Description
Public health physicians are required by the Faculty of Public Health Medicine of the Royal Colleges of Physicians of the UK, to undertake lifelong learning and to record their efforts. We know from annual returns to the Facultys continuing professional development (CPD) scheme that the vast majority of them are actively engaged. A recent analysis of the annual returns shows that most participants are completing more than the required 50 hours of CPD per year. So all is well in the world of CPD, or is it?
Professional medical practice is changing profoundly in the UK. Partly this is influenced by an international re-orientation of doctors, not least through pressure from governments and the public, towards a more open accountable relationship with their patients and their employers. However there are specific factors in the UK recently that have caused an implosion of the old system, perceived as detached and distant and embodied in the Royal Colleges, General Medical Council and British Medical Association. What is emerging, painfully, is an acknowledgement that doctors are fallible, systems in this NHS can fail patients spectacularly and the processes in place to counteract this, including previous approaches to audit and CPD, may not be powerful enough to do so.
The term clinical governance has been coined as representing …a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. It acknowledges that medical practice depends on the quality of the clinical environment as well as the skills and knowledge of the individual doctor. A Department of Health publication has placed the achievement of clinical governance within organisations – an employment environment – alongside the twin professional supports of life long learning and self-regulation. The General Medical Council in the UK is responsible for self-regulation of doctors. Its role and approaches are changing profoundly and as part of that change, the Council has proposed that doctors on the UK medical register should undergo revalidation. While the details of this remain to be worked through, the broad approach will be one of local profiling with evidence available relating to the doctors performance. Part of that evidence will be CPD records.
For those leading CPD, this means that records will need to stand up to scrutiny that life long learning is effectively underpinning routine work, and contributing to clinical governance in the specialty as well as minimising risks of harm to patients and the public. New approaches to CPD will be needed beyond the mechanistic and non-specific guidance of the past. Participants themselves will need to make the connections between their effectiveness in practice and how they maintain and improve that. The learning plan for CPD, as part of a personal development plan will be an essential first step, and this should be regularly updated. All of this and the subsequent learning undertaken will be recorded in portfolios containing a range of evidence relating to clinical governance. For those providing guidance in the Royal Colleges, it is important that more flexible approaches to CPD are considered so that learning for, and on the job can be rewarded. Although evidence-based CPD is in its infancy, it is known that certain forms of learning are more effective in adults than others, yet current CPD systems appear to take little note of this fact.
For the specialty of public health, there is the added dimension of the widening non-medical fraternity in employment in the UK; many work locations are now richly multi-disciplinary and public health physicians enjoy learning with colleagues from other disciplines whose perspectives are complementary. The Faculty of Public Health Medicine is developing a new scheme of CPD which will be piloted in 2001 and which is being circulated to all members for consultation. This new approach encompasses needed changes coming from the wider environment, and is open to all disciplines in public health, although, as in the current scheme, it will only be mandatory for doctors.
Although there is much controversy in medicine at the moment, the changes in CPD and those driven by clinical governance will ultimately have a positive effect on the practice of medicine, because they reflect the realities of a changing world, and attempt to address these in a supportive way. Staying the same is not an option. These changes need to be reflected in all walks of medicine, from undergraduate education through to leadership from the post graduate institutions so that doctors in this system are truly fit to practice. Public health physicians, like other doctors, will need to assure government, employers and their public that they offer a safe, effective and accountable service. Can they do that now? Their CPD must help them ensure that they can do so in future.
