Innovations in Continuing Professional Development — Countering the Dunning–Kruger Effect

Abstract

Continuing professional development (CPD) is the process by which doctors keep their knowledge and skills up to date throughout their working lives. The importance of CPD was first outlined in a number of National Health Service (NHS) documents in 1998e2000 and CPD remains one of the key elements of the General Medical Council revalidationprocess due to be implemented in 2012, albeit with a difference d thereisashiftofemphasisfromthepurely‘timespent’model to a more ‘reflective’ model whereby doctors are required to evaluate what they have learned from their CPD activity and how it may affect and improve their performance. The General Medical Council states that ‘the ultimate purpose of CPD is to contribute to high-quality patient care’. Therein lies a weakness of the current CPD system d even if it were possible to persuade doctors to record their reflections on their CPD activities ‘as soon as possible after the event to be contemporaneous and meaningful’, it will be virtually impossible to quantify the impact of the activity on a doctor’s performance from those reflections alone. Therefore, for most doctors, CPD will probably remain largely an exercise in ‘collecting points’, with the added requirement for creative writing skills. Some schemes have attempted to move CPD beyond the ‘collection of certificates’. In the Royal College of General Practitioners (RCGP) CPD scheme [1], demonstration of impact (through case study, data collection, audit or change in practice) is rewarded by a multiplication factor of 2 applied to time spent. An example of how this credit is calculated is shown inTable 1. Although the RCGP scheme is a commendable effort to make CPD more meaningful, the credits are self-assessed and then verified at appraisal. Concerns have been expressed by some general practitioner appraisers regarding the feasibility of moving from what is perceived to be a purely formative process to one that will involve judgements. Other schemes have attempted to make the assessment of knowledge more objective. Again the RCGP has led the way in the UK with its Essential Knowledge Update programme, which provides general practitioners with ‘six-monthly focused updates on selected items of new and changing knowledge central to everyday practice’. Each Essential Knowledge Update is accompanied by an Essential Knowledge Challenge, an ‘engaging online test’ of 50 multiple-choice questions. The American Board of Medical Specialties Maintenance of Certification (ABMS MOC) programme requires its participants to ‘demonstrate, through formalised examination, that they have the fundamental, practice-related and practice environment-related knowledge to provide quality care in their specialty’. The examination always includes a computer-based ‘writt en’ component of multiple-choice questions, with or without other elements depending on specialty [2,3].