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Recognising professional development...

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01 May 2009, at 12:00am

Jeremy Johnson wonders whether mandatory CPD is really necessary for the profession.

Of late I have become fond of saying to people that it’s not training that develops people, but responsibility. Scanning a recent copy of a publication for veterinary nurses, I stumbled across a short piece about VNs and recording CPD.

 Apparently there are concerns about compliance among “…locum nurses, those who were non-clinical but still on the register … those working in pharmaceutical companies”. And my thoughts are: how do we know they don’t do any and why are we concerned? And if they care enough to remain on the register despite pursuing “nonclinical” or other jobs, surely that’s a good thing and something that should not be discouraged? 

I know someone who decided not to register as a RVN, but remain a LVN as she could not see the benefit. She is capable, articulate, has a lot of management responsibility compared to the average VN and is developing accordingly. And I know that she undertakes CPD relevant to her role.

 Having listened to her talk about what she does in her day-to-day job, I also suspect that one of the areas she could benefit from would be to train as a SQP. That, of course, would not mean that she would necessarily need to register as a RVN or record CPD as a RVN, although studying for the SQP qualification would qualify as CPD. She could do it if she wanted to, but there would be little point as she could do no more as a LVN registered as a SQP, than she could as a RVN.

 I often wonder whether we just follow the medical professions in the belief that what they do must be right. Perhaps we make the assumption that they have already fixed their problems, or have the evidence to say their prescriptions will work, before we have even pinned down the source of our own malady, or identified just how many of us are afflicted by it.

 I know, as I have discussed it with a senior officer of the RCVS, that the intentions behind the discussions around possible mandatory CPD for vets are good. Whilst an infrequent occurrence, there are situations when the College has to deal with a complaint against a member who has both done something negligent and never done any demonstrable CPD.

 We also recognise that the College has a duty to regulate veterinary surgery. And yet, would mandatory CPD fix this particular problem? And is it a proportionate fix given that the majority of members are “not guilty of negligence m’lud”? 

What problem are we trying to fix? 

I asked another senior officer of the College a couple of years ago what proportion of complaints received were due to communication problems rather than, for example, negligence and the answer went along the lines of, “There is an element of miscommunication in most of them.” 

I know that further analysis is being done but that no detail is available yet. So, right now, if the cause of the complaint was simply that the client did not know that the damaged cat’s tail was to be amputated completely, rather than just the tip removed, because this had not been explained, of what relevance is it if a member who is the subject of the complaint has undertaken 35 hours of CPD in advanced orthopaedics? 

There are some parallels between working in pharmacovigilance, i.e. monitoring suspected adverse reactions to drugs, and working for the RCVS. Providing just technical support, “riding shotgun” for a product, can give you a biased view unless you also look at sales numbers. If you’ve just seen your tenth adverse reaction during a given period, it helps if everybody knows that there were ten million animals treated over the period in question to put things in perspective.

 Yet, if a pattern of adverse events does emerge that necessitates a change in the recommendations in the SPC or with the packaging, it’s also good to be able to share the numbers with others so that everyone buys into the solution. And perhaps that’s how it should be with complaints to the College, accepting that we need to wait patiently for the detailed analyses to be done before we leap to any conclusions – diagnosis takes time.

 So in the post-Shipman world I personally accept that some inspection of practice premises is inevitable if we want to continue to use controlled drugs without being obliged to get them from pharmacies (not an impossibility).

 And yet what condition is the “prescription” mandatory CPD supposed to fix either for MsRCVS or RVNs? What’s the prevalence and what alternative remedies might be more effective? If somebody came to you and said “My dog is scratching”, would you say, “Your dog needs a shampoo”? Or would you first take a look at the problem and attempt a diagnosis, applying appropriate diagnostic tests and analyses? 

Those familiar with the HACCP (hazard analysis critical control point) principle in manufacturing will also recognise the value of not trying to fix everything, but of focusing resources on the area presenting the greatest risk. So even if you believe it’s a good fix for something, is mandatory CPD for all members proportionate? And how will that be demonstrated to those of us that vote in RCVS elections, so that we can confidently get behind the treatment programme.

 In this January’s Pharmaceutical Journal there was a study looking at Community Pharmacist’s attitudes to CPD during 2002 and 2004, who were then obliged to participate in CE (continuing education) or CPD. The RPSGB has defined the aim of CPD as “to provide a means for the profession to reassure the public that pharmacists maintain and enhance their capabilities…”. So it’s about reassuring the public then. CPD, as opposed to CE, was defined as a cycle of: 

  • identify learning needs, 
  • planning learning activities, 
  • evaluating learning outcomes, and 
  • anticipating changes to professional development requirements.

 There are degrees of compulsion and by now for pharmacists CPD has drifted from advisory to compulsory, and will reach mandatory from October 2009, nudging out its little sister CE on the way. “Mandatory” does have a tendency to creep in if regulators are committed to it, with or without evidence for its efficacy.

 Yet the findings of this study, whilst interesting, were almost as woolly as the objectives. Feeling disillusioned with Community Pharmacy was a common finding and the paper refers to other studies in the sector suggesting that “a lack of relevant learning opportunities” may have prevented pharmacists’ engagement. Yet few hard conclusions were drawn other than a few pointers towards lack of motivation, time and uncertainty about what CPD involves.

 And as I read it I think, full marks for asking some of your members but you certainly haven’t proven yet that mandatory CPD fixed your problem. And as for your objective, if we went out to the public and said, “Are you reassured that the pharmacy profession has made CPD mandatory?”, what proportion of the public would just say, “What’s CPD … and what does mandatory mean?” 

Reassurance 

Maybe the public is reassured by other things, or maybe if having looked we then find a problem, another prescription would be a more appropriate treatment, and more efficient use of resources. What this treatment is must surely depend on prior clinical examination and diagnosis.

 When I left vet school, what was explained to me was that CPD is a bit like the Highway Code: it’s not law, but if you get into trouble they’ll look at whether you read and followed what was in the Highway Code to see if you were at least attempting to toe the line. This is a pragmatic and flexible approach for a profession that has to adapt to an environment that is far more unstable and uncertain than the NHS, and serves a more diverse customer base. The article in the veterinary nursing journal adopts a pragmatic view in the sense that it states that these records will only be looked at if there’s a problem, yet at the same time it talks of “compulsory CPD”.

 Before we perhaps drift from advisory to compulsory and beyond, dragging the veterinary nursing profession down the path of mandatory CPD as we go, maybe we could first shine a light on that path. And I don’t know but maybe if we recognised that RVNs are responsible, registered and qualified persons – RQPs – that they are at least as well trained as SQPs, and made it clear somehow that RVNs can operate as SQPs without registering separately with AMTRA, then maybe more LVNs would see that this registration might open up other doors in the future.

 And perhaps they would then voluntarily say to themselves, “Now I’m getting some recognition and I see the point in doing a bit more CPD.”