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Redesigning Continuing Education in the Health Professions Appendix D Continuing Education in Professional Fields Outside of Health Care Ongoing professional training is part of the development of high quality professionals and is necessary for complex technical professions. To understand the challenges and opportunities facing continuing education (CE) in the health professions, it may be useful to examine professional development activities in other fields. Accountants, engineers, lawyers, commercial pilots, teachers, and the workforces of many other fields also have an ongoing need to improve their skills and stay competent to perform at high levels, spurring the advancement of continuing education activities in these fields. Some are more advanced in CE while others are in their infancy. Although the content of CE in these fields may be quite different from CE in the health professions, their efforts can provide useful and instructive perspectives on CE for health care. In fields outside of the health professions, “professional development” is commonly used as a term to encompass activities analogous to CE. However, it is important to recognize that professional development is commonly defined as the entire process by which professionals learn and maintain their competence (e.g., undergraduate and graduate school), whereas CE is limited to the sum of the training activities a professional has taken part in over the course of his career. This appendix reviews the professional development of select professions. The health professions can glean many lessons from other professions, as well as share their best practices. In particular,
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Redesigning Continuing Education in the Health Professions the ways in which CE is regulated, conducted, and financed are examined. CONTINUING EDUCATION FOR ACCOUNTANTS Certified public accountants (CPAs) are, by virtue of their title, certified and licensed by state boards of accountancy. After initial certification, CPAs in 52 of 54 U.S. jurisdictions must meet continuing professional education (CPE) requirements to maintain their licenses.1 To provide a uniform approach to regulating the accounting profession, the American Institute of Certified Public Accountants (AICPA) and the National Association of State Boards of Accountancy (NASBA) publish Uniform Accountability Act rules that include a requirement for 120 hours of CPE every 3 years (AICPA and NASBA, 2007). Although each state determines its own CPE requirements, all jurisdictions require either 40 hours each year, 80 hours each 2-year period, or 120 hours each 3-year period, with a minimum of 20 hours in each year (VanZante and Fritzsch, 2006). Methods of CPE for CPAs are generally limited to self-study, either interactive (e.g., CD-ROM programs, web-based self-study) or noninteractive (e.g., journal reading), or live activities ranging from webinars to lectures and conferences. The National Registry of Continuing Professional Education Sponsors recognizes CPE providers that offer programs in accordance with nationally recognized standards (NASBA, 2009), while individual state boards of accountancy recognize providers from which CPAs can receive CPE credits for license renewal. Recent accounting scandals have highlighted the importance of ethics in accounting (Mele, 2005). In line with this, some states, including New York and Texas, require CPAs to take some level of CPE related to ethics. Other states have specific requirements for individuals who perform tasks such as attest or auditing services (VanZante and Fritzsch, 2006), and the federal government has content-specific standards for CPAs’ performing auditing work (GAO, 2005). The price of courses and webinars, among others, generally varies based on the technicality of the program’s content, the number of credit hours earned, and the provider. A typical 8-hour course offered by a professional association (e.g., Pennsylvania Institute of CPAs, California Society of CPAs) averages between $200 and $300, while a 1-hour webinar generally costs between $40 and $100. 1 Wisconsin and the U.S. Virgin Islands do not have CE requirements for license renewal (VanZante and Fritzsch, 2006).
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Redesigning Continuing Education in the Health Professions For CPAs in many national firms or working in business or industry, the costs of CPE are usually borne by the CPA’s employer, whereas some solo practitioners and some employees of local and regional firms pay for CPE out of pocket.2 The AICPA-NASBA Uniform Accountability Act also stipulates that CPAs are not required to submit documentation of every CPE course they have attended; rather, they are required to sign a statement indicating their compliance with state requirements (AICPA and NASBA, 2007). Some states have instituted random verification to ensure compliance; the Pennsylvania State Board of Accountancy, for example, verifies 10 percent of renewal applications. CONTINUING EDUCATION FOR ENGINEERS With a need for lifelong education to stay up to date in the many rapidly evolving fields of engineering, CE is becoming an increasingly important, standardized method of ensuring professional competence. CE in engineering resembles CE in the health professions both in the formats through which it is offered and in the overall goal of competence. The National Council of Examiners for Engineering and Surveying (NCEES) uses the term “continuing professional competency” to discuss CE. Although continuing professional competency requirements are mandated at the state level, as of June 2008, NCEES requires at least 15 professional development hours per year for licensure (NCEES, 2008). In engineering, professional development hours are the common currency for CE (continuing education units are also used but refer only to continuing education and training). Licensure requirements vary by state, type of engineering, and licensing body and therefore do not follow a uniform standard. However, licensure is not necessary for practice but may be required for certain jobs and areas of engineering. State requirements vary from no mandatory CE hours to 20 mandatory CE hours per year to maintain licensure (CSI Construction Education Network, 2008). Certification is awarded by area of engineering and generally needs to be continuously updated. Professional development hours can be earned by successful completion of college or continuing education courses, completing short courses or tutorials such as those offered by distance education, giving presentations at meetings or workshops, teaching or 2 Personal communication, Patricia McFadden, Pennsylvania Institute of Certified Public Accountants, June 18, 2009.
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Redesigning Continuing Education in the Health Professions instruction, authoring published articles or books, writing licensing exam items, actively participating in professional or technical societies, or completing patents. Some states hold the authority to approve courses offering professional development hours, whereas others do not. The number of professional development hours awarded varies by activity. Engineers are required to record their professional development hours using standard forms submitted to licensing bodies, and the NCEES encourages random audits of CE completion to ensure that reported CE activities are verifiable (NCEES, 2008). Those failing to meet requirements could face revocation of license, suspension, limitations on licensure, fines, and/or continuing education. Continuing professional competency activities are most often paid for or reimbursed by employers. CONTINUING EDUCATION FOR PILOTS The federal pilot certificate does not expire, but to maintain certain flying privileges, pilots are required to abide by specific regulations set forth by the Federal Aviation Administration (FAA). Much like other professions that require CE or continuing professional development (CPD), the FAA requires pilots to have “recent flight experience” before carrying passengers or acting as the pilot in command of an aircraft requiring more than one pilot. For example, a pilot must have made at least three takeoffs and three landings within the preceding 90 days if the intended flight is with passengers or the pilot is in command. If the intended flight is occurring at night, these takeoffs and landings must have been made at night.3 To maintain instrument flying privileges, a pilot must, among other things, have accomplished six instrument approaches within the 6 months before making an instrument flight. Otherwise, the pilot must undergo an instrument proficiency check with a flight instructor. Even to fly solo, pilots must undergo a flight review every 2 years, which consists of an hour of flight training and an hour of ground training with a flight instructor. The flight portion consists of maneuvers and procedures that, at the discretion of the flight instructor, demonstrate the pilot can safely exercise the privileges of the pilot certificate. The ground portion consists of reviewing current general operating and flight rules. It is the pilot’s responsibility to document proof of flight experience, such as takeoffs and landings within 90 days, in a pilot log- 3 Electronic Code of Federal Regulations. Title 14 Part 61 § 61.57, June 29, 2009.
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Redesigning Continuing Education in the Health Professions book, for example. Flight instructors also make entries in the pilot logbook. The FAA periodically conducts “ramp checks” at airports, where it can ask to see a pilot’s certificates and logbook entries. Companies that employ pilots, such as commercial airlines, may also require pilots to complete training as part of job requirements in addition to FAA-mandated training. Other types of training opportunities exist through traditional classroom training, distance learning, computer-based training, web-based professional networks, and simulations. Simulations are a means to provide pilots with training during adverse conditions and/or to learn new flight techniques while not actually in flight. This training is provided through aviation training companies, such as FlightSafety International, and business aviation associations, such as the International Business Aviation Council. The U.S. military also provides training opportunities. Costs for both mandatory and additional training are incurred by pilots if flying privately or by their employers. CONTINUING LEGAL EDUCATION The legal profession has adopted continuing legal education (CLE) as a way to maintain the highest standards for the profession in the midst of constant changes in professional knowledge and to ensure public trust in lawyers. Requirements for CLE are set by individual states and vary from 10 to 15 CLE credits per year, on average (ABA, 2009). In 2001, the American Bar Association (ABA, 2001) issued the ABA Model Rule for Continuing Legal Education, a guideline document for states to follow as they implement regulatory structures of their own for CLE.4 The rule describes a structure that would regulate CLE through CLE committees appointed by state supreme courts. CLE committees should include at least one layperson and would be made up entirely of members appointed by state supreme courts (or state bars in states with a unified bar). The CLE requirements apply to all active lawyers; however, the details of individual regulations vary from state to state, and therefore certain approved activities or exceptions to the requirement cannot be considered universal or completely consistent with the ABA Model Rule.5 Approved activities for CLE include self-study, teaching, writing 4 ABA Model Rule for Continuing Legal Education with Comments, http://www.abanet.org/cle/ammodel.html. 5 Personal communication, C. Dan Levering, Pennsylvania Continuing Legal Education Board, July 14, 2009.
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Redesigning Continuing Education in the Health Professions publications, computer-based educational activities, and in-office law firm CLE. Although states vary in terms of how they assess completion of CLE among lawyers, many require that all active lawyers submit records of their CLE completion every year on a particular date. Although there are generous grace periods for submission, after these extensions expire without proof of CLE completion, state supreme courts may revoke a lawyer’s license to practice. The delinquency must then be corrected, and a reinstatement fee of $150 to $500 must be paid. The ABA Model Rule describes CLE sponsor (analogous to “provider”) approval as well. Sponsors apply to their respective CLE committees for accreditation. Approved sponsors may be ABA-accredited law schools or organizations engaged in CLE that, during the 3 years immediately before application, have sponsored six activities that comply with CLE content requirements. The ABA rule stipulates that CLE activities must be of intellectual or practical content and, where possible, include a professional responsibility portion. The activities must contribute directly to lawyers’ professional competence, skills, or ethical obligations, and the sponsor must encourage active participation by lawyers as planners, coordinators, authors, panelists, facilitators, or lecturers. CLE sponsors must provide documentation of activities and attendance within 30 days of any request from the CLE committees. Activity leaders must have the necessary practical or academic skills to conduct or facilitate effectively, and a number of other logistical requirements must be met to ensure the adequacy of the facility and method of delivery (e.g., video, audio, web-based) for the CLE activity. CLE employs a unique method of funding: the administrative cost of CLE may be covered by an annual fee established by the CLEC and paid by all active lawyers on the annual reporting date.6 PROFESSIONAL DEVELOPMENT FOR TEACHERS For teachers, “continuous, high-quality professional development is essential to the nation’s goal of high standards of learning for every child” (AFT, 2009). High quality professional development will in turn produce high quality teachers,7 allowing teachers to 6 ABA Model Rule for Continuing Legal Education with Comments. 7 In order to be a “high quality teacher” under the No Child Left Behind Act, teachers must hold a bachelor’s degree, have full state certification, and demonstrate competency in the core academic subjects they teach (U.S. Department of Education, 2006).
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Redesigning Continuing Education in the Health Professions assist students in reaching rigorous achievement standards. This section primarily pertains to those teaching kindergarten through twelfth grades in the United States. Most states and the District of Columbia require CE or CPD credits—both terms are used throughout the profession—to maintain certification and licensure (ranging from 90 to 175 hours over 5 years). States are primarily responsible for setting CE or CPD requirements for their teachers. Advanced-level certification is also available to teachers with 3 or more years of teaching experience through the National Board for Professional Teaching Standards (NBPTS). The NBPTS operates an assessment program that awards advanced-level certification in more than 25 areas. The assessment requires teachers to assemble a portfolio of their practices and take a computer-based test of their subject matter knowledge. Pursuing advanced-level certification is a voluntary activity, although some states and districts encourage teachers to earn NBPTS certification and provide salary incentives for teachers who successfully earn the credential (NBPTS, 2009). School districts ensure that their faculties maintain licensure and certification by reporting data to state education departments, which then report to the U.S. Department of Education, although not all schools are required by law to employ certified teachers (private schools and some chartered schools are exempt). These reporting requirements track the progress of schools and teachers, required under the No Child Left Behind Act of 2001 (NCLB).8 Under this legislation, all teachers are encouraged to participate in “high quality professional development activities.” To finance these activities, state funding has been awarded through grants under NCLB, but in cases where funding has not been granted and prior to the implementation of NCLB, the brunt of the costs were and are faced by the school district (Corcoran, 1995), by states (in the form of subsidies), and by teachers themselves. Providers of CPD include an array of government and nongovernmental organizations, ranging from the U.S. Department of Education to local teacher unions and school districts. Much like the health professions, teachers are provided with many different options to receive their required CPD units. While professional development opportunities occur through lectures and workshops, e-learning is rapidly growing and can consist of web-based, interactive experiences combining text, audio, and video. The major advantages of e-learning include greater versatility of 8 No Child Left Behind Act of 2001, Public Law 107-110, 107th Congress, 1st Session (January 8, 2002).
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Redesigning Continuing Education in the Health Professions the learning materials and methods of dissemination, the potential to build communities from many different geographic regions and sources of expertise, and improvement of teacher retention through direct involvement in their own learning and professional growth. Additionally, teachers may, in some cases, fulfill CE requirements through state-mandated pursuits of further education. For these teachers, their progress through the career ladder is directly linked to ongoing professional development. LESSONS FOR THE HEALTH PROFESSIONS Many other professions outside of health care also require their workforces to undergo ongoing training and development to maintain competence and performance, with the overall goal of improving the quality of the workforce. In some professions, CE is mandated at the federal or state levels, whereas it may be voluntary for others. Like the health professions, CE requirements often vary by state and specialty area. CE increasingly includes self-directed learning, e-learning methods, and accomplishments toward professional development; it does not always focus on completion of formal continuing education courses. In some professions, tests of competence, knowledge, and skill are unannounced. Although each profession has tailored CE to its specific needs, lessons can be learned and shared with each other. Various models of learning offer promise for professional behavior and performance and ought to be explored. REFERENCES ABA (American Bar Association). 2001. ABA model rule for continuing legal education. http://www.abanet.org/cle/ammodel.html (accessed March 25, 2009). ———. 2009. Summary of MCLE jurisdiction requirements. http://www.abanet.org/cle/mcleview.html (accessed September 24, 2008). AFT (American Federation of Teachers). 2009. Professional development for teachers. http://www.aft.org/topics/teacher-quality/prodev.htm (accessed June 23, 2009). AICPA (American Institute of Certified Public Accountants) and NASBA (National Association of State Boards of Accountancy). 2007. Uniform Accountability Act standards for regulation including substantial equivalency, fifth edition. New York: AICPA. Corcoran, T. B. 1995. Helping teachers teach well: Transforming professional development. Madison, WI: Consortium for Policy Research in Education. CSI Construction Education Network. 2008. State requirements—Engineering. http://cen.csinet.org/mce_engineering.php (accessed September 23, 2009). GAO (Government Accountability Office). 2005. Government auditing standards: Guidance on GAGAS requirements for continuing professional education. Washington, DC: GAO.
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Redesigning Continuing Education in the Health Professions Mele, D. 2005. Ethical education in accounting: Integrating rules, values and virtues. Journal of Business Ethics 57:97-109. NASBA (National Association of State Boards of Accountancy). 2009. NASBA tools. http://www.nasbatools.com/display_page?id=6 (accessed June 24, 2009). NBPTS (National Board for Professional Teaching Standards). 2009. About us. http://www.nbpts.org/about_us (accessed June 24, 2009). NCEES (National Council of Examiners for Engineering and Surveying). 2008. Continuing professional competency guidelines. Clemson, SC: NCEES. U.S. Department of Education. 2006. The secretary’s fifth annual report on teacher quality: A highly qualified teacher in every classroom. Washington, DC: Office of Postsecondary Education. VanZante, N. R., and R. B. Fritzsch. 2006. Comparing state board of accountancy CPE requirement with an emphasis on professional ethics requirements. CPA Journal 76(10):58.
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