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commentary professional development commentary continuing professional development variations of the basic cpd mod el using different terms to describe in pharmacy the stages have been adopted or dis cussed in ...

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                                                                                   COMMENTARY Professional development
                                                                COMMENTARY
                 Continuing professional development                                                          Variations of the basic CPD mod-
                                                                                                           el, using different terms to describe
                                             in pharmacy                                                   the stages, have been adopted or dis-
                                                                                                           cussed in pharmacy, but the differ-
                                                                                                           ences are not significant. Implemen-
                                              MICHAEL J. ROUSE                                             tation strategies and the professional
                                       Am J Health-Syst Pharm. 2004; 61:2069-76                            and regulatory framework within
                                                                                                           which the CPD model is adopted do,
                    ontinuing professional devel-               education is society’s only real           however, differ considerably, and
                    opment (CPD) is a framework                 guarantee of the optimal quality           some examples are described later.
              Cfor, or approach to, lifelong                    of health care.1                           Essentially, the concept of CPD is
              learning and is being discussed as a                                                         based on a cycle in which individual
              potential model for pharmacists in                Perhaps ahead of their time, the           practitioners reflect on their practice
              the United States. CPD is not a re-            objectives of the ASHP statement,             and assess their knowledge and
              placement for continuing education             approved in 1989, read remarkably             skills, identify learning needs, create
              (CE), as quality-assured CE is an es-          like a framework for CPD.                     a personal learning plan, implement
              sential component of CPD. This arti-              What is CPD? CPD is an ongoing,            the learning plan, and evaluate the
              cle explains the concept and compo-            self-directed, structured, outcomes-          effectiveness  of the educational in-
              nents of CPD, describes some of the            focused cycle of learning and person-         terventions and the plan in relation
              driving forces behind the reevalua-            al improvement. The Chartered Insti-          to their practice. Documentation is
              tion of current systems of CE for              tute of Personnel and Development             an integral aspect of CPD, and a per-
              pharmacists, defines relevant terms,           (CIPD) put forth an early definition          sonal portfolio is typically used for
                                                                                           2: “CPD is      this purpose. A five-step cycle was
              and outlines some experiences with             of CPD in October 1997                        used to describe CPD in a statement
              CPD in selected foreign and U.S.               systematic, ongoing, self-directed                                         3 and an ad-
              health systems that have already               learning. It is an approach or process        adopted by FIP in 2002,
              adopted the model. This article is in-         which should be a normal part of              aptation—in which the cycle in-
              tended to provide a basis for further          how you plan and manage your cludes self-appraisal, development
              discussions regarding CPD and ex-              whole working life.”                          of a personal plan, action, documen-
              plain what it could mean for the pro-             In 2002, the concept of CPD was            tation, and evaluation—has been
              fession of pharmacy and pharmacists            defined by the International Phar-            used as the basis for some of the early
              if implemented nationwide.                     maceutical Federation (FIP) as                discussions of CPD in the United
                 The following sentences introduce                                                         States.
              the American Society of Health-                   the responsibility of individual              Another representation of the CPD
              System Pharmacists (ASHP) state-                  pharmacists for systematic main-           cycle, offered by the author (Figure
              ment on continuing education:                     tenance, development and                   1), in which documentation—the
                                                                broadening of knowledge, skills            portfolio—is shown as an integral
                 Next to integrity, competence is               and attitudes, to ensure continu-          component but not a separate stage,
                 the first and most fundamental                 ing competence as a professional,          may help to explain the elements of
                 moral responsibility of all health             throughout their careers.3                 CPD and their sequence.
                 professions . . . Each of our pro-
                 fessions must insist that compe-           MICHAEL J. ROUSE, B.PHARM. (Hons.), M.P.S.,    (mrouse@acpe-accredit.org).
                 tence will be reinforced through           is Assistant Executive Director, International
                 the years of practice. After the           and Professional Affairs, Accreditation Coun-     Copyright © 2004, American Society of
                                                            cil for Pharmacy Education, 20 North Clark     Health-System Pharmacists, Inc. All rights re-
                 degree is conferred, continuing            Street, Suite 2500, Chicago, IL 60602          served. 1079-2082/04/1001-2069$06.00.
                                                                                          Am J Health-Syst Pharm„Vol 61  Oct 1, 2004             2069
                  COMMENTARY Professional development
              Figure 1. Continuing professional development cycle centered around a portfolio.                designed or intended to support
                                                                                                              the continuous development of
                                                                                                              pharmacists to maintain and
                                                     Reflect                                                  enhance their professional com-
                                                                                                              petence. Continuing education
                                                                                                              should promote problem-
                                                                                                              solving and critical thinking and
                            Evaluate                Record                    Plan                            be applicable to the practice of
                                                   (Portfolio)                                                pharmacy.6
                                                                                                              Perhaps the terms lifelong learn-
                                                                                                          ing and CE should be synonymous.
                                                       Act                                                CE has been associated more with or-
                                                                                                          ganized or structured educational ac-
                                                                                                          tivities, as defined above by the Ac-
                                                                                                          creditation Council for Pharmacy
                 The purpose of CPD is to ensure               making abilities, a strong knowl-          Education (ACPE).
              that pharmacists maintain their                  edge base, and the ability to ap-              Why change? In a changing, in-
              knowledge, skills, and competencies              ply knowledge and experience to            creasingly complex profession, and
                                                                                                 4        with rapid medical and technological
              to practice throughout their careers             diverse patient-care situations.
              in their specific area of practice;                                                         advances, the need for lifelong learn-
              improve personal performance; and                Lifelong learning is defined as            ing for pharmacists is irrefutable.
              enhance their career progression.             follows:                                      Health care professionals are re-
              CPD is designed to be self-directed,                                                        quired to engage in CE. While appro-
              practitioner-centered, and outcomes-             All learning activity undertaken           priate, competency-based education
              based to meet the specific goals and             throughout life, with the aim of           can prepare a pharmacist to enter
              objectives of individual pharmacists,            improving knowledge, skills and            practice, no professional program
              ultimately improving patient and                 competences within a personal,             can provide or develop the knowl-
              public health outcomes. It emphasiz-             civic, social and/or employment-           edge, skills, attitudes, and abilities
              es the importance of practice-based              related perspective.5                      that a pharmacist will ever need.
              learning and, in the United King-                                                           Such development requires a combi-
              dom’s model, of identifying and                  Continuing education was defined           nation of an appropriate preservice
              achieving organizational goals and            in 2000 as follows:                           educational foundation, inservice
              objectives. As CPD is a relatively new                                                      training, hands-on work experience,
              concept, evidence has not yet been               Organized learning experiences             and lifelong learning. For profession-
              provided that widespread adoption                and activities in which pharma-            als, education is a continuum. Unlike
              of a CPD model is more effective                 cists engage after they have com-          medical practitioners, a minority of
              than traditional CE systems in                   pleted their entry-level academic          pharmacists obtain postgraduate
              achieving these goals.                           education and training. These              qualifications or specialty certifica-
                 Definitions. An understanding of              experiences are designed to pro-           tions, although a variety of such pro-
              and a distinction between the terms              mote the continuous develop-               grams are offered. Approximately
              used in this paper are important, and            ment of the skills, attitudes, and         3% of licensed pharmacists are certi-
              most of the following are currently              knowledge needed to maintain               fied, and of the 2001–02 pharmacy
              used within pharmacy or other                    proficiency, provide quality ser-          school graduates, approximately
              health care professions.                         vice or products, respond to pa-           14% successfully completed an
                 Competence is defined as follows:             tient needs, and keep abreast of           ASHP-accredited pharmacy practice
                                                                        4                                                      7-12 
                                                               change.                                    residency in 2003.      Council on Cre-
                 The ability to perform one’s du-                                                         dentialing in Pharmacy resource
                 ties accurately, make correct              A more recent (2003) definition               documents on CPD and credential-
                 judgments, and interact appro-             follows:                                      ing in pharmacy provide details of
                                                                                                                              13,14
                 priately with patients and with                                                          these programs.         Certificate pro-
                 colleagues. Professional compe-               Continuing education for the               grams, for which national standards
                 tence is characterized by good                profession of pharmacy is a                were introduced in 1999, are longer
                 problem-solving and decision-                 structured process of education            than the average CE program and de-
              2070        Am J Health-Syst Pharm„Vol 61  Oct 1, 2004
                                                                           COMMENTARY Professional development
             signed to develop knowledge or skills     times not even attempted. In the          ods and participation in self-directed
             in a specific area (e.g., immunization,   CPD model, more responsibility is         learning activities that are based on
             diabetes management). However,            placed on individual practitioners to     identified learning needs or personal
             participation in certificate programs     identify and participate in programs      goals, are relevant to practice, are in-
             by pharmacists has been limited. In       that meet their own specific learning     teractive, are ongoing, have defined
             2002–03, 4824 participants—some           needs and assess the impact and ben-      outcomes for the practitioner and
             2% of licensed pharmacists— efit of such programs.                                  the organization, and can be rein-
             completed the 81 certificate pro-            A growing body of evidence (pri-       forced through practice are more
             grams offered by 37 ACPE-accredited       marily from the medical literature)       likely to achieve sustainable learning
                        7,15                                                                                           23-25,27-31
             providers.     CE is, therefore, the      shows that, while CE can be effective     and practice change.          The CPD
             simplest and most common form of          in improving knowledge, skills, atti-     model incorporates a number of
             postgraduate training for pharma-         tudes, behavior, and patient health       these strategies.
                  16
             cists.  Emphasizing the professional      outcomes, traditional approaches to          Pressure to change approaches to
             development of practitioners, the         CE are not usually curricular in          continuing education is coming
             CPD model expands in breadth and          nature, do not optimally address all      from outside and within the pharma-
             depth the traditional model of life-      required competencies, and are not        cy profession. Providers of health
             long learning, thereby offering, some     always successful in changing prac-       care services are required to increase
                                                                      20-25
             believe, a quality improvement for        tice behaviors.     Not only is the rel-  attention to quality and quality im-
             current CE systems.                       ative effectiveness of different educa-   provement. In a series of reports, the
                Many factors are driving a critical    tional strategies difficult to measure    Institute of Medicine (IOM) high-
             reevaluation of CE systems. Virtually     and compare, many extrinsic factors       lighted deficiencies in health systems,
             all state boards of pharmacy rely on      can influence the effectiveness of CE     identified key factors contributing to
             pharmacists’ participation in a de-       and its impact on performance, prac-      the state of affairs, and made a num-
             fined number of hours of ACPE-            tice, and patient outcomes. More re-      ber of recommendations.32-34 IOM
             accredited or otherwise approved CE       search is needed to improve our un-       notes that the knowledge and skills of
             to provide assurance of pharmacists’      derstanding of these factors and how      health care professionals are often
                          7,17
             competence.      Since the mid-1970s,     they influence CE outcomes.               not optimally utilized and that prob-
             when the number of states requiring          What is evident from the litera-       lems arise because they work in a sys-
             mandatory CE started to grow, the         ture, however, is that achieving prac-    tem that does not adequately prepare
             number of accredited providers of-        tice change requires some very un-        them, or support them once they are
             fering a broad range of quality CE        common practices, which do not            in practice, to deliver the best care to
             programs has significantly increased.                                           26  their patients. IOM has concluded
                                                       consistently happen. Davis et al.
             In 1978, ACPE accredited 72 CE pro-       concluded that there is                   that the education and training of
             viders; currently there are over 400.18                                             health care professionals need a ma-
             CE programs are delivered in a               some evidence that interactive         jor overhaul and advocates that edu-
             variety of formats to accommodate            CME [continuing medical edu-           cation and training (both preservice
             different learning needs and prefer-         cation] sessions that enhance          and lifelong) must be competency
             ences. However, state boards of              participant activity and provide       based. Pharmacy has been com-
             pharmacy have few specific require-          the opportunity to practice skills     mended for its competency-based
             ments regarding the content of CE            can effect change in professional      standards for degree-program ac-
             and its relevance to the practice of         practice and, on occasion, health      creditation and cited as an example
             the pharmacist. ACPE standards re-           care outcomes [and] variables          for other health care professions to
             quire CE providers to have systems           over which the CME provider                    34 ACPE’s new definition of
                                                                                                 follow.
             in place to identify the learning needs      has control and appear to have a       CE highlights the professional com-
             of participants and offer programs to        positive effect are the degree of      petencies applicable to the practice of
                               19                                                                           6
             meet those needs. In the current CE          active learning opportunities,         pharmacy.  IOM has identified five
             model, the programs offered are in-          learning delivered in a longitudi-     core competencies that all health care
             tended to meet the learning needs of         nal or sequenced manner, and           professionals should possess: (1)
             a number of pharmacists. Clearly, it         the provision of enabling meth-        provide patient-centered care, (2)
             is unrealistic to expect CE providers        ods to facilitate implementation       work on interdisciplinary teams,
             to attempt to identify and respond to        in the practice setting.               (3) employ evidence-based practice,
             the individual needs of practitioners.                                              (4) apply quality improvement mea-
             Furthermore, meaningful assessment           Ample studies indicate that utili-     sures, and (5) use informatics. It has
             of learning is difficult and many         zation of multiple educational meth-      recommended that all health profes-
                                                                                  Am J Health-Syst Pharm„Vol 61  Oct 1, 2004       2071
                COMMENTARY Professional development
             sions should move toward requiring           Neither CPD nor CE alone can           reflect, plan, act, evaluate—are now
             licensed health care professionals to     ensure professional competence. Al-       discussed. As shown in Figure 1, the
             periodically demonstrate their ability    though CPD is a largely unproven          record (documentation) step of the
             to deliver patient care through direct    model in pharmacy, might it build         five-stage cycle is in the center of the
             measures of technical competence,         on the traditional methods of CE and      four-stage cycle.
             patient assessment, evaluation of pa-     offer more effective lifelong learning       Reflect. Also referred to as self-
             tient outcomes, and other evidence-       for pharmacists? Early adopters of        appraisal or assessment, this stage re-
                                            34
             based assessment methods.  This           the concept believe it can, and some      quires pharmacists to reflect on per-
             latter recommendation has profound        examples of CPD implementation            sonal and organizational needs and
             implications, but it is unlikely that a   are emerging in pharmacy and other        goals for professional development
             system of direct assessment (already      professions. Great Britain and On-        and to assess their knowledge, skills,
             in use in some countries) would be        tario, Canada, provide good case          and competence. Reflection is im-
             considered feasible or desirable by       studies from programs initiated for       portant to learning; it has been de-
             the pharmacy profession in the Unit-      pharmacy in the mid-to-late scribed as a complex and deliberate
             ed States at this time. While many        1990s.13,37-41                            process of thinking about and inter-
             practitioners may already use a CPD          A better learning model?  The          preting an experience in order to
             model for their lifelong learning and     CPD model for lifelong learning and                      50
                                                                                                 learn from it.  Ideally, reflection is
             professional development, could           professional development of practi-       performed in two ways: (1) on an ad
             professionwide adoption of the            tioners is sound theoretically and was    hoc or unscheduled basis, usually a
             model provide the required level of       developed using well-tested princi-       reaction to specific day-to-day prac-
             assurance (and public accountabili-       ples of learning and continuous           tice experiences (a “reflection in
                                                                                 42,43
             ty) that licensed pharmacists are         quality improvement.           In the     practice”) and (2) on a scheduled or
                                                                                           44-46
             maintaining and updating their pro-       1970s and 1980s, Kolb and Smith           proactive basis (e.g., annually, bian-
             fessional competencies?                   described how people learn and han-       nually) or when a major career
                Preparing pharmacists to deliver       dle day-to-day situations in their        change occurs or is anticipated (a
             pharmaceutical care. In 2000, a           lives.                                    “reflection on practice”).
             white paper on pharmacy’s future             Based on the work of Kolb, a four-        Accurate self-assessment is diffi-
             roles, responsibilities, and manpow-      stage cycle of experiential learning      cult, and pharmacists are likely to
             er needs noted that, while the philos-    has been described: (1) have a new        need assistance in this task. Ideally,
             ophy of pharmaceutical care had           experience, (2) reflect on that experi-   self-assessment should be balanced
             been broadly endorsed in the early        ence, (3) draw some conclusions,          with the considered judgment and
             1990s as the new vision for pharma-       and (4) act differently as a result of    opinion of others, such as peers and
             cy, progress toward widespread im-        the experience.47                         supervisors. Tools to assist pharma-
             plementation of the practice model           Research has demonstrated that         cists in appropriately and accurately
             had been frustratingly slow.35 Many       learning that is sought to meet iden-     assessing their learning needs have
             have probably underestimated the          tified and existing needs and rein-       been developed in a number of coun-
             importance and enormity of the            forced through practice is more likely    tries, including the United States.51,52
                                                                        23
             change involved. While many factors       to be sustained.  Some of the four-       The National Association of Boards
             have affected the rate of implementa-     stage cycles that have been adopted       of Pharmacy, which administers na-
             tion of pharmaceutical care, the fact     within the context of CPD incorpo-        tional licensure examinations on be-
             that many practicing pharmacists          rate these principles of learning.48,49   half of state boards of pharmacy, is
             were not originally trained for such a    In this context, the terms reflection,    developing an Internet-based self-
             practice model and may lack some of       assessment, and self-appraisal are        assessment tool to offer pharmacists
             the required knowledge and skills         somewhat interchangeable.                 the opportunity to assess, in a non-
             must be considered. For many phar-           The CPD cycle. CPD has been de-        threatening and supportive environ-
             macists, a retooling of knowledge         scribed using four- and five-stage cy-    ment, their needs and interests.53
             and skills is probably required, and it   cles. In essence, these cycles are very   Daily practice experiences should
             would appear that current CE sys-         similar. In the five-stage cycle, docu-   also contribute to the self-appraisal,
             tems, which primarily focus on im-        mentation is included as a separate       leading to identification of individu-
             proving and updating practitioner         stage to emphasize its importance.        al learning needs based on actual is-
                         36
             knowledge  (Travlos DV, ACPE,             Documentation is, however, an im-         sues confronting the pharmacist.
             personal communication, 2003 Jul),        portant component of each of the             Documentation in the pharma-
             are unlikely to adequately address        other four sequential stages. The         cist’s personal portfolio begins at this
             this need.                                elements of the four-stage cycle—         stage in the cycle.
             2072       Am J Health-Syst Pharm„Vol 61  Oct 1, 2004
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...Commentary professional development continuing variations of the basic cpd mod el using different terms to describe in pharmacy stages have been adopted or dis cussed but differ ences are not significant implemen michael j rouse tation strategies and am health syst pharm regulatory framework within which model is do ontinuing devel education society s only real however considerably opment a guarantee optimal quality some examples described later cfor approach lifelong care essentially concept learning being discussed as based on cycle individual potential for pharmacists perhaps ahead their time practitioners reflect practice united states re objectives ashp statement assess knowledge placement approved read remarkably skills identify needs create ce assured an es like personal plan implement sential component this arti what ongoing evaluate cle explains compo self directed structured outcomes effectiveness educational nents describes focused person terventions relation driving forces ...

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