Learning about CPD,
By Ursula Arens
[A little over a year ago], about 170 dietitians were in a manic panic; they were amongst the first to have been randomly selected from the total list of about 7000 dietitian registrants, required to submit their continuing professional development (CPD) portfolios to the Health Professions Council (HPC) assessment panel. Bleak futures threatened those whose reflective ramblings were deemed inadequate; appeals could be made against assessment decisions, but the ultimate sanction could be removal from the professional register.
As someone who has only just found out that reflective writing did not mean holding a laptop against a mirror, I thought, what better way to demonstrate CPD, than to write a feature on CPD. Does feature writing count as reflective practice?
What, in a nutshell, do HPC want when they assess CPD? They want evidence and a description of the meeting of five standards that overall, promote reflective professional practice and a commitment to lifelong learning. The HPC concede that for some of the professions, the requirement to write in a reflective way about CPD activities was not well received, but regardless, HPC believe that over time the professions will be persuaded of the benefits of the reflective nature of the CPD standards that have been defined. The aims of the standards are to promote reflective practice and to foster greater emphasis on the outcomes of CPD activity rather than just a demonstration of hours-collection schemes.
Of the 14 professions that the HPC regulate, dietitians have come last into the audit requirement, so in many ways we have the benefits in being able to observe how things have gone for the forerunner professions. The first HPC CPD annual report was published in March 2010, and provides outcomes and discussion of the audits of the first four professions to be audited in 2008-9: chiropodists/podiatrists, operating department practitioners, orthoptists and paramedics.
In my view, the outcomes of the first audit cycle are astonishing. I am further concerned that the conclusions of the report do not ‘reflect’ the obvious issues that arise from the data. There has been one immediate change as an outcome of the first audit procedures: because some of the profiles submitted were strikingly similar, and investigations established that they had been produced on the individuals’ behalf by a third party, an amended wording was approved for standard 5. The previous version was, “present a written profile containing evidence of their CPD upon request.” The amended wording is now: “upon request, present a written profile (which must be their own work and supported by evidence) explaining how they have met the standards of CPD.” The first cycle has also confirmed HPC’s decision to reduce the audit size from five per cent of registrants, to 2.5%.
Of the 650 chiropodists/podiatrists selected for audit, nearly 80% had their profiles accepted. Although none were removed from the register, about one in six of those selected for audit chose not to continue registration, against a reference of about one in thirteen typically expected not re-register every cycle. Of 650 chiropodists/podiatrists captured by audit snapshot, not one single individual was ‘assessed’ as unable to reach the defined five standards of the CPD hurdle, but 103 professionals, an excess of about 50 from the expected number, were lost to the services of foot health. Perhaps this ‘self-selection’ of lapsers has perfectly identified incompetent and incapable colleagues who should not be let near a corn or a bunion. This is far from proven by the HPC’s assessment, and another view could be that perhaps it represents a very unfortunate outcome of audits, resulting in an unnecessary loss to a profession, of experienced and capable colleagues. The nonchalant view expressed, that the twice-the-level expected of non re-registration indicates that this may have been influenced by selection for CPD audit, indicates little concern for further analysis of this leakage from the profession of foot healers, other than a comment that a larger number of lapsers were over the age of 50. The conclusion is not so simple, as the largest numbers of those selected for audit were in the age range 50-60 years, and the largest single age band of lapsers were 40-44 year-olds.
The due-to-audit lapser rates were lower in the other professions assessed, and lowest in the paramedics, where 3.4% did not re-register compared to expected levels of 2.7% - however numbers involved are too small to draw conclusions.
So of all the four professions audited, coming to a total of 1528 registrants, how many complied with the procedures to submit a portfolio, which was then assessed as inadequate? The answer is astonishing. Zero. Not one single submitted portfolio has been given an F-for-Fail. A few registrants have failed to meet the CPD standards, but in all cases, this is because they failed to submit a profile, not because what was submitted was considered insufficient to demonstrate professional reflection and learning. Can 1500+ health professionals really all be learning whiz kids, or could the whole CPD procedure not really be capturing what it was set up to? The very glib and non-reflective audit summary states that this “indicates that the guidance and communication provided by us [HPC] is enabling registrants to complete their CPD profiles in a way that demonstrates that they meet the CPD standards.” This self-congratulatory pat-on-the-back is undeserved, and a more critical analysis is really needed to address the leakage of perhaps competent professionals, and the contrast of the astonishing ‘100% pass rate’ of those who submit profiles.
Are there other ways to keep health professionals under a watchful and critical eye once they have escaped the nest of student hood? How, for example, are American registered dietitians channelled and assessed for quality learning and professional development?
The Commission on Dietetic Registration (CDR) is the independent credentialing agency for the American Dietetic Association (ADA). Their mission statement straddles their website (www.cdrnet.org): “protecting the nutritional health and welfare of the public through dietetic certification.” American dietitians have to pay $50 every year to be registered (less than half of the fee of £152 needed for the 2-year HPC registration). Dietitians need to obtain, over a five year recertification cycle, evidence of at least 75 hours of Continuous Professional Education (CPE), so about 15 hours per year. At the start of each cycle, dietitians need to define individual learning plans, which are verified and approved. Professional activities undertaken are then recorded, and can be logged online, into one (or several) of the predefined Learning Need Codes (see box). For example, attending a meeting presenting research on vegetarianism, would be recorded as LNC 4110. In addition to different themes and subjects, there is a requirement for different activity types of professional development; not all CPE can be gained from one kind of learning (see box for examples of CPE activity codes). For example, reading professional journals is CPE code 200 (such as Journal of the American Dietetic Association). However reading can only contribute a maximum of 15 CPE hours; this is extended up to 35 hours is one is the author of articles in peer-review journals or book chapters. Professional portfolios can be submitted for a mid-point review if it contains at least 30 hours, but required submission for all dietitians is within the five years period of the individual learning plan being set up. All American dietitians have their professional portfolios assessed every five years (but how many submissions fail?)
There are many ways to try to assess professional competency post qualification, but the ultimate aim has to be to support public confidence, and that of other professional colleagues, in the ‘brand’ of the profession. The CDR cites Mark Frankel, an American ethicist: “no longer does any profession enjoy the luxury of uncritical admiration or implicit trust from what is now an increasingly restive public.” Hence, what is not in dispute is the need for Continuing Professional Development.
Examples of Learning Need Codes
1000 Professional Skills
1140 Written communication, publishing
4110 Vegetarianism
5370 Obesity management
7200 Team building
8110 School meal service
9070 Research instruments and techniques
Examples of CPE Activity Codes
110 Case presentations
130 Exhibits
160 Journal Clubs
170 Lectures, Seminars
200 Professional reading
Information Sources
HPC. Continuing professional development annual report (CPDreport10) published March 2010
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