1. Have countries changed or adapted their CE or CPD systems to improve content or learning methods, and how have they dealt with pharmaceutical support for CE?

  2. What can the United States learn from the experiences of other countries?

The literature search, performed in December 2008, included the EBSCO, OVID, Academic Search Premier, and Medline databases. Keywords included continuing professional development, European learning, international, continuing education, nursing, pharmacy, medicine/medical, dental/dentistry, accreditation, revalidation, and competence. This review indicates requirements for training, types of training, and the mechanisms by which the requirements are enforced. However, much about the effectiveness of many of these models remains unknown.

The diverse definitions and terminologies associated with CE and CPD systems complicate comparative analyses. While CE credits or hours are the currency by which regulatory bodies often assess competence, these regulatory bodies have a myriad of purposes and synonyms, including licensure, certification, credentialing, and revalidation. For example, Merkur and colleagues (2008a) define revalidation as aiming to “demonstrate that the competence of doctors is acceptable.” These regulatory processes may include periodic application forms, fees, and required participation in activities, such as CE, CPD, and peer assessment, to maintain and improve competence.

Just as CE requirements within professions vary by state in the United States, Canadian licensing bodies, for example, which differ between jurisdictions of practice (i.e., provinces, territories), do not agree on requirements for CE and CPD as part of their processes for ensuring the competence of health professionals. The degree of inclusion of CE credits in revalidation and relicensure systems varies between and within countries.

In the early 1990s, Australia, Canada, and the United Kingdom gradually shifted from CE to CPD. Whereas CE serves to update and reinforce knowledge (e.g., management of heart attacks, how to diagnose HIV), CPD deals with personal, communication, managerial, and team-building skills in addition to content (Merkur et al., 2008a; Peck et al., 2000). Limitations in the traditional methods of CE (e.g., educational courses, lectures) led to the development of the more self-directed and self-reflective approach, which is believed to encourage lifelong learning and better meet the educational needs of health professionals (Evans et al., 2002). For example, in 1997 the government of the United Kingdom stressed the role of CPD in



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