Medical education: A renewable licence to care

Doctors have always known that their learning does not end with the last chapter of their university textbooks. Life-long learning is, in fact, what they signed up to.

The UK medical profession's regulator, the General Medical Council, refers to this point in its Good Medical Practice guidance for doctors. They have a duty, it states, to keep their professional knowledge and skills up to date.

Historically, this process of continuing education was relatively unmanaged. A far more formal process has emerged over the past years, complete with a new name - Continuing Professional Development - and a complex series of steps, which include how doctors assess gaps in their knowledge, how they intend to plug them and the effect of this on their practice.

Further big changes could add a twist: this November, the GMC will introduce a system of licensing doctors to practise. A hallmark of this system will be a requirement on doctors to renew their licence periodically. This is known as revalidation. CPD will be an important component.

How will things change? Much of the nitty-gritty is being worked out, but the emphasis is already clear.

As Professor Peter Rubin, chair of the GMC, says: "All doctors have a professional obligation to stay up to date. As the regulator, we think that is happening in the vast majority of cases. However we can't confirm that it is.

"Under revalidation it will not be enough simply to say 'I have attended 50 hours of lectures and seminars for CPD'. There will be enhanced appraisal, and multisource feedback from the health team and patients. The focus is on whether patients will benefit from the extra learning that doctors clock up.

The various Royal Colleges, which are responsible for standards of education and training for post graduate doctors, are also contributing to the debate.

Professor Steve Field, chairman of the Royal College of General Practitioners agrees the new system will shift the focus: "CPD will be a more systematic assessment of learning needs. GPs will be able to increase the number of credits for CPD by demonstrating that their learning has improved the quality of care their patients receive. The impact can be measured by clinical audits, improvement in their Quality Scores, adherence to guidelines and so on."

Clinical audits have become a familiar part of the landscape, as a way of checking that best practice is being followed and monitoring improvements.

If the focus is on outcomes - how CPD can improve practice - getting there may follow different paths.

Indeed, the rapid advance of research and the explosion of learning opportunities as technology expands, makes it hard to monitor and accredit all the ways doctors have of pursuing their "learning objectives".

A traditional example of CPD might be attendance at seminars or meetings, or taking part in research but it might also involve learning from the voluntary sector how the needs of particular patients can be better met.

It is not just doctors and regulators who are eager to see how this debate is evolving; the pharmaceutical industry is a keen participant. Andy Powrie-Smith, director of the Association of the British Pharmaceutical Industry Scotland, says the support the industry provides to education is "significant".

He says: "While the industry's support of continuing medical education is valued, some external commentators have raised the question of inappropriate influence. The industry is keen ... to find the right model for supporting education based on transparency and partnership".

CPD is evolving. This applies both to content and delivery - and to who pays for it. The overarching aim, though, is clear to most.

The spotlight is now fixed on the impact of continutng medical education. It may be harder to pin down than grades in final exams, but it is surely of greater interest to patients.

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