The Benefit of Continuing Professional Development for Continuing Pharmacy Education

As the health care environment undergoes rapid transformation, increasing costs paired with technological advancements have highlighted the need for value-based health care services and innovative models of delivery. Simultaneously, the role of the pharmacist is undergoing transformation. Pharmacy graduates are now expected to be able to engage in direct patient care roles via collaborative practice, perform comprehensive medication management, and provide preventive care services. Further, the tenets of pharmacy education, while including preparing and dispensing of product, now extend to all-encompassing pharmaceutical care responsibilities. With these transformations, expectations for ensuring competence have grown.1 To meet these and future challenges, pharmacists must be prepared for continuous learning and growth after earning their doctor of pharmacy degree. Unfortunately, the current continuing education (CE) system does not encourage intentional, individualized plans and may need to be reconstructed to meet the needs of today’s practitioners.2,3 Integrating continuing professional development into the current continuing education structure could transform continuing education into a vehicle that advances both the professional’s practice and the greater health care system. Continuing pharmacy education (CPE) has served as the standard for maintaining professional competence for over 40 years in the United States. Defined by the Accreditation Council for Pharmacy Education (ACPE), CPE is a “structured educational activity designed or intended to support the continuing development of pharmacists and/or pharmacy technicians to maintain and enhance their competence.”4 All 50 state boards of pharmacy, the District of Columbia, Guam, and Puerto Rico require CPE hours as a prerequisite for re-licensure.5 Although specific CPE requirements vary from state to state, the majority of state boards of pharmacy (43 states) require either 15 contact hours [1.5 continuing education units (CEUs)] annually or 30 contact hours (3 CEUs) biennially.5 Twenty-three states specifically require “live” CPE hours, and 17 state boards require specific CPE topics such as law, patient safety, immunizations, HIV, or pain management.5 From a regulatory standpoint, completing the hours-based CPE requirements by definition equals competency. Researchers have debated the impact of continuing education in the health professions in the literature for decades.6 The debate centers around the question, “Does participation in continuing education enable the learner to enhance their practice and ultimately improve health care outcomes?”7 The prevailing evidence suggests the answer to this question is both “yes” and “it’s complicated.” Between 1977 and 2014, 39 systematic reviews were published on the impact of continuing medical education (CME).8 These reviews have consistently demonstrated that CME more reliably impacts provider knowledge and performance versus patient outcomes.8 Further, traditional CE activities (conferences, symposia, lectures) improve participant knowledge but generally have a very limited effect on improving clinician practice and patient outcomes.8 Examples of published practice improvements include screening practices, prescribing, and adhering to guideline measurements. Patient outcome measurements include a broad array of clinical endpoints such as smoking cessation, diet, or blood pressure in patients with hypertension, to name a few.8,9 Specific to the pharmacy profession, studies analyzing individual CPE activities have generally, although not exclusively, shown positive effects on behaviors or patient outcomes,10-16 and one systematic review cited the effectiveness of the majority of CPE programs based on their reported outcomes measures, most often knowledge or skill modification.17 Given the frequency of evidence supporting continuing education outcomes, the ultimate CE research question is not “Is CE effective?” but rather “What kinds of CE are effective?”18 Learning activities that are interactive, use multiple delivery methods (case-based learning, demonstrations, feedback, simulations or patient roleplay), involve multiple exposures, and focus on outcomes considered important by the learner lead to more positive outcomes.18 Other factors that affect performance include audience/room size, shorter versus longer sessions, and complexity of intended behavior.8 ACPE classifies accredited CPE activities as one of three types: knowledge-based, application-based, and practice-based.4 In 2015, almost 90% of the 29,661 CPE activities offered by providers were knowledge-based activities or programs designed for participants to acquire factual knowledge as defined by ACPE CPE standards.4,19 Herein lies perhaps one of the major challenges facing continuing education: the overwhelming majority of activities are knowledge-based programs designed to improve a learner’s knowledge of facts when growing expectations from employers, regulators, and payers call for documented improvements in outcomes. Thus, how can one advance one’s practice in a system dominated by activities designed to improve knowledge? One model that has been proposed to aid learners in achieving goals through education is the Continuing Professional Development (CPD) approach. The CPD Approach ACPE defines CPD as an ongoing, self-directed, structured, outcomes-focused learning cycle focused on maintaining and improving performance of professional practice.20 CPD does not replace CE, but rather enhances CE in a broader approach ensuring pharmacist competence and performance and patient health outcomes.1 CPD exists as a cyclical learning process (Figure 1) where the learner reflects, plans, learns, evaluates, and applies. The determination of learning experience is based on assessment of needs and goals. Central to each step in the cycle is a personal learning portfolio where learners record self-evaluations.20 Open in a separate window Figure 1. The CPD Cycle