This column aims to generate a conversation on how continuing education and practice development is currently viewed and developed around the world, especially through the lens of the educator. We will acknowledge a variety of experiences and systems of continuing professional development (CPD) to support healthcare professionals’ (HCP) lifelong learning. 

To Be Continued… Supporting Physicians’ Lifelong Learning

By Helena Filipe, MD, MMEd, with Carolin Sehlbach, PhD

This issue, I am delighted to focus my column on the investigative work of Carolin Sehlbach, a young researcher at the School of Health Professions Education, Maastricht University.  Her doctoral thesis draws our attention to the Continuing Professional Development (CPD) world in Europe.  Entitled To Be Continued… Supporting Physicians’ Lifelong Learning, Sehlbach research has chosen to spotlight two enticing aspects of CPD today: the idea of continuity, of movement, iteration and improvement, as well as those magic two words lifelong learning, the authentic cornerstone of meaningful CPD with impact on patient outcomes and on the public well-being.

Sehlbach’s research presents how recertification and CPD practices are organised across 10 European countries.  Not surprising, despite the increasing mobility of healthcare professionals and patients across Europe calling for some harmonization to ensure patient safety and high-quality healthcare services, there is still a wide variety in rules and regulations, performance assessment criteria and stakeholders.

Current recertification systems and approaches in CPD are often misaligned with daily practice and may fall short on including feedback from relevant stakeholders, such as family and patient involvement, with little peer involvement and even less patient involvement (1).  Physicians learn from experiences in daily practice, from interactions with patients, and the exchange of experiences and knowledge with peers.  In her thesis, Sehlbach calls for integration of physicians’ learning into daily practice, as well as for regular performance evaluations from multiple stakeholders.

The importance of the patients’ “voice” in physicians’ learning has been receiving growing attention from national media.  Of importance, the ACCME has recently included activities that are planned with patient representatives and include patients in the formal program delivery among the revised ACCME Accreditation with Commendation Criteria for CME/CPD providers in the U.S. It might be that some individual physicians would oppose the idea that patients should play a role in physicians’ learning, particularly their performance assessment component. However, research findings were more nuanced by distinguishing the competences upon which patients wished to give feedback. These were physicians’ communication, collaboration and professionalism (2).  The interview data further revealed three different patients’ perspectives: the proactive perspective, the restrained perspective and the outsider perspective. These perspectives could change over time and depended on a perceived power balance, previous experiences, and self-efficacy, and impact individuals’ willingness to provide performance feedback. With patient empowerment gaining momentum, Sehlbach’s work calls for active and meaningful patients’ involvement by inviting their feedback while respecting individual preferences on how such feedback is nuanced.

Sehlbach describes a misalignment of current recertification systems and CPD approaches with physicians’ daily practice (3). Data across three different countries shows that despite differences in system requirements, most physicians indicate that they are actively engaged in lifelong learning and continue to learn from daily practice. Organisational and collegial support and an “authentic” system, with an alignment of certification requirements with daily work, would yield higher levels of acceptance of and trust in the recertification system.

Findings on workplace-based learning and on cues that physicians use of their practice based learning, further revealed variations in how sensitive individuals are in recognizing learning opportunities in daily practice (4). Implementing practical tools and training physicians to raise awareness of potential learning opportunities in and from practice, particularly communication with patients, might be worthwhile.

Sehlbach’s investigation has implications on lifelong learning and performance assessment, partly calling for a re-evaluation and redesign of current systems.  It advocates for more patient involvement, diversification of formal educational activities and integration of learning into the workplace, thereby creating a culture of collaborative and informal learning. Her research highlights the need to advance and translate scientific insight into practical approaches.  Research into lifelong learning is yet “To be continued…”.

For more detailed information, you may access the full text of Dr. Sehlbach’s thesis here. Readers are welcome to contact the author at carolin.sehlbach@maastrichtuniversity.nl

Note: Carolin Sehlbach’s PhD trajectory was made possible by a collaboration between the European Respiratory Society and the School of Health Professions Education (SHE) at Maastricht University.  We hope this might serve as an inspiration for more young researchers to select CPD as their research interest field and find support from scientific, medical organisations.

Helena Prior Filipe, MD, MMEd, is a consultant in the College of Ophthalmology of the Portuguese Medical Association International Council of Ophthalmology, University of Lisbon, Portugal.

References

1. Sehlbach C, Govaerts MJ, Mitchell S, Rohde GGU, Smeenk FWJM, Driessen EW. Doctors on the move: a European case study on the key characteristics of national recertification systems. BMJ Open. 2018;8(4).
2. Sehlbach C, Govaerts MJB, Mitchell S, Teunissen TGJ, Smeenk F, Driessen EW, et al. Perceptions of people with respiratory problems on physician performance evaluation-A qualitative study. Health expectations : an international journal of public participation in health care and health policy. 2019.
3. Sehlbach C, Govaerts MJB, Mitchell S, Rohde GGU, Smeenk FWJM, Driessen EW. Box-ticking and Olympic high jumping – Physicians’ perceptions and acceptance of national physician validation systems. Medical teacher. 2018;40(9):886-91.
4. Sehlbach C, Teunissen PW, Driessen EW, Mitchell S, Rohde GGU, Smeenk FWJM, et al. Learning in the workplace: Use of informal feedback cues in doctor-patient communication. Medical education. 2020;54(9):811-20.