EDITORIAL

Continuing Professional Development. What are we talking about?

Desarrollo profesional continuo, ¿de qué estamos hablando?

Helios Pardell Alentá

Responsable DPC-FMC.Fundación Educación Médica. E-mail: hpardell@comb.es

The term Continuing Professional Development (CPD) has recently come to the fore in the world of medical profession. Nevertheless, in practice it is interpreted in anything but a uniform manner and the different agents involved often use it for very different, and even clearly opposing, purposes. Therefore, some clarification seems to be needed in order to achieve a more rational and coherent application of the concept of CPD.

What is CPD?

In both the first international formulations by the authors that introduced the concept and the definitions drawn up by the World Federation for Medical Education or the Standing Committee of European Doctors, CPD is essentially understood to be a project undertaken on an individual basis by each physician, as part of the ideology of the profession. It has its roots in the ethical-professional commitment to keep up to date and therefore competent for lifelong, so as to be able to act in accordance with the updated scientific-medical tendencies and in tune with the health service in which the professional is working. Its underlying assumptions stem from those of traditional continuous medical education, although it goes beyond these traditional propositions in some areas that were not considered to be primary aims in the classic educational programmes. One element that clearly distinguishes it from its predecessor is the consideration of the reflexive component initially described by Schön, which includes self-education based on thinking in and on practice.

In fact, if we set out from the concept of Professional Career (PC) that is most widely accepted in the international literature, that is, the progression made by a professional in different skills and experiences throughout his or her working life, then it does not appear to be so different from CPD. In our country, however, PC has been formulated mainly on a trade-unionist basis, with the consequent occupational and salary-related repercussions. This has limited it to the scope of the organisation in which the professional offers his or her services and, with the passage of time, it has been distorted and become a slightly modified scale of seniority.

The Spanish Ley de Ordenación de las Profesiones Sanitarias (Health Professions Regulation Act) understands it to be "the public, express and individualised recognition of the development of the health professional as regards knowledge, experience in health care, teaching and research activities, as well as in satisfying the health care and research objectives set by the organisation the professional works for".

Although this last definition seems quite clear, things get a bit more complicated when we compare it with the definition of Professional Career given by the Regulatory Framework, i.e. "the right a professional has to progress, on an individual basis, as acknowledgment of their professional development in matters concerning knowledge, experience and satisfaction of the objectives of the organisation he or she works for". And as if that weren´t enough, even more confusion arises when each of the two above-mentioned laws introduces levels of progression, both for the CPD and for PC, which only makes it even more difficult to distinguish between the two concepts.

CPD in practice

From all this it can be seen that, in practice, when attempts are made to embody CPD in a concrete reality, a common mistake is to fall into the temptation of seeing it as a higher level of PC or, worse still, as a kind of PC-b that will put an end to the frustration that, just a few years after its implementation, PC has generated among physicians employed by public health services within the Autonomous Communities.

It goes without saying that at the root of the issue lies the dilemma in which most physicians find themselves immersed today, i.e. it is not altogether clear whether they are true professionals, with all that such a denomination entails, or simply employees, albeit of a statutory nature, of the autonomic public health services.

If, as we have insistently advocated, physicians and their professional organisations are to reformulate the way of thinking of the profession and fully incorporate this ideology into their daily practice, then there can be no doubt whatsoever that CPD must be taken as the individual effort made to keep oneself up to date, and therefore competent, and to progress in one´s working life. And in this context, it also becomes clear that CPD is the physician´s responsibility and that it is something he or she must bear, like a kind of backpack, throughout their entire working life, and is something that will be used for different promotional purposes, such as seeking the best job opportunities in a free and open job market.

All this takes on a different meaning when we look at things from the perspective of the physician as essentially an employee, who claims his or her continuous education and, by extension, his or her CPD as a right that the employer must satisfy. This is what accounts for the whole network of bureaucracy and regulations that exist to ensure, as far as possible, equality when it comes to assigning the levels that can be reached by all physicians employed by public institutions, which have designed their PC based on the assumptions of the Estatuto Marco Act.

If we go a little further into this situation and take the most extreme interpretation, we could say that there are as many CPDs as there are doctors, whereas the number of PCs is the same as the number of employing institutions (or employing groups or systems).

Options for the future

If understood in this way, it shouldn´t be too difficult to begin to put the situation in order, provided that we all accept that PC, with its different levels, has a direct effect on the physician´occupational and salary-related conditions, whereas the CPD does not have such repercussions, or at least not directly. It is, of course, obvious that it does exert an indirect influence due to the fact that it can and must be incorporated as a component of the scale used to measure the progression of the PC, as well as its being useful at a professional level, and this is not the case of the PC.

From there on, it should not be difficult to accept the notion that PC lies within the field of negotiations between trade unions and employers, both public and private, while CPD stands within the area of professional organisations and regulatory agents.

In this context, the players involved in CPD, and more especially the professional organisations (scientific societies and medical associations), must be able to find ways to put it to practical use, as I have briefly outlined. This is especially true with regard to the different areas of individual promotion (qualifications, credentials and PC) and self-regulation (entry register, regulations, definition of the limits of competencies and revalidation). If they do not do so, we can suppose that the force of the economic incentives of PC will end up blurring the contour of CPD completely and we will have missed a golden opportunity to realign the future of the profession.

We hope that, from within the current state of confusion surrounding CPD, each of the stakeholders (physicians, professional organisations, trade unions, employers and regulatory agents) will be able to come up with ideas that help them clarify their positions. If they manage to do so, it will have been worthwhile crossing this period of uncertainty we now find ourselves in. However, each of those involved must take on his or her responsibilities and commitments and, with a view to a brighter future and the desire to offer their services to others, try to avoid invading other fields by working in collaboration for the good of the health care system, the profession and, ultimately, society itself.