her own personal learning needs. The individual doctor should be funded for at least 50 hours annually for CPD activities.
  9. UEMO recommends that the individual GP registers his or her CPD activities throughout their professional life in order, among other things, to aid in the identification of the physician’s learning needs.
  10. Since general practitioners are a specific target group for the pharmaceutical industry's marketing activities, an acceptable ethical standard must be established, through agreement between the profession and the industry, which guarantees that education will not be influenced or undermined by commercial imperatives. National health care systems and individual physicians should expect to pay a realistic amount for high quality educational activities and should not be dependent on financial subsidy from the pharmaceutical industry.