Will receiving a credit for attending a formal continuing professional development (CPD) event improve your patients’ health?
Although improved patient outcomes are considered, by some, to be the purpose of CPD,1 making the links between acknowledging the need to learn, actually learning, reflecting on that learning, and, finally, making a commitment to change one’s behaviour can be a complex process.2
Are Canadian chiropractors incorporating this process into the care of their patients? Let’s take a look at the provincial requirements for continuing education, as outlined in the Official Directory of the Federation of Chiropractic Licensing Boards.3 (Table 1, visit www.canadianchiropractor.ca)
For over half of all Canadian chiropractors, CPD is not mandatory. The College of Chiropractors of Ontario, for example, requires its members to maintain a professional portfolio/curriculum vitae, the purpose of which is to “advise members of their obligation to quality improvement through self-directed, lifelong learning and continuous education.”4 In Manitoba, there are no CPD requirements at this time.
In the provinces where CPD is mandatory, requirements vary from 12 hours every two years to 72 hours every three years. Provincial program criteria are just as varied. Some specify subject areas such as radiology or CPR. Others are limited to accredited seminars and may not accept non-traditional learning formats considered valid by other health professions.
Such formats may include: accredited group learning activities (e.g., rounds, journal clubs, seminars, online courses); informal learning activities (e.g., journal reading, unaccredited conferences, Internet browsing); structured learning projects (e.g., personal, planned projects, traineeships, fellowships; personal practice reviews); and/or personal educational development (e.g., teaching, publications, grant proposals).5
These observations on the current Canadian CPD scenario raise some questions:
• Should CPD continue to be mandated by the provincial colleges?
• Would patients be better served if a national body such as the Canadian Federation of Chiropractic Regulatory and Educational Accrediting Boards (CFCREAB)6 were to oversee the delivery and quality of CE?
• Should there be a consistent way for all Canadian chiropractors to record their learning and earn credits?
• Is CPD the responsibility of the individual health-care practitioner?
Based on these observation and questions we recommend:
• establishing mandatory CPD for all Canadian chiropractors in practice
• promoting the approval of multiple learning formats to accommodate individual learning styles and barriers to traditional CPD attendance
• advancing lifelong, self-directed learning by encouraging reflection and commitment to change
• providing national oversight by a federation such as the CFCREA.
One of the goals of the CFCREAB is to provide leadership on issues such as licensure, accreditation, examination, continuing competence, inter-jurisdictional mobility, scope of practice, standards of practice, codes of ethics and speciality designation.6 Perhaps this federation could assist the provincial colleges in achieving consistency in CPD requirements and program criteria.
As with other health-care professionals, there is a need for chiropractors to maintain and improve their clinical competencies in order to deliver the highest standards of care to patients.7 To this key learning point we would add the concepts of mandatory CPD, adoption of multiple learning formats, more linking of CPD to patient care, national oversight, and individual responsibility.
1. Fox RD, Bennett NL. Learning and change: implications for continuing medical education. BMJ 1998; 316
2. Slotnick HB. How doctors learn: education and learning across the medical-school-to-practice trajectory. Acad Med 2001; 76(10):1013-1026.
3. Official Directory of the Federation
of Chiropractic Licensing Boards. Accessed at: http://www.fclb.org/ directory/index.htm; accessed 31/10/ 2007 (2/11/07)
4. College of Chiropractors of Ontario. Standards of Practice. Professional Portfolio. Accessed at: http://www. cco.on.ca/standard_of_practice_s001.htm (2/11/07)
5. Royal College of Physicians and Surgeons of Canada. Framework of Continuing Professional Development Activities. Accessed at: http://rcpsc.
6. Canadian Federation of Chiro-
practic Regulatory and Educational Accrediting Boards (CFCREAB). Accessed at: http://www.cfcrb.org/ (2/11/07)
7. Bolton JE. Chiropractors’ attitudes to, and perceptions of, the impact of continuing professional education on clinical practice. Med Educ 2002; 36(4):317-324.
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