Postgrad Med J 1995; 71: 129-131 C) The Fellowship of Postgraduate Medicine, 1995

Editorial

Continuing medical education

The longest and most critically important phase of adoctor's medical education is the period after he or she hasattained specialist/consultant status. Up until that point,the pressure to learn is motivated by the need to passexaminations and acquire particular skills. Thereafter,learning is generally unregulated and left to the interest,motivation, and perhaps the honesty of the individual. Allof this is either about to change or, in some countries, hasalready changed. Doctors are now expected to conformwith other professions, by showing society that they areboth efficient and up to date in their knowledge and practiceof medicine. The importance of such continuing medicaleducation (CME) and professional development has beenrecognised for some time.'`5 Hitherto, participation has ingeneral been voluntary. Increasingly, however, profes-sional bodies in several countries are making such involve-ment obligatory (see box and figures 1-3).

Motivation for continuing medical education

A variety ofmethods have been adopted, or are about to beused, to ensure that the individual doctor participates inhis/her surveillance programmes (see box). These includefinancial penalties, such as those introduced in the UK in1990 for family doctors (general practitioners). Currently,approximately £2000 of their annual income is conditionalon their attending five days of approved educationalactivities each year. Over 90% ofgeneral practitioners fulfilthese criteria and thereby receive their postgraduate educa-tional allowance each year. Another approach, popularamongst the speciality societies in the US and Australia, isthe use of time limits on the certification which a specialistreceives having completed his/her training. Recertificationor continuous certification is dependent on participation inCME. Penalties for failing to remain 'certified' mightinclude the loss ofcertain rights to charge speciality fees. In

Continuing medical education: acronyms

MOCOMP = Maintenance of Competence Programme(Canada)

AMA PRA = American Medical Association PhysiciansRecognition Award (USA)

SCOPME = Standing Committee on Postgraduate Medicaland Dental Education (UK)

UNAFORIMEC = L'Union Nationale des Associations deFormation Medicale Continue (France)

Continuing medical education: examples ofsystems

Motivation Requirements

UK hospital doctors Recertification 100 h/year

UK general practitioners £2000 of their 5 days/yearincome

USA Recertification 50 h/yearCanada Recertification daily diary

the future such continuing certification or accreditationmay be considered mandatory by the doctor's employer.

Approved activities for continuing medicaleducation

Doctors rely on many sources for continuing their medicaleducation. Attendance at approved conferences ormeetings has been the classical approach, perhaps becauseit is the easiest to monitor (see below). More recently, credithas also been given for presenting work, teaching, andgetting papers published (box). Yet the technique most

]SC0OPME

Figure 1 SGOPME working party report

Continuing med.ical education: activities

measured

Australia UK USA Canada

Attending approved V V V Vmeetings

Giving presentations V V V VTeaching V x x VGetting papers published V x x VSelf-study methods x x V V

(journal reading, use ofaudio-visual or computer-based material, etc)

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130 Hind

.0! IM.X

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Figure 2 MOCOMP

preferred and used by doctors to keep up to date, namely byregular reading of general and specialist journals, is onlyconsidered credit-worthy in Canada and the US. Moreimaginative approaches are also being considered, such asthe use of self-assessment schemes and distance learningprogrammes.

Momitoring continuing medical education

For the majority of doctors, evidence of participation inCME will consist solely of collating a list/log book ofapproved activities that he/she has undertaken. Each year,or every two or three years in some countries, that recordwill have to be submitted to the appropriate regulatorybody for review. One criticism of this approach is thatattendance at approved meetings does not necessarily meanparticipation. In Canada, the Maintenance of CompetenceProgramme (MOCOMP) scheme demands proof that thedoctor has changed his/her work practices as a result ofparticipation in educational activities. This imaginativemonitoring system makes use of a computerised diary torecord the outcome of CME activities. These data are thentransferred electronically to the MOCOMP office. Randomaudits of annual MOCOMP profiles will be undertaken bypeers to review the impact of CME activities on thatindividual's practice.

Paying for continuing medical education

Many professionals outside medicine (eg, lawyers in theUK) have to pay out of their own pocket for theircontinuing professional development. For the majority ofdoctors this is not the case. Attendances at conferences andsubscriptions to medical journals in some countries artax-deductible. Doctors attending CME courses in Franc

.... .... .... ....-

44.~~~I W+

~~ ~ 4 44 .*44

Figure 3 Royal College of Physicians CME Report

receive payment for the loss of fees thus incurred. Hospitaldoctors in the UK are allowed 10 days study leave (withexpenses) per annum to attend approved conferences,though such paid leave is not routinely allowed for self-directed study such as reading, literature searches, teachingand research.

Strategies for CME

Historically, CME has concentrated predominantly onupdating knowledge in line with the concept of a con-tinuum of medical education from medical school toretirement. Newer strategies in CME will focus on modelsfor individual educational support (box). Their aims are toencourage doctors to take more responsibility for theircontinuing education and to increase their ability to inquireand make critical judgements.

Conclusions

The pressures placed on practising clinicians are increasingat a phenomenal pace. As a consequence, clinicians have to

|Continuing medical education: models for|individual educational supportl

|Mntor: a person with established expertise as a catalyst for |

| fro e ac othe l ___I_

|444+.~4+Potoi-ae ernn:uigdcmnedeprecsaI framework forself.appraisal

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Editorial 131

prioritise their time. For the majority it is the time spent onCME that is being eroded. Clinicians may feel that theimportance society is now attaching to CME is yet anotherburden in what is already a very busy life. Hopefullyclinicians will not simply ignore these advances, but usethem to their own advantage. Successful CME requiresboth an environment of encouragement and adequateresources. Its implementation will be to the benefit ofsociety in general, and to its medical specialists in partic-ular.

CHARLES RK HINDEditor

1 Hind CRK. Coping with change. Postgrad Med J 1995; 71: 1-3.2 Continuing medical education for the trained physician. Glasgow and London:

Royal Colleges of Physicians of Edinburgh, 1994; 1-14.3 Continuing professional development for doctors and dentists. London:SCOPME, 1994; 1-40.

4 MOCOMP. Ann R Coll Physicians Surg Canada 1993; 26: 51-64.5 25 Years in continuing medical education. JAMA 1993; 270: 1092.

PROFESSOR PAUL TURNER, CBEPRESIDENT, FELLOWSHIP OF POSTGRADUATE MEDICINE

1986-1993

Paul Turner, who died on Christmas Day 1994, was anacademic and clinical pharmacologist of internationalrenown. He had been Hon Secretary to the Fellowshipof Postgraduate Medicine from 1980 to 1984 andPresident from 1986 to 1993.He trained in medicine at the Middlesex Hospital and

following medical appointments at the Royal Free andEdgware General Hospital he was appointed lecturer inpharmacology and clinical pharmacology at St Bar-tholomew's Hospital in 1963.

It was this department that he led subsequently asProfessor of Clinical Pharmacology and consultantphysician from 1972 until his retirement in 1993.During this time his involvement in, and contributionto, clinical pharmacology and medical education wasoutstanding by any measure. Both as teacher andresearcher as well as with his interest in the applicationof clinical pharmacology to patient care, Paul's reputa-tion was international, especially in Australia, India,Africa and China.

Paul had a major influence on the world of medicaljournals, being founder editor of the British Journal ofClinical Pharmacology and of Human Toxicology. Formany years he was a member of the editorial board ofthePostgraduate Medical journal making major contribu-tions to the journal itselfand to the management ofit andits supplements.For some 15 years he chaired the Committee on

Toxicity of Chemicals in Food, Consumer Products andthe Environment for the Department of Health and wasfor 14 years the vice chairman of the British Phar-macopoeia Commission where his ideas and soundpractical common sense shaped many of the changeswhich occurred in British clinical pharmacology duringthis time. He was made a Commander of the BritishEmpire (CBE) in the New Year's Honours in 1992.

In addition to his remarkable energy and infectiousenthusiasm he always found time to help those whosought his support. His contribution to the Fellowship,to which he devoted himselfwholeheartedly, did not flagdespite recent illness.

Following his retirement from St Bartholomew's hiscommittment seemed rather to increase and as vice

_E~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~. .. ... .r.. .. | is<ee> re < t4ss) ssR B | s ~~~~~~~~~~~~~~....... ......mgs F3. 8president of the Fellowship he continued to give wiseadvice and practical help to Council in addition to hismany other demanding academic posts in London.Those who have worked with him over the years will

miss those qualities of intellect, energy and goodhumour, and above all, leadership, which Paul broughtto everything he did; none will miss these more than theFellowship. MWNN

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