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.
Column Editor: Helena Prior Filipe, MD, MMEd
CPD in Australia and New Zealand: An Evolution is Underway
By Heather G. Mack, MBBS, MBA, PhD, FRANZCO, FRACS
CPD in Australia and New Zealand until now has been largely controlled by medical professional societies (“colleges”), which set the curriculum and requirements for ongoing education. Each society has its own requirements; these are expected meet the standards of the MBA and/or MCNZ as appropriate. In my specialty, for example, continuing professional development (CPD) for ophthalmologists has been evolving over the past two decades, influenced by our professional body the Royal Australian and New Zealand College of Ophthalmologists (RANZCO), the Medical Board of Australia (MBA) and the Medical Council of New Zealand (MCNZ), as well as society’s expectations.
I began my role as Chair of RANZCO’s CPD committee in 2003, when Fellows were expected to demonstrate continuing education by recording attendance at educational events and journal reading. My committee and I redesigned the program to include activities in a range of competencies and at differing levels of reflection. Based on CanMEDS we designed three categories: clinical expertise, governance (leader) and professional values (communicator, collaborator, health advocate, scholar, professional); and two levels: level 1- passive learning e.g., attending lectures, and level 2- active learning with written reflective elements e.g., clinical audit. Fellows were required to earn points (usually 1 point per hour of learning) in clinical expertise and at least one other category to a total of 50 points, plus undertake 30 hours of reflective activity (typically one clinical audit) per year.
The program was transformative, embedding the concept of reflective practice. It received the first commendation of a CPD program by the Australian Medical Council. It met the new requirement for audit introduced by the MCNZ, and easily met the requirements of the newly formed MBA in when it was established in 2010.
Over time Australia has had its share of poor patient outcomes due to poor medical practice. Prior to establishment of the Medical Board of Australia, each Australian state had separate registers of practitioners, and it was possible for poorly performing practitioners to move to another state and recommence practice. Society expects increased accountability of its medical practitioners, and this led to the development of a single Australia-wide practitioner register (MBA), which then developed formal standards of practice, including participation in CPD.
The MBA and MCNZ have signalled the need to further improve CPD. Starting in 2023, Australian medical practitioners will need to formulate an annual professional development plan targeted to their learning goals and which strengthens their practice. Practitioners will be required to perform 25 hours of performance and outcome review, 12.5 hours of traditional lecture activities and a further 12.5 hours of their choice of activity. CPD will be performed through ‘CPD homes’, which will typically be the medical colleges. The MCNZ has adopted more formal recertification, and similarly requires medical practitioners to demonstrate participation in CPD, peer reviews, audits of medical practice and continual medical education. In response to these changes RANZCO is currently modifying the existing CPD program to facilitate development of personal learning plans and reflective/audit activities.
CPD in Australia and NZ is moving from a list of lectures attended to meaningful lifelong learning. We await with interest the results of forthcoming changes, which have potential to alter the educational role of the colleges, and future evaluation studies.
Professor Heather Mack is the immediate past President of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). She shares her perspective of the evolution of CPD for ophthalmologists in Australia and New Zealand.
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, firstname.lastname@example.org
Becoming an International Virtual CPD/CME Provider to the Americas
By Alvaro Margolis, MD MS FIAHSI
With our new virtual learning competencies, many CME providers are considering expanding their regional and national presence to an international audience. The Americas are a unique and challenging region to explore. Latin America is a large and heterogeneous middle-income region, with one million physicians. One third of the region by several counts is Brazil, where Portuguese is spoken, while the rest of the countries speak Spanish. This dynamic creates an opportunity for online regional activities to be delivered in the two native languages. In this brief article, I hope to provide you with an overview the major elements to be considered when engaging in these complex, international CPD projects, especially across the Americas.
Over a decade ago, we sought to provide much needed CME/CPD programs in a variety of specialties to a Latin American audience. Over this period, my team has implemented educational activities throughout this region (1,2). Typically, these activities offer a sequential, mostly asynchronous curriculum, delivered to large audiences, however, they are still able to provide an active learning experience through social interaction and reflection. The virtual program includes automated formats to support meaningful dialogue for large audiences (3). Some of these activities have had a North American academic partner as a part of the institutional design of the program (5, 6). Each project has had similar learning experiences and planning criteria resulting in successful educational outcomes.
American academic institutions seeking to offer CME/CPD courses in the Americas may wish to identify and recruit an academic partner institution in the region for a jointly offered activity. The advantages of a local institutional partner in the region cannot be overstated in terms of planning, marketing and implementation processes.
A number of best practices are discussed here when initiating an international program. First, the educational program curriculum should address the unmet, practical learning needs of the target audience(s). The program should not be focused solely on scientific ‘breakthrough advances’ which at the moment may not yet have any practical treatment application, especially in the non-academic and often resource-constrained, clinical practice settings of the region.
If working with a Latin American academic partner, the clinical practice needs of the target audience should be determined via a needs assessment survey preferably developed jointly by the U.S. host and the Latin American academic institutional partner/planner and their regional faculty. The challenge of addressing clinical practice needs of these diverse healthcare systems must be considered as well. To this point, the best approach we have found is to design a course curriculum that includes a live, team-based analytic deliverable where course participants from the same institution discuss how to apply what was learned in the course to their respective working environment.
Second, everything should be translated into the native language of the target audience (e.g. convening, registration, customer support, educational materials, activities, and online interactions). Sometimes people who speak English as a first language underestimate the challenge for non-native speakers to study and interact with colleagues and faculty in a foreign language, such as English. Beyond this, an awareness of the cultural differences among the countries should be considered when working with an international faculty, even in the same language such as Spanish. For example, in some countries people tend to be very polite and diplomatic, while in other countries people are quite direct. Such cultural characteristics are especially important to understand when negotiating contracts.
Third, in such a large geography as the Americas, online learning can still be complemented with face-to-face live activities, either centrally or distributed across a region (7,8), including not only formal CME but also team-based learning in the workplace, as discussed earlier.
Fourth, in general, the US-based CME accreditation is not “value added” in Latin American countries, since each country has a different accreditation system. In fact, some countries are only now developing a system. Of course, the principles behind accreditation and CME best practices should still be followed, particularly regarding educational design and management of conflicts of interest. However, the actual accreditation process itself is not typically required in most Latin American countries. When it is, it is likely to be very different than the ACCME process. If working with a regional partner, allow them take the lead for the local accreditation process.
Fifth, since there is such a large number of physicians in the region, financing a program is typically achieved through learner registration fees, although grants and vendor exhibit fees are certainly possible. Further, in the registration payment process, allowing participants to use local currencies and payment methods is highly encouraged since many will not have an international credit card.
In conclusion, large international educational programs throughout the Americas are achievable, but these projects require careful consideration of the factors discussed herein to be successful. Once an activity is established, the repetition of programs between the same partner institutions over the years creates a common procedural knowledge and a cultural experience that facilitates and improves both the work process and program quality.
- A. Margolis and A. López-Arredondo, Eight years of MOOCs for physicians across Latin America, 2019 IEEE Learning With MOOCS (LWMOOCS), 2019, pp. 133-137, https://ieeexplore.ieee.org/document/8939603
- Margolis A, Joglar F, de Quirós FG, et al, Hersh WR. 10x10 comes full circle: Spanish version back to United States in Puerto Rico. Stud Health Technol Inform. 2013;192:1134. PMID: 23920908. https://pubmed.ncbi.nlm.nih.gov/23920908/
- Margolis A, López-Arredondo A, García S, , et al. 2019, Social learning in large online audiences of health professionals: Improving dialogue with automated tools, MedEdPublish, 8, , 55, https://doi.org/10.15694/mep.2019.000055.2
- Medina-Presentado JC, Margolis A, Teixeira L, et al Online continuing interprofessional education on hospital-acquired infections for Latin America. Braz J Infect Dis. 2017 Mar-Apr;21(2):140-147. https://pubmed.ncbi.nlm.nih.gov/27918888/
- Kidney transplant course with the University of Virginia, Latin American version. https://redemc.net/renalcasos
- Palmer, B. Meeting Professionals: What Would You Do? PCMA Convene. November 30, 2020. https://www.pcma.org/medical-education-conference-simulation/
- Cohen H, Margolis A, González N, et al. Implementation and evaluation of a blended learning course on gastroesophageal reflux disease for physicians in Latin America. Gastroenterol Hepatol. 2014 Aug-Sep;37(7):402-7. https://pubmed.ncbi.nlm.nih.gov/24679378/
- Margolis A, Balmer J, Zimmerman A, López-Arredondo A, 2020, The Extended Congress: Reimagining scientific meetings after the COVID-19 pandemic, MedEdPublish, 9, , 128, https://doi.org/10.15694/mep.2020.000128.1
Alvaro Margolis, MD MS FIAHSI is a SACME member and president of EviMed, an international virtual provider of CME/CPD. For more information contact Dr. Margolis via email at email@example.com