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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 PharmVol 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 PharmVol 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 PharmVol 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 PharmVol 61 Oct 1, 2004
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