The General Dental Council (GDC)

4 1. Executive summary Executive summary Executive summaryExecutive summary Executive summary Executive summary Executive summary Introduction The General Dental Council (GDC) is currently undertaking a review of mandatory Continuing Professional Development (CPD) requirements for all its registrants. As part of this exercise, it commissioned a literature review to investigate the impact of CPD activity on individual practice and competence assurance of the professions it regulates. The overall aim of the literature review was to establish what evidence exists to demonstrate the range of likely positive and optimum impact of CPD upon the practice of dental professionals. The literature review addressed seven questions posed by the GDC under the themes of: models of CPD, regulatory purposes of CPD, CPD participation and CPD and performance. The questions were: Models of CPD 1. What are the least and most effective modes of CPD for the healthcare professions, and in particular dentistry? 2. What are the least and most effective qualitative and quantitative measures of CPD activity for the healthcare professions, and in particular dentistry? Regulatory purposes of CPD 3. What are the regulatory benefits of CPD participation in dentistry? 4. What are the regulatory purposes of making CPD a mandatory requirement in healthcare professional regulation? CPD participation 5. How do healthcare professionals, and in particular dental professionals, currently engage with, perceive and benefit from CPD; and does CPD have particular consequences for different groups and forms of practice in dentistry? CPD and performance 6. Is CPD participation a valid indicator of professional competence or performance? Based on what criteria? 7. Is there a link between participation in CPD activity and performance enhancement in the healthcare professions including dentistry, and how is that formed? Research Methods As there had been no previous comprehensive review of the literature, evidence for dental CPD was obtained by interrogating electronic databases for papers from peer reviewed journals, using a wide range of search terms. The search terms for the seven research questions were developed and agreed by the GDC, a comprehensive search of the literature on CPD for dental registrants and for other healthcare professions was performed, and the resulting evidence was synthesised. There had previously been several systematic reviews and reports on CPD for other healthcare professionals. These were identified and analysed for further information to answer the seven questions. A range of organisations and academics, with an administrative or research interest in CPD, were then contacted to identify any reports or other literature on CPD that were not listed on electronic databases. 5 These activities commenced on 15 August 2011, an interim report was submitted to the GDC on 22 September, a draft final report was submitted on 17 October 2011 and the final report on 24 October 2011. Weekly telephone or face-to-face progress and review meetings were held throughout the review between the GDC and the research team. Analysis of the Literature 94 relevant papers were identified for the purposes of this review. The initial database search located 3,779 papers on dental CPD. After applying exclusion criteria, 140 abstracts were reviewed and narrowed down to a final total of 94. Relevant information from these papers was captured on a standardised template. The papers were graded for the scientific quality of their methodologies using the criteria of the National Health Service Research and Development Centre for Evidence-Based Medicine, as set out in Table One, page 11 of the report. Only one paper was graded as 1 (highest Grade) and six as Grade 2. A number of the papers contained information relevant to more than one of the seven questions. None of the papers on dental CPD provided answers to the questions relating to CPD and its effect on performance and only two provided insights into the questions on the regulatory aspects of CPD. However, there were 55 papers that provided information on models of CPD and 54 on CPD participation. The information from the 94 relevant papers and from the analysis of systematic reviews and reports of CPD for other health care professions was then used to address the seven questions. Definition of CPD The definition of CPD that has been adopted in this report is that used in the CPD guidance issued by the GDC, namely “study, training, courses, seminars, reading and other activities undertaken by a dentist or dental professional, which could reasonably be expected to advance their professional development, as a dentist or dental professional” (GDC 2011). Outcomes The review of literature on CPD, for both dental and other healthcare professions, produced few robust evidence-based answers to the seven questions posed by the GDC. This was perhaps unsurprising as numerous authors have commented on the difficulties of conducting robust research into educational outcomes (Bloom, 2005, Marinopoulos et al. 2007, Schostak et al. 2010, Grant 2011). It was not the purpose of this review to analyse these difficulties. However, they should be borne in mind when considering the conclusions, set out below, which address each of the seven questions posed by the GDC. Models of CPD Question 1. What are the least and most effective modes of CPD for the healthcare professions, and in particular dentistry? No studies of high quality (Grade 1 – systematic review(s) or Grade 2 – Randomised Controlled Trials (RCTs) )existed to demonstrate the effectiveness of CPD, in terms of quality of care delivered, performance, professional standards, competence, public satisfaction or safety, or their longer-term effects on knowledge retention and application. However, particular elements of individual CPD programmes including sustained, repeated, or longer term CPD activities, involving an interactive method of delivery utilising multimedia, or combining techniques, for example, interactive education were found to be effective. The importance of planning, self directed learning and reflective 6 practice for effective CPD was highlighted in the literature, as were the perceived benefits of personal learning plans and reflection to help clinicians to identify and take part in appropriate CPD. Question 2. What are the least and most effective qualitative and quantitative measures of CPD activity for the healthcare professions, and in particular dentistry? The Pharmaceutical Society of Ireland (PSI) highlighted the benefits of blended learning using a mixture of online and face-to-face activities and an online portfolio to allow a flexible approach that focuses on outcomes relevant to an individual practitioner’s practice (PSI 2010). The clearest advice with regard to qualitative and quantitative measures of CPD came from this report where authors suggested that all Irish Pharmacists should be required to record a balance of different CPD activities in a portfolio accompanied by a robust external competency assessment which should be developed by peers and recreate “patient facing scenarios” (PSI 2010). It has been suggested that hours accumulated from activities involving active and targeted participation, which have been shown to be more effective than passive learning, should attract more credits (Bloom 2005). However, both Schostak (2010) and Grant (2011) have described the weakness of using inputs, such as hours of CPD completed to measure CPD. Freidman and Woodhead (2008) have suggested that an output approach that attempts “to measure what CPD is intended to achieve directly” and enables individual professionals to monitor their own progress may be better. However, overall, both the dental and non-dental literature demonstrated the difficulties in developing effective and evidence-based recommendations for quantitative or qualitative measures of CPD. At present it is not possible to draw firm generalisable conclusions to answer question 2. Regulatory purposes of CPD Question 3. What are the regulatory benefits of CPD participation in dentistry? The literature identified a range of potential regulatory benefits of participation in CPD. These encompass assuring activity levels and competency, satisfying public expectations, keeping abreast of advances in patient care and as a registration instrument. The literature did not reveal any studies that demonstrated benefits relating to regulatory purposes of CPD participation in terms of improved quality of care delivered, performance, professional standards, competence, public satisfaction or safety. Question 4. What are the regulatory purposes of making CPD a mandatory requirement in healthcare professional regulation? The peer reviewed dental literature did not reveal any studies that demonstrated the regulatory purposes of making CPD a mandatory requirement in healthcare professional regulation. However, the GDC website (GDC 2011) reminds registrants that: “Patients are right to expect that all members of the dental team are keeping their skills and knowledge up to date throughout their careers. We ensure that this is happening by making CPD a requirement for all dental professionals registered with us.” Information from other healthcare sectors focussed on the role of CPD in maintaining and demonstrating professional standards and competency to the public. They include: helping to improve the safety and quality of care provided for patients and the public, maintaining skills and knowledge and reflecting on the standards of practice.