Jooma, Rashid

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eCommons@AKU Section of Neurosurgery Department of Surgery 12-2011 Proposals for a scheme for continuing professional development in Pakistan Rashid Jooma Follow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_neurosurg  Part of the Medical Education Commons Despite the efforts over a decade by various nationalinstitutions and funding from the WHO,1 little progress hasbeen made in design or implementation of a national schemefor Continuing Professional Development (CPD) in Pakistan.The imperatives of such a scheme have been well perceivedin the profession's circles and the Pakistan Medical andDental Council (PM&DC) which, like other medicalregulatory authorities round the world, consider that it is thephysicians' professional responsibility to maintain andimprove the quality of their practice. It is desired that allphysicians regularly engage in educational activities withdocumented demonstration that they are fulfilling thisprofessional obligation and it is foreseen that in the future thiswill be a pre-requisite for re-registration. However, it must beappreciated that strict regulatory measures are not likely to beeffective in assuring quality practice but rather that themotivating factor for continuous learning should be a sense ofpride in his/her performance as a physician.2Recently, the PM&DC has notified a Committee forCPD and the observations arising from consideration of waysand means of the Committee's subject are the basis of thissubmission.CPD vs. CME:As opposed to continuing medical education which isusually in the nature of a teacher- based didactic clinicalupdate, it is desired to stress more physician-centeredcontinuing professional development which focuses on notjust medical but also social, communication, personnel andmanagement skills.3The Difficulties Ahead:Establishing a widely accepted scheme of CPD that issustainable and of the desirable quality is fraught withdifficulty. This is owing to the poorly inculcated habit of self-directed learning amongst our physicians, a poorly developedinfrastructure of educational opportunities for practitionersand poorly practiced documentation of professional activity.4Thus, if the PM&DC were to pursue its objectives relating toCPD by edict, setting out its expectations in this regard andthen hoping that these are embraced by the physicians as wellas the individuals and organizations that would provide theprogrammes, the outcome is likely to defeat the statedobjectives. The Council would require playing a proactiverole in all the various steps and aspects of CPD in order toachieve the desired results. Practitioners:There are some 145,000 medical and dentalpractitioners registered with the PM&DC of whom 60% havecurrent registration and probably a similar proportion isprofessionally active in the country. These are thepractitioners whom the Council would wish to accrue to itsschemes of CPD. As this would be on a voluntary basis, themotivation should be engendered by the quality andrelevance of the programmes. The subdivision of medical anddental practitioners into those with basic and those withspecialist qualification lends itself to the two tracks alongwhich the CPD schemes would be organized i.e. One for theGeneral Physician and Second for the Specialist. Providers:The critical links in the CPD chain are the individuals,the organizations and the institutions which would function asthe providers of programmes and courses. The mostcomprehensive resource of providers are the medicalprofessional organizations (MPOs) which are wellestablished in the country particularly for the specialists, withvirtually all medical specialties covered. The generalpractitioners are represented by the College of FamilyMedicine, the Forum of General Practitioners and thePakistan Medical Association. These organizations all haveconsiderable experience of offering continuing medicaleducation activity to their members and would be thenaturally facile partners of the PM&DC in a coalition to offernational CPD programmes. Recently, the CPD Committeeconvened a meeting of the MPOs and they have been taskedwith the provision of specialty-specific educational activity,accreditation of courses and quality assurance by feedbackbesides a verifiable certification of the extent of a physician'sCPD activity for eventual submission to the PM&DC.There are now in excess of 100 universities andcolleges imparting medical and dental undergraduateteaching in the country and these could be engaged toparticipate in the CPD scheme by involvement of theirfaculty in educational meetings in their geographical areasand other outreach events, besides offering refresher teachingmodules in their institutions. The ability of the medicalcolleges to contribute to CPD as an outreach activity would1231 J Pak Med AssocProposals for a scheme for continuing professional development in PakistanRashid JoomaAga Khan University Hospital, Member, CPD Committee, PM&DC, Islamabad.Short Reportbe enhanced by encouraging the establishment ofDepartments of Family Medicine. Venues and Facilitation:Clearly, the acceptability is greatest when thephysician can participate with least disruption of routine andminimum traveling. It is anticipated that the DistrictHeadquarter Hospitals (DHQs) are eminently suited to serveas the focal point of CPD activity for the general practitionerssupported by the regional medical schools. The ExecutiveDistrict Officers for Health (EDOs), the Town HealthOfficers (THOs) and the respective Medical Superintendents(MS)would be engaged, through the good offices of theProvincial Health Departments, to serve as the interfacebetween the providers and the programme sites. They wouldbe assisted in undertaking situational analyses to determinefrom their local practitioners, the clinical problems fordiscussion and learning. They would facilitate the hosting ofevents for the practitioners of their catchment areas andcontribute to documentation of activities. They would workwith PM&DC and all others concerned to upgrade theeducational infrastructure in the DHQ Hospital with theprovision of appropriate spaces, audio- visual aids andteaching aids etc. PM&DC:The PM&DC would have to commit to funding thegestational stages of the scheme. This would involve thecreation of a CPD Cell within its secretariat which wouldprepare the ground work for implementation of nation-wideCPD including a situational analysis of the educational needsof the medical practitioners to guide programmedevelopment. The CPD Cell would work with the healthofficers of local government to bridge the disparity betweenthe possibilities and the realties of education within theDHQs. It would seek a budget line from the Governmentthrough Public Sector Development funds or internationalfunding of an "Establishment of CPD for MedicalPractitioners" project.The CPD cell would aim to develop an electronicdatabase capability to log the CPD activities across thecountry in an interactive process of data collection andguidance to support the CPD programmes of the providers. Inaddition the PM&DC could work towards and in-housecapacity of CPD programmes to supplement the resources ofthe providers.Ministry of Health:The education section of the Federal Ministry ofHealth could make an important contribution to theimplementation and success of the national CPD scheme byassisting in securing material resources and facilitating theinvolvement of the health officials across the country. Theeffective functional incorporation of the health officers in thescheme will require political will on the part of theProvisional and the District Governments. In particular,commitment of the EDO Health to the CPD scheme wouldrequire to be embedded into his/her job description. Programme Content:The programme content of CPD activitiescredentialed by the PM&DC, particularly for the communityphysicians would have to be innovative and broad-based toappeal to the Pakistani medical practitioner and encouragemaximum participation. A considerable degree of creativework would be required to be done in this regard, utilizinginput from medical educationists, family medicine specialistsand representatives of the practitioners themselves. Priorexperience affirms that learning is most effective when linkedto clinical practice and this rather that the traditional didacticmodel would be pursued.Accreditation of CPD Programmes:The crucial role of the PM&DC in the nationalscheme of CPD would be the process and procedures foraccreditation of programmes and sites. This would be bestachieved in conjunction with the MPOs and EDOs as anongoing process designed to also serve as a robustmechanism for quality review and updating and improvingactivities. At its best, this is a function of trained and full-timeauditors who review documentation from the providersincluding feedback from the physicians and site visits toallow recognition and accreditation of the provider'sprogrammes and venues.The activities granted accreditation may be dividedinto three categories: (a) "live" or external activities (courses,seminars, meetings, conferences, audio and videopresentations and visits or brief attachments to teachinginstitutions), (b) internal activities (practice based activities,case conferences, grand rounds, journal clubs, teaching,consultation with colleagues), and (c) "enduring" materials(books, journals and other printed matter).Documentation of Credits:It is recommended that the Council adopt an hoursrelated credit system in vogue internationally. In this one hourof educational activity equates to one credit. Practitioners witha basic qualification may be expected to initially devote aminimum of 2 hours per month for professional development.If a three-year cycle is introduced initially, then 75 pointswould be required to be accumulated. Specialists have moremature systems of continuing educational activities andshould be expected to demonstrate 5 hours per month of CPDwhich would equate to 200 hours in a three-year cycle. At aVol. 61, No. 12, December 2011 1232later stage weightings or categories could be accorded tovarious activities to reflect their educational merit. Theeducational activities should receive documentation from theproviders and the practitioner would be expected to compile afolio of CPD to submit to the Council in a three-year cycle ofverification and certification.5Funding and Budgets:It is suggested that in the initial stages of the CPDscheme, the providers should receive material support fromthe PM&DC to allow low cost programmes. Onceestablished, the providers should be encouraged to follow theprinciple of no profit, no loss in the pricing of their coursesand programmes. Unabashed commercialism can make amockery of education and for CPD to achieve its altruisticmotives of enhancing physician performance with a view toimproving patient care outcomes, the profit motive, whichmay attract the unscrupulous providers, must be kept out ofthe equation.Rewards and Motivation for the National CPDScheme:While the rewards of CPD, undertaken sincerely anddiligently, should be intrinsic and self-evident, the Councilshould recognize compliance by physicians of the set outrequirements by special certification and posting of theirnames on its web-site as Proficient Practitioners. The Councilshould work with its partners in its CPD scheme to encourageemployment and promotions of only those doctors with therequisite credits. It is the intent of the PM&DC to progress to re-certification contingent on CPD achievements but it is crucialthat all involved in the development and implementation ofthe national CPD scheme be clear that the motivation thatdrives the efforts towards the National CPC scheme is toimprove the health of the population by improving theeffectiveness of physicians through positive changes inprofessional knowledge, skills and consequently, health careoutcomes.6References1. Samad S. Continuing Medical Education: National Policy and StrategicGuidelines for Pakistan (Consensus document). Karachi: CPSP, 2005; pp 62.2. Continuing professional development of medical doctors - WFME globalstandards for quality improvement. (Online) (Cited 2009 August 14). Availablefrom URL: http://www.3.sund.ku.dk/activities/WFME standard documents andtranslations/WFME cpd.pdf.3. Peck C, McCgall M, McLaren B, Rotem T. Continuing medical education andcontinuing professional development: international comparisons. BMJ 2000;320: 432-5.4. Siddiqui ZS, Secombe MJ, Peterson R. Continuous professional development— development of a framework for medical doctors in Pakistan. J Pak MedAssoc 2003; 53: 290-3.5. Stewart GD, Teoh KH, Pitts D, Garden OJ, Rowley DI. Continuing professionaldevelopment for surgeons. Surgeons 2008; 6: 288-92.6. Robertson MK, Umble KE, Cervero RM. Impact studies in continuingeducation for health professions: update. J ContinEduc Health Prof 2003;23: 146-56.1233 J Pak Med Assoc

Proposals for a scheme for continuing professional development in Pakistan

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Proposals for a scheme for continuing professional development in Pakistan

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