Maintenance Of Professional Competence Research Articles

Doctors' attitudes to maintenance of professional competence: A scoping review.

Recent decades have seen the international implementation of programmes aimed at assuring the continuing competence of doctors. Maintenance of Professional Competence (MPC) programmes aim to encourage doctors' lifelong learning and ensure high-quality, safe patient care; however, programme requirements can be perceived as bureaucratic and irrelevant to practice, leading to disengagement. Doctors' attitudes and beliefs about MPC are critical to translating regulatory requirements into committed and effective lifelong learning. We aimed to summarise knowledge about doctors' attitudes to MPC to inform the development of MPC programmes and identify under-researched areas. We undertook a scoping review following Arksey and O'Malley, including sources of evidence about doctors' attitudes to MPC in the United States, the United Kingdom, Canada, Australia, New Zealand and Ireland, and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a guide. One hundred and twenty-five sources of evidence were included in the review. One hundred and two were peer-reviewed publications, and 23 were reports. Most were from the United Kingdom or the United States and used quantitative or mixed methods. There was agreement across jurisdictions that MPC is a good idea in theory but doubt that it achieves its objectives in practice. Attitudes to the processes of MPC, and their impact on learning and practice were mixed. The lack of connection between MPC and practice was a recurrent theme. Barriers to participation were lack of time and resources, complexity of the requirements and a lack of flexibility in addressing doctors' personal and professional circumstances. Overall, the picture that emerged is that doctors are supportive of the concept of MPC but have mixed views on its processes. We highlight implications for research and practice arising from these findings.

Doctors\u2019 maintenance of professional competence: a\xa0qualitative study informed by the theory of planned behaviour

BackgroundMedical regulators worldwide have implemented programmes of maintenance of professional competence (MPC) to ensure that doctors, throughout their careers, are up to date and fit to practice. The introduction of MPC required doctors to adopt a range of new behaviours. Despite high enrolment rates on these programmes, it remains uncertain whether doctors engage in the process because they perceive benefits like improvements in their practice and professional development or if they solely meet the requirements to retain medical registration. In this study, we aimed to explore the relationship between doctors’ beliefs, intention and behaviour regarding MPC through the lens of the Theory of Planned Behaviour (TPB) to make explicit the factors that drive meaningful engagement with the process.MethodsWe conducted a qualitative study using semi-structured interviews. From a pool of 1258 potential participants, we purposively selected doctors from multiple specialities, age groups, and locations across Ireland. We used thematic analysis, and the TPB informed the analytic coding process.ResultsForty-one doctors participated in the study. The data analysis revealed doctors’ intention and behaviour and the factors that shape their engagement with MPC. We found that attitudes and beliefs about the benefits and impact of MPC mediated the nature of doctors’ engagement with the process. Some participants perceived positive changes in practice and other gains from participating in MPC, which facilitated committed engagement with the process. Others believed MPC was unfair, unnecessary, and lacking any benefit, which negatively influenced their intention and behaviour, and that was demonstrated by formalistic engagement with the process. Although participants with positive and negative attitudes shared perceptions about barriers to participation, such perceptions did not over-ride strongly positive beliefs about the benefits of MPC. While the requirements of the regulator strongly motivated doctors to participate in MPC, beliefs about patient expectations appear to have had less impact on intention and behaviour.ConclusionsThe findings of this study broaden our understanding of the determinants of doctors’ intention and behaviour regarding MPC, which offers a basis for designing targeted interventions. While the barriers to engagement with MPC resonate with previous research findings, our findings challenge critical assumptions about enhancing doctors’ engagement with the process. Overall, our results suggest that focused policy initiatives aimed at strengthening the factors that underpin the intention and behaviour related to committed engagement with MPC are warranted.

Maintenance of professional competence in Ireland: a national survey of doctors’ attitudes and experiences

ObjectivesProgrammes to ensure doctors’ maintenance of professional competence (MPC) have been established in many countries. Since 2011, doctors in Ireland have been legally required to participate in MPC. A significant...

Motivation or demotivation of health workers providing maternal health services in rural areas in Vietnam: findings from a mixed-methods study.

BackgroundMotivation is an important driver for health professionals to maintain their professional competencies, continue in the workforce and make a positive contribution to their workplace. While there is some research about the motivation of health workers in low- to middle-income countries, maternal morbidity and mortality remains high and this can be lowered by improving the quality of maternal health services and the training and maintenance of the skills of maternal health workers. This study examines the impact of motivation on maintenance of professional competence among maternal health workers in Vietnam using mixed methods.MethodsThe study consisted of a survey using a self-administered questionnaire of 240 health workers in five districts across two Vietnamese provinces and in-depth interviews with 43 health workers and health managers at the commune, district and provincial level to explore external factors that influenced motivation. The questionnaire includes a 23-item motivation instrument based on the Kenyan health context, modified for Vietnamese language and culture.ResultsThe 240 responses represented an estimated 95% of the target sample. Multivariate analysis showed that three factors contributed to the motivation of health workers: access to training (β = −0.14, P = 0.03), ability to perform key tasks (β = 0.22, P = 0.001) and shift schedule (β = −0.13, P = 0.05). Motivation was higher in health workers self-identifying as competent or who were enabled to provide more maternal care services. Motivation was lower in those who worked more frequent night shifts and those who had received training in the last 12 months. The interviews identified that the latter was because they felt the training was irrelevant to them, and in some cases, they do not have the opportunity to practice their learnt skills. The qualitative data also showed other factors relating to service context and organisational management practices contributed to motivation.ConclusionsThe study demonstrates the importance of understanding the motivations of health workers and the factors that contribute to this and may contribute to more effective management of the health workforce in low- and middle-income countries.

Nurse competence between three generational nurse cohorts: A cross‐sectional study

Research indicates significant differences between nurse cohorts in many work-related factors. This study compared nurse competence between three generational cohorts comprising the current nursing workforce. The Nurse Competence Scale was used to collect data for this cross-sectional study from 2052 nurses in a university hospital in Finland. Data were analysed statistically. Significant differences were found between nurse cohorts in their competence. The length of work experience had a significant impact on the development of competence. The oldest cohort, with the longest work experience, had the highest competence scores (70.1 on a visual analogue scale), and the youngest had the lowest (59.0). All cohorts were most competent in patient-related nursing tasks, in maintenance of professional competence and in ethical care. Nurses were weakest in the development of nursing practice and the use of evidence-based knowledge. Targeted interventions in teaching-coaching for different nurse generations are needed to ensure the maintenance of nurse competence and high-quality patient care.

Information transfer in medicine: modus vivendi out of paradise

Medical communication constitutes the backbone of acquisition and maintenance of professional competence for physicians. The fact that during recent decades, the vast majority of medical innovations has either been developed by commercial companies or at least been marketed on a commercial basis represents a huge challenge to the freedom of medical communication from commercial bias. This article summarises the current situation regarding bias in medical information transfer and focuses on international CME/CPD activities from the point of view of a European accreditor, the European Board for Accreditation in Cardiology (EBAC).

Competence and scope of practice: ethics and professional development

In this article, I discuss the importance of the psychotherapist's capacities and attributes that go beyond formal education and training as they relate to both readiness for clinical training and continued competence throughout one's professional life. Professional development is essential to the maintenance of professional competence as a psychotherapist. Principles and standards from the American Psychological Association's (2002) Ethics Code are reviewed and illustrated with clinical vignettes. In striving to maintain competence, psychotherapists are strongly encouraged to focus on proactive self-care and professional development in addition to complying with the formal continuing education mandated by most states.

Knowledge and Social Work in Health Care—The Case of Finland

Studies carried out in different countries have shown that there is a lack of a common and up-dated knowledge base in social work, and that social workers make use of research in their everyday practice only to a very limited extent. On the other hand it has been shown that social workers feel they need knowledge but not necessarily in the form it is produced by the researchers. This paper explores issues of knowledge and competence in health social work based on the results of a survey and a focus group interview conducted among social workers in Finland. According to the results, social workers in health care do feel they need new knowledge. Some significant differences were found in the way health social workers view the acquisition and maintenance of professional competence and in the way they seek knowledge, when compared to social workers working in the municipal social services.

Geographic delivery models for radiotherapy services.

The study described here was undertaken to quantify the societal cost of radiotherapy in idealized urban and rural populations and, hence, to generate a measure of impediment to access. The costs of centralized, distributed comprehensive and satellite radiotherapy delivery formats were examined by decomposing them into institutional, productivity and geographical components. Our results indicate that centralized radiotherapy imposes the greatest financial burden on the patient population in both urban and rural scenarios. The financial burden faced by patients who must travel for radiotherapy can be interpreted as one component of the overall impediment to access. With advances in remote-monitoring systems, it is possible to maintain technical quality while enhancing patient access. However, the maintenance of professional competence will remain a challenge with a distributed service-delivery format.

The future for clinical scientists in laboratory medicine.

Clinical science in the UK has been presented with a range of opportunities and new initiatives in recent years. This review summarizes the contribution of clinical scientists to the changing face of laboratory medicine, and describes some recent UK Government initiatives to modernize the scientific service and develop the people who work in it. Recent changes in the regulation of professional practice and the need for maintenance of professional competence are also discussed.

From competent novice to competent expert: a discussion of competence in the light of the post registration and practice project (PREPP)

The nursing profession in the UK, is today faced with major changes in the light of the Post Registration and Practice Project (PREPP) (UKCC 1990). This paper raises questions about how the maintenance of professional competence as detailed in PREPP can be assured. Through a discussion of professional portfolios and continuing education, the subjectivity of guaranteeing a practitioner's competence at tri-annual re-registration is raised. With reference to Benner's (1984) work, the paper suggests that there may be some similarities on the ‘novice to expert’ continuum that relate directly to the UKCC's proposals. However, the inherent deficiencies with such a mandatory approach to professional development are discussed and questions posed about the extent of nurses' continuing education needs being met. In view of the controversy that still surrounds who will finance the changes, and what format the portfolios will adopt, practitioners are at risk of conforming to the changes but being denied the opportunity of ensuring that they possess the necessary skills and frameworks, that are essential in ensuring the maintenance of clinical competence. The paper suggests that a concerted effort will be required by both educators and service personnel to ensure that the PREPP proposals are successful.

Canon 9 - Competence—Ethical Responsibility in Establishing and Maintaining Professional Competence

Establishment and maintenance of professional competence in the knowledge, skill, and affective domains are discussed. Personal responsibility for competence is emphasized as embodied in Canon 9 of the Code of Professional Ethics for Rehabilitation Counselors, including the maintenance of personal health and wellness.

Relicensure and Recertification

A commitment to the maintenance of professional competence by a continuing educational process is nothing new to medicine. It has been the motivating force for the formation of professional societies including the American Medical Association, for the launching of an imposing number of professional journals as well as the development of postgraduate programs, both by professional societies and by educational institutions. The attendance at meetings, continuing education courses, and refresher seminars all indicate wide interest by many practitioners in remaining currently informed about new developments in medicine. Individual motivation has been augmented by organizational requirements for participation in postgraduate training. The first such program was launched by the American Academy of General Practice (now the American Academy of Family Practice). More recently, nine state medical associations have adopted systems requiring the acquisition of educational credits as a condition for continued membership. Other encouragement has been offered by such accolades as

Ethical psychiatry and biosocial humanism.

In discussing the ethical issues of special relevance to contemporary psychiatry, the author raises some provocative questions, ranging in subject from the practitioner's responsibility for the maintenance of professional competence to the ethical ramifications of some current treatment concepts. He concludes that psychiatry's task includes the development of a more satisfactory statement of human nature, from which a new and comprehensive ethical system can be derived.