The RACGP copped flak for CPD changes, but the principles behind PLAN are internationally accepted
In November last year, WONCA – the organisation for global family doctors – launched its CPD standards for general practitioners worldwide. WONCA expects its new standards will inform local CPD design, and advance both the profession and patient care internationally.
In the new standards, WONCA reasons that no pre-fellowship training program, no matter its length or complexity, can equip a general practitioner with all the skills required of them in their career.
“Strong evidence exists that a commitment to life-long learning with a deliberate CPD plan is necessary for the beginning medical professional to achieve an expert level of clinical knowledge and experience”, the guidelines say.
According to WONCA, the “best available evidence suggests that effective CPD is characterised by a clear need or reason for that particular CPD to be undertaken; learning is based on such an identified need or reason; and follow-up provision for reinforcing the learning accomplished. These three factors have played a large role in the development for CPD guidelines from various medical associations and organisations worldwide”.
WONCA requires the CPD participant to “continually assess his or her own context and practice, with both formal and informal needs assessment, to identify learning objectives”. The needs assessment should include a practice profile, because “knowing this information will allow the family doctor to identify potential gaps in their knowledge, which could benefit from CPD”.
In addition to context-derived learning needs, WONCA refers participants to a number of robust competency frameworks that define what is expected of general practitioners, including what is expected in different contexts. The RACGP curriculum is referenced directly as one of these internationally recommended frameworks.
Once the learning objectives are identified, practitioners need to seek out learning opportunities to address them. After completion of the activity, they should reflect on its impact, short and long term, on their general practice and document their CPD activities.
There’s a whole section in the WONCA standards on the kind of CPD program that needs to be accessed, once individual learning needs are determined from context, curriculum and competency frameworks. General practitioners should “select CPD content based upon self-assessment (based on personal reflection and external indicators of performance) and plans for learning that are consistent with their various professional roles”.
In summary, WONCA is requiring all general practitioners to have a PLAN – a tool that allows each general practitioner to:
• Assess their practice profile
• Consider the core competencies expected of them in their context
• Choose appropriate learning activities
• Reflect on changes to their practice
• Record their learning activities against those identified needs
WONCA requires the discipline of general practice, in consultation with employers and relevant authorities, to set CPD outcomes that arise from the health priorities and needs of the society served. CPD should be explicitly linked to positive health outcomes.
“Family doctors must ensure that CPD activities undertaken are adequate to maintain and develop competencies necessary to meet the needs of their patients and society and to link them to the health outcomes of their patients insofar as this is feasible.”
The WONCA standards even reference formal scoring systems to evaluate the impact of CPD activities against community need. This is also the Medical Board of Australia’s perspective when it calls for strengthened CPD to protect the public and to build the capability of all medical professionals to serve the community.
The WONCA standards’ requirement for a contextual and comprehensive needs assessment to guide learning objectives – as well as reflection on those learning outcomes – is entirely in line with Australian Medical Council (AMC) requirements.
According to the AMC, the colleges must require participants to select CPD activities relevant to their learning needs, based on their current and intended scope of practice within their specialty(s). The college must require general practitioners to complete a cycle of planning and self-evaluation of learning goals and achievements.
WONCA, the AMC and the RACGP all require an integrated, proactive, reflective and demonstrative approach to identifying and documenting doctors’ learning needed “to maintain and develop competencies necessary to meet the needs of their patients and society and to link them to the health outcomes of their patients”.
For general practitioners in Australia from next year, PLAN is a self-reflective tool, enabling general practitioners to ask themselves – and perhaps their practice members – how they can continue to protect patients while building their professional capability, practicing safely the craft for which their fellowship has admitted them.
While many general practitioners may be disciplined in their CPD behaviour, linking it transparently and objectively to health outcomes in their context, as well as against the core competencies required of all general practitioners, many do not.
Rather, a more fluid approach drives many of our choices – guiding us imperceptibly towards what seems interesting and relevant, pragmatic and opportunistic, and towards areas in which we are already expert, if not highly competent.
WONCA, like the RACGP, in no way seeks to diminish the autonomy, adaptability and agility of doctors in augmenting their CPD activities, and both recognise that personal-choice activities build enthusiasm and commitment to CPD overall.
However, the WONCA compliance standards state very clearly – indeed repetitively – that the “delivery of high-quality patient care must be the driving force for family doctors participating in CPD activities”.
So CPD enables general practitioners to do both. That is, to select appropriate ways to continue to be safe, confident doctors for our communities and also to build competence even further in our individual interest areas.
The WONCA standards suggest worldwide CPD is entirely in line with the position taken by the RACGP, and set a clear vision for strengthened CPD in the next triennium.
Professor Janice Bell is CEO of Western Australian General Practice Education and Training Ltd and chair of the RACGP Expert Committee – Post Fellowship Education
