Continuing Professional
Development within Physiotherapy-
a Special Perspective
Devdeep Ahuja.*
Introduction
Continuing Professional
development (CPD) has been defined as any process or activity that provides added value to the capability of the professional through increase
in knowledge, skills and
personal qualities necessary for the appropriate execution of professional duties.1 The profile of CPD has risen
substantially across the
professions and in all sectors of employment in recent years.
The demand for quality,
accountability and efficacy of practice has highlighted the need for professionals to demonstrate that they are
keeping abreast of new
knowledge, techniques and developments related to their
professions. There is a
demand on healthcare
professionals to critically
review their skills and
knowledge, and continuously keep up to date with changes in practice. It includes clinical proficiency as well as
non-clinical activities such as
information technology,
management, and leadership
and communication skills.2
This article aims to review the underlying concepts of CPD within physiotherapy, explore
ABSTRACT
The demand for quality, accountability and efficacy of practice has highlighted the need for professionals to demonstrate that they are keeping abreast of new knowledge, techniques and developments related to their professions. The article defines the basics of what constitutes Continuing Professional Development (CPD), explores the relationship between CPD and competence, draws on various studies on the effectiveness of CPD on physiotherapist learning and patient outcomes. The paper also identifies the factors that encourage participation in or act as barriers to CPD. Implications for future research are also discussed.
Key words: professionalism, continuing professional development, professional need.
Authors’ information:
*- Corresponding author. Rehabilitation Response Lead at
Broadspire Rehabilitation Ltd. Milton Keynes, United Kingdom.
E-mail for correspondence: [email protected]
the relationship between CPD,
competence and evidence
based practice. In addition, this paper reviews the current
CPD trends for
physiotherapists report the
barriers that limit the
participation in and
implementation of CPD, and
issues that should be
addressed for the future. What constitutes CPD? As defined in the introduction section, CPD is used to
describe the process to
maintain, develop and
enhance skills, knowledge and
competence in order to
improve performance at work.
The basic principle
underpinning CPD is that it is individual to a professional as per his/ her perceived goals of
development. It is a
continuous process of
analysis, action and review. This process needs to base on
identifiable outcomes of
learning.3
Though the regulatory bodies
around the world have
developed individual
regulations and policies
requirements from the members, the recurring theme is the acceptance of both formal and informal learning processes as a part of the
CPD.4-8 While the formal
learning includes working
towards a post graduate
certification and attending
courses, it also encompasses informal learning opportunities like peer review, journal clubs, in service training, critical reading, clinical supervision, teaching and research as a part of the CPD learning process.
In a survey of musculoskeletal
physiotherapists in United
Kingdom, Stevenson et al,9
found that ‘courses’ and ‘in-service training’ were the most common tools for informing the clinical practice. A similar
survey of Irish
physiotherapists also included ‘clinical supervision’ as one of the most important factors in professional development.10 Approaches to CPD
While various national
regulatory bodies having
adopted a mandatory CPD
requirement,4-8 which means
that the members have to fulfill a minimum requirement of CPD and maintain portfolios to renew memberships, there has been a continuous debate as to whether CPD should be voluntary or mandatory.11
Mandatory minimum
requirement of CPD enables
professional bodies to
demonstrate competence of its
members and has been
preferred over re-examination,
but the proponents of
voluntary CPD postulate that it is in conflict with self-learning and self-motivation.11
Clyne12 has postulated a third
model which is the obligatory CPD, wherein a professional is
strongly encouraged to
participate in CPD and it affects the career progression, but no explicit sanctions are imposed for non-compliance.
Another model of CPD
performance is the reflective practice which incorporates an element of style within it, outlining the necessity to conduct and record the CPD reflectively; it can be used in combination with either of the above three models.13
CPD and competence
Professional competence has been defined in a variety of ways including the ability to
perform the task to a
prescribed standard,14
acknowledging the need for underpinning knowledge and
research,15 and appropriate
updating in line with
developments in professional practice and thinking, research findings, educational changes,
technological advances,
changing priorities in patient care, contextual change and legislative change.16
While CPD can be seen as relating to individuals’ interests and plans for their personal
development and career
progression, however, it is not be a guarantor of competence; individuals might demonstrate a strong commitment to their professional development in terms of the volume of activity they undertake but fail to address fundamental shortfalls in their competence through so doing.
This leads to a fundamental question as to whether patient safety and access to effective care be assured and the needs and interests of
individual professionals and a
profession be served?
Gosling17 has postulated that this would be possible if the
approach taken to CPD
revolves around an outcomes-based approach that focuses on learning achievements and benefits for patients, rather
than learning inputs or
process, and that encourages individuals to relate their CPD to identified learning needs and to evaluate their learning in terms of its impact on patient care (whether directly or indirectly).
Evidence for effect of CPD within Physiotherapy
Recently, there have been a number of studies which have looked into the effect of CPD on practice in physiotherapy.
Gunn and Goding18 in their
qualitative phenomenological study to gain an insight into
individual physiotherapists’
experiences of CPD
concluded that undertaking CPD improves confidence as well as competence, enabling individuals to form effective therapeutic relationships with patients and other members of
their teams. In a cross
sectional mail survey, Li et al,19 found that participation in arthritis related CPD courses led to significantly increased the expected number of roles
assumed by physical
therapists in management of
arthritis patients. In a
randomized controlled trial on 19 physiotherapists, Cleland et
al,20 demonstrated that
ongoing education for the management of neck pain was beneficial in reducing disability for patients with neck pain while reducing the number of physical therapy visits. There
have been previous similar studies as well, which have shown beneficial effects of CPD on clinical practice in physiotherapy.21-23
Even though these studies demonstrate some positive effects of CPD on clinical practice, the results need to be seen in the light on small sample sizes and restrictive
methodology. In addition,
while formal learning has been evaluated, there has been no research on informal learning
activities. In addition,
attribution of improved
outcomes to CPD alone
presents considerable
methodological difficulties.
Participation and
non-participation in CPD
French and Dowds24 have
claimed that those
professionals most likely to need participation in CPD programs are the least likely to attend. Some studies have been done to look into the
factors that encourage
participation and those that act as barriers to participation. Motivation has been described as a continual feature in subjects willing to get involved
in CPD. Karp25 had concluded
that “Motivation is a casual
factor, the mediator and
consequence of learning” and that “before learning can take place, the learner must be motivated”. This has been recognised by CSP as well in their briefing paper on CPD.8
While acquisition of new
knowledge and competencies remains the primary motivation for CPD, softer gains like self-esteem, morale, enjoyment,
job satisfaction, personal
confidence and reassurance
important motivators.3Job
security has been highlighted as another reason for people participating in CPD. In most of the developed countries,
there is some minimum
requirement for CPD to remain on the professional register.5-8 It has been shown that left to their own conscience or if the
mandate was removed,
physiotherapists would
participate in lesser CPD activities11.
Another important factor is the learning culture and aims of
the organization. It is
imperative that within the context of aims and objectives
of the organization,
professionals’ needs and
learning goals are addressed. It has been highlighted that learning environment needs to
be established within an
organization for progression of
skills and competence.15
Workplace support is an
important aspect and the lack of it can be a major barrier to CPD participation.
Along with the individual and
organizational culture, the
society plays an important role
in development of CPD
pathways. It is no longer realistic to think in terms of education, working life and
retirement as successive
phases of life, as the
knowledge acquired in the early years becomes obsolete at an accelerated rate. The concept of lifelong learning in
society, by promoting
education and training
throughout the life cycle opens up new prospects for shaping and conduct of peoples’ lives and for the way they manage their work and culture4.
There have been various barriers highlighted in the literature as contributors to
include time, finances, staff shortage, family commitments,
lack of workplace
encouragement26-29. As time
away from work can cause loss of earning in private practice or staff shortage in teams, it can act as a demotivator for the individual or for the manager who has to
approve the course and
funding. The relevance of the course to practice may also
influence a manager’s
decision to fund courses for staff.29
Though there is no published resource as to the total cost of CPD within physiotherapy, it can a prohibitive factor which can influence the decision of
the managers in course
approval.30
Future Directions for CPD The responsibility for CPD lies at different levels including
individual, workplace and
professional bodies and
government. While the
governments need to give utmost importance to CPD to
enhance patient care,
professional bodies have to
demonstrate that their
members are accountable, efficient and effective through
CPD. Similarly, employers
would like to have staff with
appropriate skills and
knowledge to deliver
exemplary service. At an individual level, a professional need to understand the focus and needs of the employer and the requirements of the professional registering bodies
to develop measurable
outcomes, ensuring that it is
relevant to their current
practice and future career development.
In order to curtail the effects of the identified barriers, flexible learning systems and greater accessibility to resources is needed. In addition, it is
imperative that
physiotherapists are provided greater education about the CPD process and what all it constitutes to allow them to move away from the traditional
methods of formal CPD
towards innovative informal learning methods.
This paper highlights the lack
of research on CPD in
physiotherapy, its effect on clinical practice and career
development of
physiotherapists. Future
research needs to explore the types of CPD activities being
undertaken by
physiotherapists and use of sound research methods to assess their impact on clinical practice and patient outcomes. Conclusion
CPD is an essential aspect of
the profession of
physiotherapy to maintain up
to date knowledge with
continuing development in
understanding of the theory and practice of physiotherapy. Various forms of CPD have been identified and there is a
need for greater
understanding of the informal
methods of CPD to
complement the formal
learning. Future research
needs to incorporate sound methodology to quantify the effects of both formal and informal learning and compare their effects on patient related
outcome measures. In
addition, the perceptions and attitudes of physiotherapists towards CPD also need further exploration.
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ACKNOWLEDGMENTS
None
CONFLICTS OF INTEREST
