February 25, 2014

Is Continuing Education Really Worth It?

by Brittany Palasik, Doctor of Pharmacy Candidate, University of Maryland School of Pharmacy

My parents are both pharmacists practicing in the state of Maryland.  Over the years, I have attended many continuing education sessions with them.  I have snored through most, but was intrigued by some of the topics discussed.  Some pharmacists are so specialized now, that it seems useless to spend time learning topics that don’t directly pertain to their specialty. How essential is it to learn topics that seem unrelated to your scope of practice?

Continuing education (CE) is required by law for many health professionals.  The Accreditation Council for Continuing Medical Education describes the importance of maintaining knowledge for health professionals.1  Indeed, knowledge has been moving forward increasingly fast and health professionals need to continually learn the latest information in science and medicine. However, many healthcare professionals complain about the extra work required and wonder if CE is actually beneficial.  I decided to investigate the pros and cons of continuing education.  Is it really necessary?  After all, aren’t we all supposed to be learning on the job every day? 

Why Require CE?

Fact:  CE has been directly correlated to positive health outcomes.2

In a study completed by the American College of Surgeons, continuing education resulted in reduced morbidity and mortality rates for surgeons performing segmental colon resections as well as repair of ruptured abdominal aortic aneurysms.  Additionally, rates of myocardial infarction were lower in cardiologists who had participated in continuing education, than those who had not.2  

Fact: CE can improve knowledge in the short- and long-term.3

Twenty eight different studies were examined by the Johns Hopkins Evidence-based Practice Centre to determine the efficacy of continuing education.  Twenty-two (79%) of the studies showed knowledge improvement, whereas only 4 (14%) of the studies showed no difference in knowledge (2 studies [7%] had mixed results).  These same 28 studies were evaluated through follow-up and resulted in 15 studies (68%) demonstrated long-term knowledge retention.3

Why shouldn’t we require CE?

Fact:  CE programs can be biased.
All too often health professions will obtain most of continuing education funding from pharmaceutical companies.  This can introduce bias, as each company can influence the subject matter.  Additionally, this can reduce the availability of content that may be relevant for contemporary practice but which is not within the business interests of the sponsor.2 For example, a new guideline that is important for the healthcare community may not be promoted through continuing education because the guideline does not favor the use of more expensive brand-name products.   

Fact:  CE is time-consuming.

In Maryland, 30 hours of approved continuing education must be completed by pharmacists within 2 years in order to renew licensure.  Two of these hours must be live sessions.4 Some pharmacists complain that 30 hours is a large amount of time to dedicate to continuing education.  Some pharmacists and other healthcare professionals believe that they learn every day through their work activities and this extra work should not be required.

For those who believe CE should be required, the evidence suggests, that under optimal conditions, continuing education is beneficial.3 But CE isn’t without problems.  Its potentially biased and requires an investment of time and money. I think we can all agree that poorly designed instruction that’s not engaging or relevant to the audience is unlikely to lead to improvements in practice or patient care outcomes.  How can we ensure that healthcare professionals are getting a snooze-free, informative, knowledge refresher that improves their skills and the care of patients? 

How can we improve CE?

A systematic review completed evaluated different forms of educational techniques including live sessions, computer-based instruction (off-line and online real-time), videos, audio recordings, handheld materials such as laminated cards, and printed documents (articles and monograph).3  Simulations and other interactive lessons, whether online or in person, were the most effective.  There was no differences found in any of the other instructional techniques when used alone. However, there was a significant difference when instructional techniques were combined.  So, by combining different techniques such as videos, hand-outs, and live simulations, continuing education can produce significant improvements in healthcare practitioner knowledge and skills.  It was also shown that repetition led to improvements in short and long-term knowledge retention.

There are many recommendations to reduce the potential bias due to commercialism.  Increasing awareness among healthcare providers regarding the potential bias within continuing education programming seems to be the best first step.  By revealing the possibility for bias, professionals may be more apt to critically evaluate continuing education programs.  Other suggestions include requirements mandated by the Accreditation Council for Continuing Medical Education (ACCME):5

1. Compiling a list of (that year’s) most important topics
2. Requiring proper disclosure of amounts received for funding
3. Limiting the amount of funding received from commercial entities or completely removing commercial funding.  

Lastly, there has been a lot of hype about implementing the Continuous Professional Development (CPD) Model.  The CPD differs from traditional CE in that it incorporates practice-based learning.  The goal is to improve performance of healthcare providers and to individualize objectives for a particular person or organization.6

Figure 1
Source:  https://www.acpe-accredit.org/pdf/images/CPDCycle2011Color.jpg

The CPD cycle (Figure 1) begins with self-appraisal: the individual reflects upon his or her own experiences, strengths, and weaknesses.  Then the individual creates a personalized learning plan, implements it (with documentation of course!), and evaluates the efficacy of what’s been learned.  The circle metaphorically represents the never-ending cycle of knowledge and skill development in healthcare.  As healthcare professionals, we have to continually learn new advances and skills if we want to make a positive impact in patients’ lives.6

  1. Why Accredited CME is Important: CME That Supports a Lifetime in Medical Practice [Internet]. Chicago, IL: Accreditation Council for Continuing Medical Education; 2012 [cited 5 Feb 2014].
  2. Ahmed K, Wang TT, Ashrafian H, et al.  The effectiveness of continuing medical education for specialist recertification. Can Urol Assoc J. 2013;7:266–272.
  3. Marinopoulos SS, Dorman T, Ratanawongsa N, et al. Effectiveness of continuing medical education. Evid Rep Technol Assess 2007;(149):1–69.
  4. Pharmacy Laws and Regulations for the State of Maryland. 14th ed. Baltimore, MD: Maryland Pharmacists Association; 2014. P. 297
  5. Harrison RV. The uncertain future of continuing medical education: commercialism and shifts in funding. J Contin Educ Health Prof. 2003;23:198-209.
  6. Rouse MJ. Continuing Professional Development in Pharmacy. J Am Pharm Assoc. 2004;44:517-520.

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