Continuing education in the medical professions: professional development or bureaucratic convenience?

Abstract

This article examines the bureaucratic framework of the credit-based continuing medical education (CME) systems which have been introduced by the Medical Royal Colleges of the United Kingdom. Discussion of the impact of these systems on doctors' continuing education reveals common issues regarding the proper balance of CME methods and content, the relevance of extrinsic motivation to learn, and the place of adult learning principles and educational evaluation. The issue of the consensus basis for the CME initiative is also identified. Evidence from the evaluation of continuing professional development (CPD) diaries returned by members of the Faculty of Public Health Medicine in 1996 offers a counterpoint to credit-based CME. It shows that some public health doctors are seeking more reflective and practice-based approaches to professional learning. They value internal, unaccredited activity, personal learning plans, coherence and continuity in their learning, evaluative professional development and creative development of public health practice. The diary evaluation cannot claim to have established consensus (based on a 35% response rate), yet it successfully challenges some central assumptions of CME in the Colleges and strengthens the case for adding educational substance to the new bureaucratic frameworks.