The PAPERs Podcast

Background 

CPD (continuing professional development—that enormous phase of medical education after entering practice) is often neglected. Let’s face it, basic HPE lasts a few years, specialization lasts a few more, and CPD lasts for decades, but it doesn’t get the same attention and resources.  

First a few definitions apropos to today’s paper. Here are my personal handy definitions of faculty development vs CPD: 

• Faculty development = planned learning to enhance professionals’ academic competence. 
• CPD = planned learning to enhance professionals’ clinical competence. Also known as “CME”, “CE”, “MoC”, etc.  

The authors of the paper I selected today point out that numerous reports describe the world of CPD as undervalued, under-resources, lacking infrastructure, lacking good practices, and lacking evidence of impact (for the most part). More and better CPD is needed, they argue, for better care, a better workforce, and better health. So who are the CPD leaders who will deliver on this call to arms?  

Purpose 

The authors set out to “understand the challenges and opportunities facing CPD developers and leaders as they seek to build the CPD of the future.” This they operationalized into: “…to learn how CPD leaders and developers came into their roles, if they are engaged in scholarship and the challenges and opportunities in pursuing scholarship…” 

Methods 

The authors described using a mixed grounded theory (MGT) study with an “exploratory sequential approach”. Their MGT used both interviews and survey methods. In the setting of one large academic health sciences centre with 387 CPD programs and ~45000 participants annually, they identified and interviewed CPD leaders in the institution. They then used the results of these interviews to inform a survey that was sent to CPD course and program directors. The two methods explored CPD leaders’ career paths, challenges, scholarship, community of practice, resources, and activities.   

The study was approved by the University ethics board. Participants were selected using “purposeful, convenience, and snowball…techniques”. Interviewees held formal leadership roles in CPD. No incentives. Usual interview procedures were used, including use of a guide, capturing of transcripts, and iterative coding.  

Survey participants were drawn from a list of course directors who previously applied for CPD accreditation. A 35-item unique instrument was developed and piloted prior to use.   

The authors provide a reflexivity statement.  

Results/Findings 

The authors conducted 13 interviews and surveyed 405 people. The survey response rate was 28.6%.  

To interpret the data, the authors chose Rowland’s ontological choreography as applied to education as a theoretical aid. Ontological choreography was first described in reproductive medicine, where diverse participants with different backgrounds and settings come together to “make parents”. Applied to CPD, this lens may help understand how education leaders navigate the many actors, approaches, assumptions, settings, methods, epistemologies, etc. that come together to enhance care and practice.  

The authors identified three themes: 

1. The pathway to becoming an expert in CPD planning and delivery is often unplanned, unclear, and uncredentialed. 50% had formal training, few had an intentional plan to assume this role. Quote: “…I never really sort of sought after CPD as a career…” 

2. CPD is undervalued as a field, with inadequate time and funding allocated. CPD work was often done as a volunteer role, or without protected time. Resources, time, and methodological support were major barriers to doing quality CPD. CPD was undervalued in university promotions as well.  

3. Engagement with scholarship was variable. Same barriers. <50% said they would like to do CPD scholarship.  

Conclusions 

The authors concluded that CPD leadership is “unplanned, unclear, and uncredentialed” even in a large academic centre. Because CPD means different things to different people, ontological choreography is needed to successfully enhance CPD of the future.  

Comments

1. CPD deserves more attention, given its huge duration and potential impact on so many practicing health professionals.  

2. Now you know that “ontological choreography” is not AI-generated nonsense.  

References mentioned in the episode

Hu, W. C. Y., Thistlethwaite, J. E., Weller, J., Gallego, G., Monteith, J., & McColl, G. J. (2015). ‘It was serendipity’: A qualitative study of academic careers in medical education. Medical Education, 49(11), 1124–1136. https://doi.org/10.1111/medu.12822

Sabel, E., Archer, J., & Early Careers Working Group at the Academy of Medical Educators. (2014). ‘Medical education is the ugly duckling of the medical world’ and other challenges to medical educators’ identity construction: A qualitative study. Academic Medicine: Journal of the Association of American Medical Colleges, 89(11), 1474–1480. https://doi.org/10.1097/ACM.0000000000000420

Zibrowski, E. M., Weston, W. W., & Goldszmidt, M. A. (2008). ‘I don’t have time’: Issues of fragmentation, prioritisation and motivation for education scholarship among medical faculty. Medical Education, 42(9), 872–878. https://doi.org/10.1111/j.1365-2923.2008.03145.x