Letters to the Editor
FROM CME TO CPD
The importance of learning through clinical experience, problem-solving and practise-based work as the substrate of CME needs to be emphasised. To be effective, learning needs to be context specific and practical. Doctors combine all manners of explicit and latent knowledge as they deliberate on alternative analyses of problems, compare different courses of action and ultimately form professional judgements. How decisions are made are as important as the scientific and technological up-grading.
To this whole change in thinking about CME, the term CPD or continuing professional development has been coined(1). “The switch from CME to CPD amounts to more than a change of terminology. It highlights the deeper divisions of the nature of professional knowledge, medical education, the relationship between professionals, organisations and external groups, the meaning of effective practice and how to judge it. CPD may be defined as the self-development of professional knowledge which includes essential reference to the personal, social and political aspects of medicine and public health.”
The principal focus of CME is on individual professionals and their
presumed knowledge gap. The latter is seen as inevitable, given the speed
and complexity of scientific and technological change. Teaching and learning
is conducted in a relatively didactic and impersonal mode. In contrast,
in CPD, practitioners play an active role in defining the knowledge which
they see as relevant to their professional needs. Tutors are not merely
the conduits, and learners the receptacles of packaged theoretical knowledge.
The principal focus of CPD is the reflective process of the individual
doctor on his practice and thoughts of how he could improve patient care.
He is encouraged to keep a diary to keep track of his thoughts and to discuss
them with colleagues. The views of the latter will be necessary to eliminate
subjective distortion of the individual’s learning priorities and to broaden
professional and organisational base of learning. The selection of a particular distance-learning course, scientific meeting or journal reading must be clearly related by the individual to a view of professional practice and direction in which they plan to take it.
Face-to-face CME sessions can take on a new shape. Instead of just lectures, they can consist of short plenary overviews on current practice issues, followed by break-up into small workshop groups to discuss, share and come to consensus on the practice issues. The deliberation can then be presented to the whole class. CME will have moved from passively “sitting in lectures, struggling to stay awake”(2), to being actively involved and participative. Towards effective CME, at the individual level, the doctor can keep a portfolio of clinical materials and questions encountered in practice. He could endeavour to find answers to these questions through looking them up for himself from books and reputable websites on the Internet. There are now a growing number of reputable sites hosted by the British Medical Journal, the New England Journal of Medicine, JAMA, the University of Iowa website and the American College of Medicine website, just to mention a few of the good ones. The full-text of articles of the Singapore Medical Journal too has gone on-line at the SMA website. The website address is http://sma.mip.nus.edu.sg.
Groups of doctors could also meet periodically as a study group to share and discuss clinically-related experiences. At the College, Academy and Medical Association level, opinion leaders could work together to develop CME materials for the profession.
To be useful, there must be a fairly large and structured menu for self-directed learners to choose from. Self-directed learners should also be encouraged to contribute to the pool of CME resources. The SMA website could be a repository of such materials, now that a website has been developed and will be officially launched on 5th March this year.
Singapore has a desire to be a regional medical hub. The development of effective CME for self-directed learning for our doctors and doctors in the region is one activity that Singapore can provide a leadership. Let us all work together towards effective Continuing Professional Development.
A/PROF GOH LEE GAN