The Pharmaceutical Journal Vol 267 No 7171 p594
27 October 2001

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CPD is about learning for life

By Terry Maguire and Heather Bell

The November evening was dark, cold and wet. We arrived at the venue half an hour before we were due to present the workshop. At two minutes to eight only three people had arrived. The inclement weather had kept the rest at home. One of the three apologised profusely for the pathetic turnout. "I haven't the slightest interest in diabetes," he said in a confidential sort of way, "but it's so important to come out and support speakers who take the time to come and speak to us."

Following our talk on the extended role of the pharmacist, a newly qualified pharmacist asked us how pressure could be put on the universities to ensure that clinical testing is incorporated into the pharmacy curriculum. He was annoyed that he had not covered this in his pharmacy course and therefore couldn't provide this service to his patients.

Quality has never been more at the heart of the health service than at present. Total quality management (TQM) is being cemented into the service by civil servants with the passion of zealots. TQM is nothing new; the Conservatives started it when they held power but the emphasis has now changed with the target having shifted to improved patient care rather than cost savings. Out goes an obsession with audit and in comes clinical governance. For the health care professional this will mean a lot of things but most importantly, it will mean the need to maintain professional competence throughout one's career.

Maintenance of competence has always been enshrined in professional ethics and therefore, rather than create, impose and monitor a completely new system, the Government has placed this responsibility with the professional bodies. We are entering a creative phase in which systems are being designed to satisfy the requirements of both the Government and the public while assuring the competence of practitioners.

Pharmacy is adopting a system based on continuing professional development (CPD). The CPD model is based on Kolb's experiential learning model, which promotes lifelong learning by encouraging individuals to reflect on their learning experience and to integrate the knowledge and skills learnt into practice. Pharmacy is moving rapidly towards implementation of a system of mandatory CPD perhaps without a full objective assessment of how the system will operate and, more importantly, without evidence that the system can provide assurance of competence. At present, little resistance is being offered to the scheme under consideration and, although we support the introduction of such a scheme in principle, we are concerned about the lack of debate and discussion.

The Royal Pharmaceutical Society's Code of Ethics states that "in the case of continuing education, as distinct from other forms of continuing professional development, the Council requires you to participate to the extent of at least 30 hours per annum". It has been acknowledged therefore that pharmacists cannot "do 30 hours of CPD" as had previously been suggested. What pharmacists can do, however, is to comply with a scheme that makes them record their input to each of the steps in the CPD cycle while then undertaking continuing education (CE) linked to the identified training needs. They must show, for example, that they have identified their training needs, but it does not really matter how long this exercise took and therefore to measure it in terms of hours or days makes no sense. Other steps within the CPD cycle, such as reflection, are similarly non-quantifiable, because this process will be different for each pharmacist. However, the time spent by pharmacists participating in continuing education activities that are linked to their personal professional development needs is a measurable quantity.

Portfolio

How do pharmacists demonstrate participation in the other stages of the CPD cycle — is it sufficient to say that a training need was identified before participating in a CE event? No. To ensure accountability, pharmacists should be required to keep a portfolio of evidence to confirm their participation in each stage of the CPD model. Within a mandatory system, portfolios will be assessed to confirm compliance. The pilot organised by the Royal Pharmaceutical Society to assess its CPD portfolio has reached the final stages and we look forward to their report. Our organisation, the Northern Ireland Centre for Postgraduate Pharmaceutical Education and Training, has independently assessed the use of a portfolio while other organisations such as Boots The Chemists have developed their own portfolio, "B", and no doubt will assess its use.

The challenge to those involved in devising a system of mandatory CPD is to ensure that it is personal to each individual pharmacist and yet assessable by the profession. It is our belief that the scheme adopted by the profession must be both qualitative and quantitative to demonstrate compliance with the CPD cycle while providing evidence of completion of accredited training linked to identified training needs. Only such a scheme will avoid the abuse that is inherent in either an exclusively qualitative or exclusively quantitative CE scheme. What we will have then is the need for pharmacists to maintain a portfolio and complete, for example, 30 hours of CE that is linked to CPD.

The introduction of such a mandatory CPD scheme will have consequences. Pharmacists will need to learn how to practise CPD as opposed to CE; there will be increased uptake of CE courses. It is likely that the UK CPPEs will be swamped and will be unable to facilitate all pharmacists with continuing education provision. It will be essential therefore to create some accreditation process to assure the quality of courses undertaken by pharmacists that are provided by other education providers. The College of Pharmacy Practice may fulfil this role and further develop their system of accreditation.

But what do pharmacists think of CPD? Our research in Northern Ireland1 showed theoretical support for the introduction of CPD with many positive outcomes to participation being identified. However, almost 70 per cent continued to practise unstructured CE and very few pharmacists maintained any evidence of participation. Barriers that have traditionally been identified as impeding the introduction of many additional activities were highlighted by pharmacists as preventing their participation in CPD — lack of time, lack of remuneration and lack of locum cover.

Although they realised that mandatory CPD is imminent, under 50 per cent of respondents supported the introduction of such a scheme. Female pharmacists, those registered after 1990 and those claiming to participate in more than 30 hours of CE were more supportive, while community pharmacists were less likely to support such a scheme. Almost 90 per cent opposed a mandatory system whereby pharmacists who failed to meet the requirements would be reprimanded or disciplined by the professional body. Initially, it is likely that the role of the Society will be to facilitate CPD and to encourage those members who have failed to reach the required standards.

There are a lot of uncertainties surrounding CPD. Like the two pharmacists we mentioned in the introduction, many pharmacists perhaps miss the point of CPD. It is a lifestyle that is essential for personal and professional development. Continuing professional development is about learning for life. Let the debate begin.

Dr Maguire is director and Dr Bell is assistant director of the Northern Ireland Centre for Postgraduate Pharmaceutical Education and Training, School of Pharmacy, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7BL