Clin Chem Lab Med 2015; 53(1): 35–44
Jan Martin*, Visnja Gasljevic, Tomáš Šálek, Attila Horvath, Charles Borg, Zlata Flegar-Meštrić, Mladen Jakovcic, Josef Silhavik, Adrienn Adonics, Zsófia Szlamka, Ian Brincat, Dorianne Buttigieg, Noel Ciantar, Anna Lisa Sciortino, Antoinette Mifsud, Alison Adkins, Tracey Bennett, Kirstie Rice and Yvette Taylor
Comparison of approaches and measurement of continuing professional development for specialists in laboratory medicine within four European countries Abstract Background: This study investigated approaches to continuing professional development (CPD) for specialists in laboratory medicine within four European countries: Croatia, the Czech Republic, Malta and the UK. Methods: The research questions focussed on ascertaining if continued registration/licence was linked to CPD and if so, were there requirements for certain amounts and types of CPD and for CPD activities to meet specified accreditation criteria. The Professional Associations Research Network (PARN) model of CPD measurement was applied to each country’s registration/licencing body’s CPD requirements. Results: Our results indicate a spectrum of approaches to CPD within participating countries. Conclusions: It will be necessary for European employers to be familiar with these differences and to take them into account for this increasingly mobile European workforce.
*Corresponding author: Dr. Jan Martin, CBiol CSci FHEA FIBMS FSB, Deputy Head of School of Biomedical Science and Physiology, Principal Lecturer for Accreditation and Development, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK, Phone: +44 1902 321154, Fax: +44 1902 322714, E-mail: [email protected] Visnja Gasljevic and Mladen Jakovcic: Croatian Metrology Society, Zagreb, Croatia Tomáš Šálek and Josef Silhavik: Tomas Bata Regional Hospital, Inc, Zlin, Czech Republic Attila Horvath, Adrienn Adonics and Zsófia Szlamka: Horvath and Dubecz Consulting Ltd, Budapest, Hungary Charles Borg, Ian Brincat, Dorianne Buttigieg, Noel Ciantar, Anna Lisa Sciortino and Antoinette Mifsud: Mater Dei Hospital, Msida, Malta Zlata Flegar-Meštrić: University Hospital Merkur, Zagreb, Croatia Alison Adkins: Clinical Immunology Service, University of Birmingham, Birmingham, UK Tracey Bennett: Shrewsbury and Telford Hospital, Shrewsbury, UK Kirstie Rice: New Cross Hospital, Wolverhampton, UK Yvette Taylor: Birmingham Children’s Hospital, Birmingham, UK
Keywords: continuing professional development; education; laboratory medicine. DOI 10.1515/cclm-2014-0415 Received April 16, 2014; accepted June 10, 2014; previously published online July 23, 2014
Introduction As the academic education and qualifications of specialists in laboratory medicine varies within European countries [1, 2], the EC4 Register has been established to not only ‘coordinate the automatic and mutual recognition of European Clinical Chemists on the basis of equivalence of standards’ but also to ‘foster high standards of continuous professional development…… [3]’. Continuing professional development (CPD) is imperative for specialists in laboratory medicine to maintain fitness to practice thus supporting quality service delivery. Understanding of CPD requirements within Europe is needed to underpin mobility of specialists in laboratory medicine and to ensure excellence in provision of EUpatient laboratory test results. The EU directive 2005/36/ EC [4] is committed to the recognition of professional qualifications and the free movement of professionals, with associated economic success via a more mobile workforce. Specialists in laboratory medicine are already motivated to practice in different EU countries and are amongst the top 25 most mobile of the regulated professions [5]. As a mobile profession there is therefore a need for recognition of an individual’s CPD across the EU. The first step towards this has been to achieve an understanding of CPD crediting systems within European countries [6] and to create a European electronic-based CPD portfolio for specialists in laboratory medicine [7].
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36 Martin et al.: CPD for specialists in laboratory medicine within four European countries The purpose of this study was to compare the approaches to and measurement of CPD by registration/ licence authorities for specialists in laboratory medicine in four European countries. The CPD requirement for continued membership of professional bodies within participating countries was beyond the scope of this study.
Materials and methods Partner organisations from five European countries who are participating in a Leonardo Partnership European Lifelong Learning Project took part in this study. The Partnership consortium [8] has received funding of over €100,000 to enhance hospital laboratory standards for CPD by developing a Quality Improvement Toolkit and an online CPD providers Community of Practice network [9]. Participants representing four of the partner organisations provided the information requested in the questionnaire in Table 1 regarding approaches and measurement of CPD for specialists in laboratory medicine within their countries. Throughout this study the European name of ‘specialist in laboratory medicine’ has been used within the same context as specified in the EFLM Position Statement to refer to ‘all specialists working in the field from whatever academic background and whether polyvalent or sub-specialized [10]’. Professional Associations Research Network (PARN) scores [11] for each country were decided upon by collaborative discussion and agreement by at least two participants from each country.
Results The four European countries that took part in this study are Croatia, the Czech Republic, Malta and the UK. Table 2 shows that in three countries (Croatia, Czech Republic and
the UK) the organisation that is responsible for registration/licence provides a formal definition of CPD. In Malta, although the organisation that is responsible for registration/licence does not provide a formal definition, CPD is defined by the Pathology Department. The varying definitions for CPD for specialists in laboratory medicine are shown in Table 2 along with their individual components [12] and it can be seen that all four countries included the nature of CPD, the nature of the value added to capability, the object and the effective period of CPD within their definitions. While the nature of capability to be supported and linking capability to object were defined by three countries, only two countries included the context, organisation and the range of beneficiaries within their definitions. Table 3 illustrates the different staff grades that are employed in hospital laboratories in each partner country, together with their education and qualifications. The results show that while the level of education and qualifications for equivalent grades of laboratory staff is generally comparable within all four European countries, the main difference is at the level of pathologists/specialists in different fields who are medically qualified in the Czech Republic, Malta and UK and are scientifically qualified in Croatia. The information presented in Table 4 provides details of the organisations within each country which have responsibility for granting initial registration/licence along with subsequent re-registration/re-licence and shows the law/notice by which it is governed. Table 4 also indicates that although specialists in laboratory medicine must be initially registered in all of the participating countries, there is considerable variation with regard to the period of registration which ranges from lasting 2 years
Table 1 Questions regarding approaches to continuing professional development in four European countries. Number 1 2 3 4 5 6 7 8 9 10
Question What are the different types of staff grades employed in hospital laboratories? What are the educational requirements of the different types of staff grades? Is there a requirement for re-registration/re-license of specialists in laboratory medicine? What is the name of the organisation granting re-registration/re-license? What is the period of validity for re-registration/re-license? Which law governs re-registration/re-licence? Is participation in CPD activities required for re-registration/re-licence? Is there a specified amount of CPD required for re-registration/re-licence? Is there a requirement for different types of CPD to be carried out for re-registration/re-licence? Using the professional development value measurement scale – How is CPD planned? – How are outcomes recorded? – How are actions assessed? – What are the requirements for reflection?
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Martin et al.: CPD for specialists in laboratory medicine within four European countries 37 Table 2 Definitions and their components of continuing professional development in four European countries. Country
Definition of CPD from organisation responsible for registration/licence
Components of definitions of CPD [11]
Croatia
Croatian Chamber of Medical Biochemists ‘Continuing professional development of masters of medical biochemistry is a permanent process which shall include the following: – Continuous following of the advancements in the medical-biochemical science – Acquiring new knowledge, competences, skills, and attitudes’.
1. Context of CPD 2. Nature of CPD 3. Organisation of CPD 4. Nature of the value added to capability
5. Nature of capability to be supported 6. Link capability to object 7. Object
Czech Republic
Ministry of Health (Law No. 96/2004) ‘...continuing maintenance and development of knowledge, skills, and capabilities of health care professionals and of health care related professionals in the context of the development of the field and of the latest scientific findings’.
Malta
Pathology Department ‘CPD is an on-going learning process undertaken throughout one’s professional career aimed at acquiring, maintaining and improving knowledge, skills and professional behaviour in line with evolving standards. CPD ensures quality in practice as well as personal development which are best achieved through reflective evaluation of each CPD activity. Professional expertise is centred on providing an optimal Health Care Service’.
UK
Health and Care Professions Council ‘a range of learning activities through which health and care professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely, effectively and legally within their evolving scope of practice’.
8. Effective period 9. Range of beneficiaries
1. Context of CPD 2. Nature of CPD 3. Organisation of CPD
4. Nature of the value added to capability 5. Nature of capability to be supported 6. Link capability to object 7. Object 8. Effective period 9. Range of beneficiaries
Field development Maintenance and development Persons (both legal and natural) recognised by professional body Synchronisation of science and practice
Reflect current development Reflection Science-based practice Continuing Not specified
1. Context of CPD
2. Nature of CPD 3. Organisation of CPD
4. Nature of the value added to capability 5. Nature of capability to be supported 6. Link capability to object
7. Object 8. Effective period 9. Range of beneficiaries
Not specified (Permanent) process Not specified Continuous following of the advancements..... Acquiring new knowledge, competences, skills, and attitudes New knowledge, competences, skills, and attitudes Not specified Continuous following of the advancements in the medical-biochemical science Permanent Masters of Medical Biochemistry
1. Context of CPD 2. Nature of CPD 3. Organisation of CPD 4. Nature of the value added to capability 5. Nature of capability to be supported 6. Link capability to object 7. Object 8. Effective period 9. Range of beneficiaries
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Providing an optimal health care service in line with evolving standards On-going learning process CPD activities are organised in such a way so as to ensure the personal development of the professional and quality in practice Acquiring knowledge and skills, maintaining competence and improving performance Knowledge, skills and professional behaviour Not yet defined. Participation is on a voluntary basis Personal achievement Throughout one’s professional career Health care service providers (All pathology staff including MLS, medical professional, phlebotomists and paramedic aides) and users (clinicians and patients)
Not specified A range of learning activities Not specified Maintain and develop…. …retain their capacity to practice…… Not specified
To ensure that they retain……. Evolving scope of practice’ Throughout their career Not specified
38 Martin et al.: CPD for specialists in laboratory medicine within four European countries Table 3 Education of hospital laboratory staff within partner countries. Country
Laboratory staff
Education
Croatia
Master of Medical Biochemistry
Specialist of Medical Biochemistry and Laboratory Medicine
PhD degree in Pharmaceutical-Biomedical Sciences
Baccalaureate in Medical Laboratory Diagnostics
Laboratory technician
Medical associates
–U niversity education: 5 years’ study of medical biochemistry at the Faculty of Pharmacy and Biochemistry –1 -year program of supervised practical training in a laboratory –U niversity education: 5 years’ study of medical biochemistry at the Faculty of Pharmacy and Biochemistry –1 -year program of supervised practical training in laboratory – Specialisation in medical biochemistry and laboratory medicine (4 years) –P ostgraduate doctoral studies ‘Pharmaceutical-Biomedical Science’ –U niversity degree (Faculty of Pharmacy and Biochemistry) –G raduate studies achievement (grade point average 4.0, or references from two teachers; English language competence and computer literacy) –1 year of organised scientific or specialist postgraduate course –P reparation and defence of the PhD thesis –B achelor’s degree (Bacc.) – University of Applied Health Studies – 3 years’ professional study of medical laboratory diagnostics – 1-year program of supervised practical training in a laboratory – 4 years of a secondary school for laboratory technicians – 1-year program of supervised practical training in laboratory – University education: minimally 4 years’ study at a Faculty, such as the Faculty of Natural Science, which does not belong to the biomedical group of faculties at the University – MD degree professionals – 6 years MD plus 5 years’ specialisation
Czech Republic
Malta
UK
Specialists in different fields in laboratory medicine (clinical biochemists, hematologists, microbiologists) Specialist in laboratory medicine
Laboratory technician Pathologists Medical laboratory scientists
Paramedic aides and phlebotomists
Support staff (laboratory assistants) Consultant pathologists Clinical scientists
STPs
Biomedical scientists
Associate practitioner of biomedical science (APBMS)
Medical laboratory assistants (MLA)
– Non-MD University degree professionals – master degree 5 years plus 3–5 years’ specialisation – Bachelor degree 3 years plus possible specialisation – Must be MRCPath or equivalent – University graduates holding a BSc (EQF 6) or Diploma (EQF 5) in medical laboratory sciences – Many continue with their studies to obtain further qualifications, such as MSc or PhD – MCAST graduates, generally with BTEC (Applied Lab Sciences) or – Other related health care courses (EQF4) – Unskilled to semi-skilled work. Basic requirements – Minimally MRC Path (part 2) – HCPC registered – University graduates, usually with PhD (another MSc as part of in depth training) – Awarded by Association of Clinical Biochemistry and Laboratory Medicine – HCPC registered – Specific training programme (also includes another MSc) – HCPC registered – University graduates holding a HCPC verified BSc (or Higher National Diploma if already in post) in Biomedical Science. – Alternate route available assessed individually by HCPC – IBMS Certificate of Competence (other routes available) – Often MSc, professional (IBMS) qualification, occasional PhD/professional or thesis – Foundation degree in health sciences – BTEC National Diploma (Science) – NVQ Level 3 (laboratory science) or – Equivalent qualification (or higher) in a relevant science-based subject – Minimum of 5 GCSEs – May take IBMS Certificate of Achievement Part I or II
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Council of Open-ended Professions Complimentary to Medicine Health and Care 2 years Professions Council
No
Yes
Malta
UK
Croatian Chamber of 6 years Medical Biochemists
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A mixture of learning activities which are relevant to current or future practice are required. HCPC Standards for CPD state that a minimum of three different types of CPD must be included which must be continuous with no gaps of > 2/3 months
N/A
A maximum of 50% of CPD credits are allowed from one type of CPD activity 40 CPD points within 10 No requirement to undertake years different types of CPD
30 CPD credits within 6 years
N/A as CPD not N/A required for re-registration/ re-license The Health Professions Order 2001 Yes Amount of CPD not specified by law but must adhere to Health and Care Professions Council (HCPC) Standards for CPD (Professional body recommendation of 250 CPD points within 5 years)
Yes
Yes
Participation in Specified amount Requirement for different types CPD activities of CPD required for of CPD for re-registration/ required for re-registration/re-licence re-licence re-registration/ re-licence
Notice (105/2011) which stipulates the conditions under which competence of non-medical health care professionals is acquired and recognised Notice 4/2010 which defines the number of credits from each activity (e.g., passive or active attendance at conference, publication as first author or co-author, poster etc.) The Health Care Professions Act (2003)
Law on the Health Care (1993)
Period of Law governing re-registration/ validity for re-licence re-registration/ re-license
The Ministry 10 years of Health (for Biomedical scientists) The Czech Medical Chamber (for medical doctors)
Yes
Name of organisation granting re-registration/ re-license
Czech Yes Republic
Croatia
Country Is there a requirement for re-registration/ re-license
Table 4 Partner country requirements of continuing professional development for re-registration/re-license.
Martin et al.: CPD for specialists in laboratory medicine within four European countries 39
40 Martin et al.: CPD for specialists in laboratory medicine within four European countries (UK) to open-ended (Malta). In all partner countries (except Malta), there is a requirement for re-registration/ re-licensing (Table 4) with participation in CPD activities being a mandatory pre-requisite. Data in Table 4 also illustrates the amounts of CPD in terms of points which are required, along with an indication of criteria for inclusion of different types of CPD activities. Figure 1 illustrates the scores for each of the four spokes when the PARN CPD measurement model [11] is applied to the CPD schemes for each of the partner countries. Applying the PARN model measurement scale for Planning [11] to the CPD schemes of each of the countries, illustrated a range from a score of 2 (Malta) where ‘goals are set along with an associated assessment of need’, to a score of 3 (UK) where ‘a loose competency framework is implemented’, to a maximum score of 4+ where there is ‘a detailed competency framework with different areas for different types of competency, an online planner, incorporation of linking point allocation to different competencies and prioritization’ (Czech Republic) plus ‘individualization’ (Croatia). All four countries scored the maximum score of 1+ on the PARN model measurement scale for Action [11] which indicated that they all implemented a system which included ‘a record of hours plus evidence of attendance, a points system with different allocations for different types of activity along with evidence of participation.’ The PARN model measurement scores for Outcomes [11] ranged from a score of 2 (Malta) where the outcome is ‘assessed informally against the learning objectives to ascertain whether or not they have been met’ to a score of 4 (UK) where there is ‘objective scoring in combination with self-assessment’ to the maximum score of 4+ with ‘objective assessment methods’ (Croatia) plus ‘peer/client appraisal and mixed assessment techniques tailored for different aspects of CPD’ (Czech Republic). In contrast to Malta where reflection is not employed as a measure of the effectiveness of a CPD activity the PARN model measurement scores for Reflection [11] within the other three countries illustrated a score of 3 for Croatia where ‘group reflection’ is implemented to scores of 4 for both the Czech Republic and the UK where ‘question templates are used and the questions are linked to competencies.’
Discussion As there are a wide range of objectives, functions and scope for CPD [13], this study began by comparing the definitions of CPD which are used by the registration/ licencing bodies for specialists in laboratory medicine in
each of the four participating European countries (Table 2). Applying the nine components of definitions of CPD ‘in order to discern the purposes of CPD from its definition’ [12] it is clear that the definitions of CPD from the four countries place different emphasis on different components and purposes. The Croatian Chamber of Medical Biochemists [14] and the Czech Republic Ministry of Health [15] definitions of CPD have similar purposes as both focus on keeping up-to-date with new improvements, expertise and ensuring proficiency in novel techniques in an ever changing scientific arena. The definition of CPD used in Malta includes ensuring quality in practice and personal development and the HCPC definition used within the UK is similar as it encompasses the main purposes of maintaining both capacity and developing in the future as scope of practice changes [16]. Although it is interesting that only two definitions of CPD used within this study specified the range of beneficiaries of CPD, our results show similarity to another study which demonstrated that from 55 professional body definitions of CPD, only 10 definitions specified the range of beneficiaries of CPD [12]. Input models for participation in CPD involve measurement of the number of CPD hours along with a requirement for completion of a specified number of hours within a given time period [17]. CPD hours are usually expressed as CPD points where one CPD hour usually equates to one CPD point. While input systems provide a fairly easy way for professional bodies to monitor CPD compliance, they fail to recognise learning, effectiveness or impact as ‘simply attending a CPD credit-rated meeting will give you CPD points [18]’. However, an output model for participation in CPD involves a focus on the participant as a learner whose aim is to achieve set learning outcomes. Although an output system is more difficult for professional bodies to monitor it does provide for an ‘emphasis on recognising learning [18]’. While an input system records the amount of hours of CPD and an outputs system records the fact that reflection has taken place, it has been suggested that an outcomes approach is required in order to make a difference and to show that the CPD is having the desired impact on patients and the organisation [19]. Participating countries exhibited a spectrum of requirements with regard to the amount of CPD activity that is required for relicensing/continued registration. This ranged from CPD activity not being required (Malta) to input-based models with mandatory, precisely specified, numbers of CPD points per year (Croatia and Czech Republic) to an outcomes-based approach in the UK to ‘maintain a continuous, up-to-date and accurate record of their CPD activities.’ Croatia and the Czech Republic have similar requirements with regard to the amount of
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Martin et al.: CPD for specialists in laboratory medicine within four European countries 41
Country
Spoke of Comments and categories identified from reference Mean PDV [11] score
Croatia (Courses organised by the Croatian Chamber of Medical Biochemists)
Planning Goals set Assessment of needs Planned activities/timescale Detailed competency framework with different areas for type of competency or specific to certain roles Individualisation Linking point allocation to different competencies Action Record of hours + evidence of attendance Points system with different allocations for different types of activity Evidence of participation Outcomes Objective assessment methods Reflection Group reflection
4+
1+
4+ 3
Czech Republic Planning Detailed competency framework with different areas (Czech Society for type of competency or specific to certain roles for Clinical Online planner Biochemistry/ Linking point allocation to different competencies Charles Prioritisation University Action Record of hours + evidence of attendance Moodle system) Points system with different allocations for different types of activity Evidence of participation Outcomes Objective scoring in combination with selfassessment Objective assessment methods Peer/client appraisal Mixed assessment techniques tailored for different aspects of CPD Reflection Question templates Questions linked to competencies
4+
1+
4+
4
Planning Goals set and assessment of needs. Decision on the theme to be discussed during activity takes into account current local developments in health-related topics and their impact on laboratory practices. Planned activities/timescale. Planning of CPD activity starts approximately 6 months before to set the date/s, content of activity, target audience and potential speakers. Action Records of all activities are documented and attendance records are kept centrally. A certificate of attendance is awarded to participants based on the number of hours attended. Evidence of attendance takes the form of signed attendance sheets which are circulated during the activity Outcomes Effectiveness of activity is measured informally through feedback by participants. Feedback is collected either through questionnaires circulated after the activity or through informal discussions with participants Reflection The importance of reflection is still not considered as an essential measure of the effectiveness of a CPD activity.
2
Malta
1+
2
0
Figure 1 (Continued)
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42 Martin et al.: CPD for specialists in laboratory medicine within four European countries
Country
Spoke of Comments and categories identified from reference Mean PDV [11] score
UK Planning Example activities list and example evidence list (Health and Care Framework for assessing profile Professions Loose framework (see outcomes) Council) Example profiles Individualisation Action Record of activities (dates), description and evidence of participation Outcomes Demonstrate activities are a mixture of learning activities relevant to current or future practice. Seek to ensure CPD has contributed to the quality of their practice and service delivery Seek to ensure service user has benefitted Produce a written profile with supporting evidence to explain how standards have been met (on request 2.5% registrants 2 yearly) Reflection Produce a written profile with supporting evidence to explain how standards have been met (on request 2.5% registrants 2 yearly) Audit (as above) Questions linked to competencies but only 2.5% have to complete this
3
1+
4
Z
4
Figure 1 Applying the Professional Associations Research Network (PARN) CPD measurement model to the CPD schemes for each of the partner countries.
CPD that is necessary for relicensing/continued registration of medical laboratory staff. In Croatia the minimum requirement for CPD is the achievement of 30 credits within a 6-year period and in the Czech Republic 40 CPD points are required every 10 years. In the UK although an outcomes-based approach with no mandatory requirement for a certain number of CPD points to be achieved within a certain timeframe is in place, the HCPC does specify that CPD must be continuous [20] which is defined as one CPD activity every 2 months [21]. These requirements are in contrast to the current situation in Malta where although ‘it is highly recommended that every Medical Laboratory Scientist carries out Continuing Professional Development’ [22] there is no legal requirement for them to do so. With such a wide range of requirements for amounts of CPD required within participating countries, it was interesting to also note their different requirements for certain types of CPD to be carried out, particularly as an extensive array of activities are known to be acceptable for CPD requirements [23]. While the Czech Republic does not have any requirement to undertake different types of CPD, in some partner countries requirements for specific types of CPD are specified. In Croatia, a maximum of 50% of CPD credits are allowed from one type of CPD activity while in the UK many different types of CPD activities are acceptable, and there is
a stipulation that a minimum of three different types of CPD must be included with registrants ‘demonstrating that their CPD activities are a mixture of learning activities which are relevant to current or future practice [16]’. Partner countries differed in the criteria which were required to be met for a CPD activity to be acceptable for registration/license. In Croatia in order to satisfy the regulatory body, the requirements for a Chamber’s CPD activity are that it must be: relevant; have a duration of between 6 and 10 h, include written working materials, have a written exam plus a course evaluation. The Croatian Chamber of Medical Biochemists also carry out approval and creditation of other CPD activities and in order to satisfy the regulations, the proposed CPD activity must be relevant and demonstrate objective evidence. Similarly, in the Czech Republic there are also several requirements that must be met in order for a CPD activity to be acceptable and these include the activity being registered with the Professional body beforehand, being allocated a unique CPD number, including at least one lecture, having a defined professional guarantor for the activity, the number of awarded points being related to the duration of the activity, and participants being awarded a certificate of attendance with active participants and co-authors receiving a higher number of points. The requirements for CPD activities
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Martin et al.: CPD for specialists in laboratory medicine within four European countries 43
within Croatia specify that there is a requirement for the course to last between 6 and 10 h and to conclude with a written test. In the UK, in order to meet the HCPC requirements for CPD, there is no requirement for a specialist in laboratory medicine’s CPD activities to have met any formal accreditation criteria as the onus is on the registrant to ‘seek to ensure that their CPD has contributed to the quality of their practice and service delivery’ [16] rather than, as is the case in most of the other partner countries, the onus being on the CPD provider. As participation in CPD is not a mandatory requirement for relicensing/continued registration of specialists in laboratory medicine in Malta, CPD activities are not therefore required to meet specified accreditation criteria associated with registration/licence as is the case in Croatia and the Czech Republic. We wished to not only compare each of the four country’s requirements for participation, amounts and different types of CPD but also to investigate if their registration/licensing bodies took into account associations between CPD and competence. There is much debate in the literature regarding how CPD is related to competence plus its perceived benefits within the clinical setting. While some health professionals including career grade doctors [24], consultant doctors [25] and physiotherapists [26] perceive that their CPD results in changes which impact positively on their clinical practice, there is no evidence to show the impact of CPD on dentists [27] competence or that specialist nurses [28] had actually taken part in CPD that would be appropriate for their extended roles. Models have been developed to address this issue including the Allied Health Professions Project which piloted an outcomes model aimed at facilitating professionals being able to demonstrate links between their CPD and competence [19]. A further model for CPD measurement was developed involving identification of professionalism in the form of a ‘Professional Development Value (PDV)’ in order to specifically measure how well CPD has achieved its aims [11]. This innovative design uses a wheel framework based on the CPD cycle [29] with spokes for planning, action, outcomes and reflection. Applying this PARN model to the CPD requirements of registration/licencing bodies from participating countries allowed a ‘picture of the CPD measurement system as a whole’ [11] to be viewed and compared to others. Profiles showed that because the system in Malta does not recognise the importance of reflection as a measure of CPD effectiveness, the CPD profile for Malta was a mirror image of the CPD profile for the other countries. The
remaining three countries (Croatia, Czech Republic and UK) had similar CPD profiles which emphasised high scores for planning, outcomes and reflection. These profiles are similar to four case studies within the medical sector where it is recognised that because professionals must maintain competence it is necessary to have robust systems in place for measuring CPD, assessing CPD outcomes and auditing CPD procedures to make certain that professionals retain their continued competence [11]. However, there is still difficulty in relating CPD to competence as illustrated in UK by the simple statement by the HCPC [20] that ‘there is no automatic link between your CPD and your competence’ with further acknowledgement by the HCPC [20] that ‘it would be possible (although unlikely) for a competent professional not to undertake any CPD and yet still meet our standards for their skills and knowledge. Equally, it would be possible for a registrant who was not competent to complete a lot of CPD activities but still not be fit to practise’. Although the HCPC cites these two extreme examples as they state for most specialists in laboratory medicine ‘it is assumed that their CPD activities will be related to their competence.’ Our results demonstrate important similarities and differences in both CPD requirements and CPD profiles for specialists in laboratory medicine within the four participating European countries which would need to be taken into consideration if European harmonisation of CPD is to be achieved. In addition, the essential link between CPD and competence remains an area for further investigation and improvement in order to enhance the role of laboratory medicine in delivering quality service and excellent patient care. Acknowledgments: This research was funded by a Leonardo Partnership [30] Grant from the European Union Lifelong Learning Programme [31] – Leonardo Grant Number LdVP/13/006C ‘Enhancing Hospital Laboratory Standards for Continuing Professional Development: A Quality Improvement Toolkit’. Author’s contribution: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Financial support: None declared. Employment or leadership: None declared. Honorarium: None declared. Role of sponsor: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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44 Martin et al.: CPD for specialists in laboratory medicine within four European countries
References 1. Kovacs GL, Ludany A, Koszegi T, Liszt F, Kellermayer M. Graduate and postgraduate state university education of laboratory specialists in Hungary: medical doctors, pharmacists and laboratory analysts. Biochem Med (Zagreb) 2011; 21:22–9. 2. Simundic AM, Topic E, Cvoriscec D, Cepelak I. Clinical chemistry and laboratory medicine in Croatia: regulation of the profession. Special themed issue: education in clinical chemistry and laboratory medicine in various European countries. Biochem Med (Zagreb) 2011;21:15–21. 3. McMurray J, Zérah S, Hallworth M, Schuff-Werner P, Haushofer A, Szekeres T, et al. The European register of specialists in clinical chemistry and laboratory medicine: guide to the register, version 3-2010. Clin Chem Lab Med 2010;48:999–1008. 4. Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. OJEU. Available from: http://ec.europa.eu/internal_market/qualifications/policy_developments/legislation/ indexen.htm. Accessed on April 15, 2014. 5. EU single market regulated professions database. Ranking the most mobile professions. Available from: http://ec.europa.eu/ internal_market/qualifications/regprof/index.cfm?action = stat_ ranking&b_services = false. Accessed on April 15, 2014. 6. Topic E, Beletic A, Zima T. Continuing professional development crediting system for specialists in laboratory medicine within 28 EFLM national societies. Biochem Med 2013;23:332–41. 7. EucoLABS. A road to a European credit system for continuing professional development of biomedical laboratory scientists in Europe 2010–2012. Available from: http://www.europeansharedtreasure.eu/detail.php?id_project_base = 2010-1-BE3LEO04-02269. 8. Martin J. A European project to enhance hospital laboratory standards for biomedical scientists continuing professional development by establishing a quality improvement toolkit and an online community of practice. NAPC Rev 2013;14:29–30. 9. Martin J. A European project to enhance continuing professional development for biomedical scientists. Biomed Sci 2014;58:155. 10. Zerah S, Murray J, Horvath AR. EFLM position statement – our profession now has a European name: specialist in laboratory medicine. Biochem Med 2012;22:272–3. 11. Friedman A, Woodhead S. Approaches to CPD measurement. Bristol: Professional Associations Research Network PARN, 2008. Available from: http://www.ifac.org/sites/default/files/ meetings/files/3629.pdf. Accessed on April 15, 2014. 12. Friedman A, Davis K, Philips M. Continuing professional development in the UK: policies and programmes. Bristol: Professional Associations Research Network (PARN), 2000. 13. Friedman A, Phillips M. Continuing professional development: developing a vision. J Educ Work 2004;17:361–76. 14. Croatian Chamber of Medical Biochemists: rules of continuing education for masters of medical biochemistry. Available from: http://www.hkmb.hr/. Accessed on April 15, 2014. 15. Czech Republic Ministry of Health. Available from: http://www. mzcr.cz/. Accessed on April 15, 2014. 16. HCPC: Health and Care Professions Council. Your guide to our standards for continuing professional development. 2012.
Available from: http://www.hpc-uk.org/assets/documents/10 003B70Yourguidetoourstandardsofcontinuingprofessionaldev elopment.pdf. Accessed on April 15, 2014. 17. Friedman A, Mason J. The professionalisation of UK professional associations: governance, management & member relations. Bristol: Professional Associations Research Network (PARN), 2004. 18. Wilson G. Continuing professional development: current understanding and practice. Biomed Sci 2004;54:168–9. 19. Department of Health. Allied health professions project: demonstrating competence through continuing professional development – final report. London: Department of Health, 2003. 20. HCPC: Health and Care Professions Council. Continuing professional development and your registration. 2012. Available from: http://www.hpc-uk.org/assets/documents/10001314CPD_and_ your_registration.pdf. Accessed on April 15, 2014. 21. HCPC: Health and Care Professions Council. Continuing professional development, frequently asked questions. 2012. Available from: http://www.hpc-uk.org/registrants/cpd/ faqs/. Accessed on April 15, 2014. 22. CPSM: Council for the Professions Complementary to Medicine – Malta. Code of practice – medical laboratory science. 2006. Available from: http://www.ba-malta.org/file. aspx?f = 642. Accessed on April 15, 2014. 23. O’Sullivan J. Continuing professional development. In: Jones R, Jenkins F, editors. Developing the allied health professional. London: Radcliffe Publishing, 2006. 24. Saidi G, Weindling AM. An evaluation of a national scheme for continuing professional development (CPD) for career grade doctors; the Royal College of Paediatrics and Child Health’s programme for paediatricians evaluated by focus group methodology. Med Educ 2003;37:328–34. 25. Schostaka J, Davis M, Hanso J, Schostakd J, Brown T, Driscoll P, et al. The effectiveness of continuing professional development project: a summary of findings. Med Teach 2010;32:586–92. 26. Gunn H, Goding L. Continuing professional development of physiotherapists based in community primary care trusts: a qualitative study investigating perceptions, experiences and outcomes. Physiotherapy 2009;95:209–14. 27. Eaton K, Brookes J, Patel R, Batchelor P, Merali F, Narain A. The impact of continuing professional development in dentistry: a literature review. 2011. Available from: http://www.gdc-uk.org/ Aboutus/policy/Documents/Impact%20Of%20CPD%20In%20 Dentistry.pdf. Accessed on April 15, 2014. 28. Drey N, Gould D, Allan T. The relationship between continuing professional education and commitment to nursing. Nurs Educ Today 2009;29:740–5. 29. Cook S. RSPGB continuing professional development. A guide to getting started. A journey round the CPD cycle 2004. Available from: http://www.uptodate.org.uk/PlanandRecord/ getting_started_guide/getting_started_/2.pdf. Accessed on April 15, 2014. 30. European Union Leonardo Partnerships. Available from: http:// www.leonardo.org.uk/default.asp?section = 00010001§ionTitle = Home. Accessed on April 15, 2014. 31. European Union Lifelong Learning Programme. Available from: https://www.lifelonglearningprogramme.org.uk/. Accessed on April 15, 2014.
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Jan Martin*, Visnja Gasljevic, Tomáš Šálek, Attila Horvath, Charles Borg, Zlata Flegar-Meštrić, Mladen Jakovcic, Josef Silhavik, Adrienn Adonics, Zsófia Szlamka, Ian Brincat, Dorianne Buttigieg, Noel Ciantar, Anna Lisa Sciortino, Antoinette Mifsud, Alison Adkins, Tracey Bennett, Kirstie Rice and Yvette Taylor
Comparison of approaches and measurement of continuing professional development for specialists in laboratory medicine within four European countries Abstract Background: This study investigated approaches to continuing professional development (CPD) for specialists in laboratory medicine within four European countries: Croatia, the Czech Republic, Malta and the UK. Methods: The research questions focussed on ascertaining if continued registration/licence was linked to CPD and if so, were there requirements for certain amounts and types of CPD and for CPD activities to meet specified accreditation criteria. The Professional Associations Research Network (PARN) model of CPD measurement was applied to each country’s registration/licencing body’s CPD requirements. Results: Our results indicate a spectrum of approaches to CPD within participating countries. Conclusions: It will be necessary for European employers to be familiar with these differences and to take them into account for this increasingly mobile European workforce.
*Corresponding author: Dr. Jan Martin, CBiol CSci FHEA FIBMS FSB, Deputy Head of School of Biomedical Science and Physiology, Principal Lecturer for Accreditation and Development, Faculty of Science and Engineering, University of Wolverhampton, Wulfruna Street, Wolverhampton WV1 1LY, UK, Phone: +44 1902 321154, Fax: +44 1902 322714, E-mail: [email protected] Visnja Gasljevic and Mladen Jakovcic: Croatian Metrology Society, Zagreb, Croatia Tomáš Šálek and Josef Silhavik: Tomas Bata Regional Hospital, Inc, Zlin, Czech Republic Attila Horvath, Adrienn Adonics and Zsófia Szlamka: Horvath and Dubecz Consulting Ltd, Budapest, Hungary Charles Borg, Ian Brincat, Dorianne Buttigieg, Noel Ciantar, Anna Lisa Sciortino and Antoinette Mifsud: Mater Dei Hospital, Msida, Malta Zlata Flegar-Meštrić: University Hospital Merkur, Zagreb, Croatia Alison Adkins: Clinical Immunology Service, University of Birmingham, Birmingham, UK Tracey Bennett: Shrewsbury and Telford Hospital, Shrewsbury, UK Kirstie Rice: New Cross Hospital, Wolverhampton, UK Yvette Taylor: Birmingham Children’s Hospital, Birmingham, UK
Keywords: continuing professional development; education; laboratory medicine. DOI 10.1515/cclm-2014-0415 Received April 16, 2014; accepted June 10, 2014; previously published online July 23, 2014
Introduction As the academic education and qualifications of specialists in laboratory medicine varies within European countries [1, 2], the EC4 Register has been established to not only ‘coordinate the automatic and mutual recognition of European Clinical Chemists on the basis of equivalence of standards’ but also to ‘foster high standards of continuous professional development…… [3]’. Continuing professional development (CPD) is imperative for specialists in laboratory medicine to maintain fitness to practice thus supporting quality service delivery. Understanding of CPD requirements within Europe is needed to underpin mobility of specialists in laboratory medicine and to ensure excellence in provision of EUpatient laboratory test results. The EU directive 2005/36/ EC [4] is committed to the recognition of professional qualifications and the free movement of professionals, with associated economic success via a more mobile workforce. Specialists in laboratory medicine are already motivated to practice in different EU countries and are amongst the top 25 most mobile of the regulated professions [5]. As a mobile profession there is therefore a need for recognition of an individual’s CPD across the EU. The first step towards this has been to achieve an understanding of CPD crediting systems within European countries [6] and to create a European electronic-based CPD portfolio for specialists in laboratory medicine [7].
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36 Martin et al.: CPD for specialists in laboratory medicine within four European countries The purpose of this study was to compare the approaches to and measurement of CPD by registration/ licence authorities for specialists in laboratory medicine in four European countries. The CPD requirement for continued membership of professional bodies within participating countries was beyond the scope of this study.
Materials and methods Partner organisations from five European countries who are participating in a Leonardo Partnership European Lifelong Learning Project took part in this study. The Partnership consortium [8] has received funding of over €100,000 to enhance hospital laboratory standards for CPD by developing a Quality Improvement Toolkit and an online CPD providers Community of Practice network [9]. Participants representing four of the partner organisations provided the information requested in the questionnaire in Table 1 regarding approaches and measurement of CPD for specialists in laboratory medicine within their countries. Throughout this study the European name of ‘specialist in laboratory medicine’ has been used within the same context as specified in the EFLM Position Statement to refer to ‘all specialists working in the field from whatever academic background and whether polyvalent or sub-specialized [10]’. Professional Associations Research Network (PARN) scores [11] for each country were decided upon by collaborative discussion and agreement by at least two participants from each country.
Results The four European countries that took part in this study are Croatia, the Czech Republic, Malta and the UK. Table 2 shows that in three countries (Croatia, Czech Republic and
the UK) the organisation that is responsible for registration/licence provides a formal definition of CPD. In Malta, although the organisation that is responsible for registration/licence does not provide a formal definition, CPD is defined by the Pathology Department. The varying definitions for CPD for specialists in laboratory medicine are shown in Table 2 along with their individual components [12] and it can be seen that all four countries included the nature of CPD, the nature of the value added to capability, the object and the effective period of CPD within their definitions. While the nature of capability to be supported and linking capability to object were defined by three countries, only two countries included the context, organisation and the range of beneficiaries within their definitions. Table 3 illustrates the different staff grades that are employed in hospital laboratories in each partner country, together with their education and qualifications. The results show that while the level of education and qualifications for equivalent grades of laboratory staff is generally comparable within all four European countries, the main difference is at the level of pathologists/specialists in different fields who are medically qualified in the Czech Republic, Malta and UK and are scientifically qualified in Croatia. The information presented in Table 4 provides details of the organisations within each country which have responsibility for granting initial registration/licence along with subsequent re-registration/re-licence and shows the law/notice by which it is governed. Table 4 also indicates that although specialists in laboratory medicine must be initially registered in all of the participating countries, there is considerable variation with regard to the period of registration which ranges from lasting 2 years
Table 1 Questions regarding approaches to continuing professional development in four European countries. Number 1 2 3 4 5 6 7 8 9 10
Question What are the different types of staff grades employed in hospital laboratories? What are the educational requirements of the different types of staff grades? Is there a requirement for re-registration/re-license of specialists in laboratory medicine? What is the name of the organisation granting re-registration/re-license? What is the period of validity for re-registration/re-license? Which law governs re-registration/re-licence? Is participation in CPD activities required for re-registration/re-licence? Is there a specified amount of CPD required for re-registration/re-licence? Is there a requirement for different types of CPD to be carried out for re-registration/re-licence? Using the professional development value measurement scale – How is CPD planned? – How are outcomes recorded? – How are actions assessed? – What are the requirements for reflection?
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Martin et al.: CPD for specialists in laboratory medicine within four European countries 37 Table 2 Definitions and their components of continuing professional development in four European countries. Country
Definition of CPD from organisation responsible for registration/licence
Components of definitions of CPD [11]
Croatia
Croatian Chamber of Medical Biochemists ‘Continuing professional development of masters of medical biochemistry is a permanent process which shall include the following: – Continuous following of the advancements in the medical-biochemical science – Acquiring new knowledge, competences, skills, and attitudes’.
1. Context of CPD 2. Nature of CPD 3. Organisation of CPD 4. Nature of the value added to capability
5. Nature of capability to be supported 6. Link capability to object 7. Object
Czech Republic
Ministry of Health (Law No. 96/2004) ‘...continuing maintenance and development of knowledge, skills, and capabilities of health care professionals and of health care related professionals in the context of the development of the field and of the latest scientific findings’.
Malta
Pathology Department ‘CPD is an on-going learning process undertaken throughout one’s professional career aimed at acquiring, maintaining and improving knowledge, skills and professional behaviour in line with evolving standards. CPD ensures quality in practice as well as personal development which are best achieved through reflective evaluation of each CPD activity. Professional expertise is centred on providing an optimal Health Care Service’.
UK
Health and Care Professions Council ‘a range of learning activities through which health and care professionals maintain and develop throughout their career to ensure that they retain their capacity to practice safely, effectively and legally within their evolving scope of practice’.
8. Effective period 9. Range of beneficiaries
1. Context of CPD 2. Nature of CPD 3. Organisation of CPD
4. Nature of the value added to capability 5. Nature of capability to be supported 6. Link capability to object 7. Object 8. Effective period 9. Range of beneficiaries
Field development Maintenance and development Persons (both legal and natural) recognised by professional body Synchronisation of science and practice
Reflect current development Reflection Science-based practice Continuing Not specified
1. Context of CPD
2. Nature of CPD 3. Organisation of CPD
4. Nature of the value added to capability 5. Nature of capability to be supported 6. Link capability to object
7. Object 8. Effective period 9. Range of beneficiaries
Not specified (Permanent) process Not specified Continuous following of the advancements..... Acquiring new knowledge, competences, skills, and attitudes New knowledge, competences, skills, and attitudes Not specified Continuous following of the advancements in the medical-biochemical science Permanent Masters of Medical Biochemistry
1. Context of CPD 2. Nature of CPD 3. Organisation of CPD 4. Nature of the value added to capability 5. Nature of capability to be supported 6. Link capability to object 7. Object 8. Effective period 9. Range of beneficiaries
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Providing an optimal health care service in line with evolving standards On-going learning process CPD activities are organised in such a way so as to ensure the personal development of the professional and quality in practice Acquiring knowledge and skills, maintaining competence and improving performance Knowledge, skills and professional behaviour Not yet defined. Participation is on a voluntary basis Personal achievement Throughout one’s professional career Health care service providers (All pathology staff including MLS, medical professional, phlebotomists and paramedic aides) and users (clinicians and patients)
Not specified A range of learning activities Not specified Maintain and develop…. …retain their capacity to practice…… Not specified
To ensure that they retain……. Evolving scope of practice’ Throughout their career Not specified
38 Martin et al.: CPD for specialists in laboratory medicine within four European countries Table 3 Education of hospital laboratory staff within partner countries. Country
Laboratory staff
Education
Croatia
Master of Medical Biochemistry
Specialist of Medical Biochemistry and Laboratory Medicine
PhD degree in Pharmaceutical-Biomedical Sciences
Baccalaureate in Medical Laboratory Diagnostics
Laboratory technician
Medical associates
–U niversity education: 5 years’ study of medical biochemistry at the Faculty of Pharmacy and Biochemistry –1 -year program of supervised practical training in a laboratory –U niversity education: 5 years’ study of medical biochemistry at the Faculty of Pharmacy and Biochemistry –1 -year program of supervised practical training in laboratory – Specialisation in medical biochemistry and laboratory medicine (4 years) –P ostgraduate doctoral studies ‘Pharmaceutical-Biomedical Science’ –U niversity degree (Faculty of Pharmacy and Biochemistry) –G raduate studies achievement (grade point average 4.0, or references from two teachers; English language competence and computer literacy) –1 year of organised scientific or specialist postgraduate course –P reparation and defence of the PhD thesis –B achelor’s degree (Bacc.) – University of Applied Health Studies – 3 years’ professional study of medical laboratory diagnostics – 1-year program of supervised practical training in a laboratory – 4 years of a secondary school for laboratory technicians – 1-year program of supervised practical training in laboratory – University education: minimally 4 years’ study at a Faculty, such as the Faculty of Natural Science, which does not belong to the biomedical group of faculties at the University – MD degree professionals – 6 years MD plus 5 years’ specialisation
Czech Republic
Malta
UK
Specialists in different fields in laboratory medicine (clinical biochemists, hematologists, microbiologists) Specialist in laboratory medicine
Laboratory technician Pathologists Medical laboratory scientists
Paramedic aides and phlebotomists
Support staff (laboratory assistants) Consultant pathologists Clinical scientists
STPs
Biomedical scientists
Associate practitioner of biomedical science (APBMS)
Medical laboratory assistants (MLA)
– Non-MD University degree professionals – master degree 5 years plus 3–5 years’ specialisation – Bachelor degree 3 years plus possible specialisation – Must be MRCPath or equivalent – University graduates holding a BSc (EQF 6) or Diploma (EQF 5) in medical laboratory sciences – Many continue with their studies to obtain further qualifications, such as MSc or PhD – MCAST graduates, generally with BTEC (Applied Lab Sciences) or – Other related health care courses (EQF4) – Unskilled to semi-skilled work. Basic requirements – Minimally MRC Path (part 2) – HCPC registered – University graduates, usually with PhD (another MSc as part of in depth training) – Awarded by Association of Clinical Biochemistry and Laboratory Medicine – HCPC registered – Specific training programme (also includes another MSc) – HCPC registered – University graduates holding a HCPC verified BSc (or Higher National Diploma if already in post) in Biomedical Science. – Alternate route available assessed individually by HCPC – IBMS Certificate of Competence (other routes available) – Often MSc, professional (IBMS) qualification, occasional PhD/professional or thesis – Foundation degree in health sciences – BTEC National Diploma (Science) – NVQ Level 3 (laboratory science) or – Equivalent qualification (or higher) in a relevant science-based subject – Minimum of 5 GCSEs – May take IBMS Certificate of Achievement Part I or II
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Council of Open-ended Professions Complimentary to Medicine Health and Care 2 years Professions Council
No
Yes
Malta
UK
Croatian Chamber of 6 years Medical Biochemists
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A mixture of learning activities which are relevant to current or future practice are required. HCPC Standards for CPD state that a minimum of three different types of CPD must be included which must be continuous with no gaps of > 2/3 months
N/A
A maximum of 50% of CPD credits are allowed from one type of CPD activity 40 CPD points within 10 No requirement to undertake years different types of CPD
30 CPD credits within 6 years
N/A as CPD not N/A required for re-registration/ re-license The Health Professions Order 2001 Yes Amount of CPD not specified by law but must adhere to Health and Care Professions Council (HCPC) Standards for CPD (Professional body recommendation of 250 CPD points within 5 years)
Yes
Yes
Participation in Specified amount Requirement for different types CPD activities of CPD required for of CPD for re-registration/ required for re-registration/re-licence re-licence re-registration/ re-licence
Notice (105/2011) which stipulates the conditions under which competence of non-medical health care professionals is acquired and recognised Notice 4/2010 which defines the number of credits from each activity (e.g., passive or active attendance at conference, publication as first author or co-author, poster etc.) The Health Care Professions Act (2003)
Law on the Health Care (1993)
Period of Law governing re-registration/ validity for re-licence re-registration/ re-license
The Ministry 10 years of Health (for Biomedical scientists) The Czech Medical Chamber (for medical doctors)
Yes
Name of organisation granting re-registration/ re-license
Czech Yes Republic
Croatia
Country Is there a requirement for re-registration/ re-license
Table 4 Partner country requirements of continuing professional development for re-registration/re-license.
Martin et al.: CPD for specialists in laboratory medicine within four European countries 39
40 Martin et al.: CPD for specialists in laboratory medicine within four European countries (UK) to open-ended (Malta). In all partner countries (except Malta), there is a requirement for re-registration/ re-licensing (Table 4) with participation in CPD activities being a mandatory pre-requisite. Data in Table 4 also illustrates the amounts of CPD in terms of points which are required, along with an indication of criteria for inclusion of different types of CPD activities. Figure 1 illustrates the scores for each of the four spokes when the PARN CPD measurement model [11] is applied to the CPD schemes for each of the partner countries. Applying the PARN model measurement scale for Planning [11] to the CPD schemes of each of the countries, illustrated a range from a score of 2 (Malta) where ‘goals are set along with an associated assessment of need’, to a score of 3 (UK) where ‘a loose competency framework is implemented’, to a maximum score of 4+ where there is ‘a detailed competency framework with different areas for different types of competency, an online planner, incorporation of linking point allocation to different competencies and prioritization’ (Czech Republic) plus ‘individualization’ (Croatia). All four countries scored the maximum score of 1+ on the PARN model measurement scale for Action [11] which indicated that they all implemented a system which included ‘a record of hours plus evidence of attendance, a points system with different allocations for different types of activity along with evidence of participation.’ The PARN model measurement scores for Outcomes [11] ranged from a score of 2 (Malta) where the outcome is ‘assessed informally against the learning objectives to ascertain whether or not they have been met’ to a score of 4 (UK) where there is ‘objective scoring in combination with self-assessment’ to the maximum score of 4+ with ‘objective assessment methods’ (Croatia) plus ‘peer/client appraisal and mixed assessment techniques tailored for different aspects of CPD’ (Czech Republic). In contrast to Malta where reflection is not employed as a measure of the effectiveness of a CPD activity the PARN model measurement scores for Reflection [11] within the other three countries illustrated a score of 3 for Croatia where ‘group reflection’ is implemented to scores of 4 for both the Czech Republic and the UK where ‘question templates are used and the questions are linked to competencies.’
Discussion As there are a wide range of objectives, functions and scope for CPD [13], this study began by comparing the definitions of CPD which are used by the registration/ licencing bodies for specialists in laboratory medicine in
each of the four participating European countries (Table 2). Applying the nine components of definitions of CPD ‘in order to discern the purposes of CPD from its definition’ [12] it is clear that the definitions of CPD from the four countries place different emphasis on different components and purposes. The Croatian Chamber of Medical Biochemists [14] and the Czech Republic Ministry of Health [15] definitions of CPD have similar purposes as both focus on keeping up-to-date with new improvements, expertise and ensuring proficiency in novel techniques in an ever changing scientific arena. The definition of CPD used in Malta includes ensuring quality in practice and personal development and the HCPC definition used within the UK is similar as it encompasses the main purposes of maintaining both capacity and developing in the future as scope of practice changes [16]. Although it is interesting that only two definitions of CPD used within this study specified the range of beneficiaries of CPD, our results show similarity to another study which demonstrated that from 55 professional body definitions of CPD, only 10 definitions specified the range of beneficiaries of CPD [12]. Input models for participation in CPD involve measurement of the number of CPD hours along with a requirement for completion of a specified number of hours within a given time period [17]. CPD hours are usually expressed as CPD points where one CPD hour usually equates to one CPD point. While input systems provide a fairly easy way for professional bodies to monitor CPD compliance, they fail to recognise learning, effectiveness or impact as ‘simply attending a CPD credit-rated meeting will give you CPD points [18]’. However, an output model for participation in CPD involves a focus on the participant as a learner whose aim is to achieve set learning outcomes. Although an output system is more difficult for professional bodies to monitor it does provide for an ‘emphasis on recognising learning [18]’. While an input system records the amount of hours of CPD and an outputs system records the fact that reflection has taken place, it has been suggested that an outcomes approach is required in order to make a difference and to show that the CPD is having the desired impact on patients and the organisation [19]. Participating countries exhibited a spectrum of requirements with regard to the amount of CPD activity that is required for relicensing/continued registration. This ranged from CPD activity not being required (Malta) to input-based models with mandatory, precisely specified, numbers of CPD points per year (Croatia and Czech Republic) to an outcomes-based approach in the UK to ‘maintain a continuous, up-to-date and accurate record of their CPD activities.’ Croatia and the Czech Republic have similar requirements with regard to the amount of
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Martin et al.: CPD for specialists in laboratory medicine within four European countries 41
Country
Spoke of Comments and categories identified from reference Mean PDV [11] score
Croatia (Courses organised by the Croatian Chamber of Medical Biochemists)
Planning Goals set Assessment of needs Planned activities/timescale Detailed competency framework with different areas for type of competency or specific to certain roles Individualisation Linking point allocation to different competencies Action Record of hours + evidence of attendance Points system with different allocations for different types of activity Evidence of participation Outcomes Objective assessment methods Reflection Group reflection
4+
1+
4+ 3
Czech Republic Planning Detailed competency framework with different areas (Czech Society for type of competency or specific to certain roles for Clinical Online planner Biochemistry/ Linking point allocation to different competencies Charles Prioritisation University Action Record of hours + evidence of attendance Moodle system) Points system with different allocations for different types of activity Evidence of participation Outcomes Objective scoring in combination with selfassessment Objective assessment methods Peer/client appraisal Mixed assessment techniques tailored for different aspects of CPD Reflection Question templates Questions linked to competencies
4+
1+
4+
4
Planning Goals set and assessment of needs. Decision on the theme to be discussed during activity takes into account current local developments in health-related topics and their impact on laboratory practices. Planned activities/timescale. Planning of CPD activity starts approximately 6 months before to set the date/s, content of activity, target audience and potential speakers. Action Records of all activities are documented and attendance records are kept centrally. A certificate of attendance is awarded to participants based on the number of hours attended. Evidence of attendance takes the form of signed attendance sheets which are circulated during the activity Outcomes Effectiveness of activity is measured informally through feedback by participants. Feedback is collected either through questionnaires circulated after the activity or through informal discussions with participants Reflection The importance of reflection is still not considered as an essential measure of the effectiveness of a CPD activity.
2
Malta
1+
2
0
Figure 1 (Continued)
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42 Martin et al.: CPD for specialists in laboratory medicine within four European countries
Country
Spoke of Comments and categories identified from reference Mean PDV [11] score
UK Planning Example activities list and example evidence list (Health and Care Framework for assessing profile Professions Loose framework (see outcomes) Council) Example profiles Individualisation Action Record of activities (dates), description and evidence of participation Outcomes Demonstrate activities are a mixture of learning activities relevant to current or future practice. Seek to ensure CPD has contributed to the quality of their practice and service delivery Seek to ensure service user has benefitted Produce a written profile with supporting evidence to explain how standards have been met (on request 2.5% registrants 2 yearly) Reflection Produce a written profile with supporting evidence to explain how standards have been met (on request 2.5% registrants 2 yearly) Audit (as above) Questions linked to competencies but only 2.5% have to complete this
3
1+
4
Z
4
Figure 1 Applying the Professional Associations Research Network (PARN) CPD measurement model to the CPD schemes for each of the partner countries.
CPD that is necessary for relicensing/continued registration of medical laboratory staff. In Croatia the minimum requirement for CPD is the achievement of 30 credits within a 6-year period and in the Czech Republic 40 CPD points are required every 10 years. In the UK although an outcomes-based approach with no mandatory requirement for a certain number of CPD points to be achieved within a certain timeframe is in place, the HCPC does specify that CPD must be continuous [20] which is defined as one CPD activity every 2 months [21]. These requirements are in contrast to the current situation in Malta where although ‘it is highly recommended that every Medical Laboratory Scientist carries out Continuing Professional Development’ [22] there is no legal requirement for them to do so. With such a wide range of requirements for amounts of CPD required within participating countries, it was interesting to also note their different requirements for certain types of CPD to be carried out, particularly as an extensive array of activities are known to be acceptable for CPD requirements [23]. While the Czech Republic does not have any requirement to undertake different types of CPD, in some partner countries requirements for specific types of CPD are specified. In Croatia, a maximum of 50% of CPD credits are allowed from one type of CPD activity while in the UK many different types of CPD activities are acceptable, and there is
a stipulation that a minimum of three different types of CPD must be included with registrants ‘demonstrating that their CPD activities are a mixture of learning activities which are relevant to current or future practice [16]’. Partner countries differed in the criteria which were required to be met for a CPD activity to be acceptable for registration/license. In Croatia in order to satisfy the regulatory body, the requirements for a Chamber’s CPD activity are that it must be: relevant; have a duration of between 6 and 10 h, include written working materials, have a written exam plus a course evaluation. The Croatian Chamber of Medical Biochemists also carry out approval and creditation of other CPD activities and in order to satisfy the regulations, the proposed CPD activity must be relevant and demonstrate objective evidence. Similarly, in the Czech Republic there are also several requirements that must be met in order for a CPD activity to be acceptable and these include the activity being registered with the Professional body beforehand, being allocated a unique CPD number, including at least one lecture, having a defined professional guarantor for the activity, the number of awarded points being related to the duration of the activity, and participants being awarded a certificate of attendance with active participants and co-authors receiving a higher number of points. The requirements for CPD activities
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Martin et al.: CPD for specialists in laboratory medicine within four European countries 43
within Croatia specify that there is a requirement for the course to last between 6 and 10 h and to conclude with a written test. In the UK, in order to meet the HCPC requirements for CPD, there is no requirement for a specialist in laboratory medicine’s CPD activities to have met any formal accreditation criteria as the onus is on the registrant to ‘seek to ensure that their CPD has contributed to the quality of their practice and service delivery’ [16] rather than, as is the case in most of the other partner countries, the onus being on the CPD provider. As participation in CPD is not a mandatory requirement for relicensing/continued registration of specialists in laboratory medicine in Malta, CPD activities are not therefore required to meet specified accreditation criteria associated with registration/licence as is the case in Croatia and the Czech Republic. We wished to not only compare each of the four country’s requirements for participation, amounts and different types of CPD but also to investigate if their registration/licensing bodies took into account associations between CPD and competence. There is much debate in the literature regarding how CPD is related to competence plus its perceived benefits within the clinical setting. While some health professionals including career grade doctors [24], consultant doctors [25] and physiotherapists [26] perceive that their CPD results in changes which impact positively on their clinical practice, there is no evidence to show the impact of CPD on dentists [27] competence or that specialist nurses [28] had actually taken part in CPD that would be appropriate for their extended roles. Models have been developed to address this issue including the Allied Health Professions Project which piloted an outcomes model aimed at facilitating professionals being able to demonstrate links between their CPD and competence [19]. A further model for CPD measurement was developed involving identification of professionalism in the form of a ‘Professional Development Value (PDV)’ in order to specifically measure how well CPD has achieved its aims [11]. This innovative design uses a wheel framework based on the CPD cycle [29] with spokes for planning, action, outcomes and reflection. Applying this PARN model to the CPD requirements of registration/licencing bodies from participating countries allowed a ‘picture of the CPD measurement system as a whole’ [11] to be viewed and compared to others. Profiles showed that because the system in Malta does not recognise the importance of reflection as a measure of CPD effectiveness, the CPD profile for Malta was a mirror image of the CPD profile for the other countries. The
remaining three countries (Croatia, Czech Republic and UK) had similar CPD profiles which emphasised high scores for planning, outcomes and reflection. These profiles are similar to four case studies within the medical sector where it is recognised that because professionals must maintain competence it is necessary to have robust systems in place for measuring CPD, assessing CPD outcomes and auditing CPD procedures to make certain that professionals retain their continued competence [11]. However, there is still difficulty in relating CPD to competence as illustrated in UK by the simple statement by the HCPC [20] that ‘there is no automatic link between your CPD and your competence’ with further acknowledgement by the HCPC [20] that ‘it would be possible (although unlikely) for a competent professional not to undertake any CPD and yet still meet our standards for their skills and knowledge. Equally, it would be possible for a registrant who was not competent to complete a lot of CPD activities but still not be fit to practise’. Although the HCPC cites these two extreme examples as they state for most specialists in laboratory medicine ‘it is assumed that their CPD activities will be related to their competence.’ Our results demonstrate important similarities and differences in both CPD requirements and CPD profiles for specialists in laboratory medicine within the four participating European countries which would need to be taken into consideration if European harmonisation of CPD is to be achieved. In addition, the essential link between CPD and competence remains an area for further investigation and improvement in order to enhance the role of laboratory medicine in delivering quality service and excellent patient care. Acknowledgments: This research was funded by a Leonardo Partnership [30] Grant from the European Union Lifelong Learning Programme [31] – Leonardo Grant Number LdVP/13/006C ‘Enhancing Hospital Laboratory Standards for Continuing Professional Development: A Quality Improvement Toolkit’. Author’s contribution: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission. Financial support: None declared. Employment or leadership: None declared. Honorarium: None declared. Role of sponsor: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
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44 Martin et al.: CPD for specialists in laboratory medicine within four European countries
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