ensuring quality and encouraged professional bodies to strengthen systems for self-regulation and lifelong learning (UK Department of Health, 1997). This process of CPD, defined by Davis and colleagues as an “umbrella for all sorts of interventions,” including CE, ties learning more closely to practice (Davis et al., 2003, p. 11). Compared to CE, which is frequently based on acquiring credits, CPD relies on processes of self-accreditation and reflection via personal portfolios.


In a series of articles in the British Medical Journal exploring how the United States can improve its health care system, Quam and Smith (2005) argue the United States could improve its continuing medical education (CME) system by more closely mirroring the United Kingdom’s guidelines for CPD. A brief historical survey provides the background in which CE systems can adapt and change based on international models presented in Table C-1.

Although methods of CE are continually evolving around the world, CE models may be classified into two distinct categories: the learning model, seeking to improve clinical competence, and the assessment model that emphasizes both performance and competence (Merkur et al., 2008a). These CE models are presented in Table C-2. The majority of countries use the learning model only. While some countries (e.g., Austria, France, the Netherlands, United Kingdom) screen all physicians for competence, no countries included in the 2008 comparative survey used more selected, targeted screenings to ensure competence.

Maintenance of Certification in Canada

Through the latter half of the twentieth century, Canadian concepts of CME developed alongside those in the United States until patient advocacy, government regulation, and an increase in medical knowledge led the Royal College of Physicians and Surgeons of Canada (RCPSC) to explore new frameworks for continued competency. The framework, known as CanMEDS, was adopted in 1996 and outlines essential physician competencies with the aim of improving patient care. A program of mandatory professional development, called the Maintenance of Certification (MOC) program was mandated by the RCPSC beginning in 2000 (Royal College of Physicians and Surgeons of Canada, 2008). At this time, fellows of the college

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