Continuing education, continuing professional development, and high-value continuing professional development exist along a continuum. Continuing education (CE) “often is associated with didactic learning methods, such as lectures and seminars, which take place in auditoriums and classrooms,” and is often viewed by health professionals as merely a path to maintaining licensure and certification through the accumulation of credits (IOM, 2010). Continuing professional development (CPD), in contrast, embraces a wider array of learning formats and methods that are driven by learners. Countries such as Canada, New Zealand, the United Kingdom, and those within the European Union have embraced CPD as a way of “maintaining, improving, and broadening knowledge and skill throughout one’s professional life” (IOM, 2010). It focuses on improving individual performance in order to drive quality and safety in the clinic and to improve the health and well-being of populations. Finally, high-value CPD is driven by outcomes. Those outcomes—which may benefit the practitioner, individuals and patients, the team, or populations—must demonstrate value in order for funders to decide whether to invest in CPD. According to the 2010 Institute of Medicine (IOM) report Redesigning Continuing Educa-
1 The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop was prepared by the workshop rapporteurs as a factual summary of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants, and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine, and they should not be construed as reflecting any group consensus.
tion in the Health Professions, “Arriving at the value proposition for CPD will be essential to understanding the best ways to invest CPD resources.”
The Global Forum on Innovation in Health Professional Education (Global Forum) hosted a workshop on April 6–7, 2017, to explore the value proposition for CPD. Forum members and workshop participants gathered in Washington, DC, to learn about innovative CPD programs around the world, to consider the perspectives of those who invest in CPD, and to discuss the business case for CPD (see the full Statement of Task in Box 1-1). Leatherman et al. (2003) define a business case for health care improvement, which was adapted to high-value CPD for this workshop. A business case for high-value CPD
exists if the entity that invests in the intervention realizes a financial return on its investment in a reasonable time frame, using a reasonable rate of discounting. This may be realized as “bankable dollars” (profit), a reduction in losses for a given program or population, or avoided costs. In addition, a business case may exist if the investing entity believes that a positive indirect effect on organizational function and sustainability will accrue within a reasonable time frame. (p. 18)
Most financial investors—whether governments, philanthropists, or businesses—want to see a return on their investment (ROI) within 5 years or less. Researching the value proposition is essential for making the business case that a CPD intervention will provide the intended ROI within the defined period of performance. However, the value of CPD may not
be purely monetary. For example, a business case may not demonstrate a financial return, but the value to stakeholders may be great enough that it tips the balance so the decision is made to move forward despite the lower rate of return on the investment. For the purpose of this workshop, the value proposition for CPD is spelled out in the background paper by Ronald Cervero and Holly Wise in Appendix B [Value = (Quality + Outcomes)/Cost].
Cervero and Wise provided introductory comments to the workshop attendees that describe the value proposition. Wise, who represents the American Council of Academic Physical Therapy on the Global Forum, reminded the audience this is not the first time the National Academies of Sciences, Engineering, and Medicine (the National Academies) has explored continuing education and continuing professional development. In 2010, an IOM committee released a report, Redesigning Continuing Education in the Health Professions, that put forth requirements for achieving a new vision for CPD. It included improvements in “the value and cost-effectiveness of CPD delivery,” and it required a system that considers “ways to relate the outputs of CPD to the quality and safety of the health care system” (IOM, 2010, p. 8). In this regard, quality may be considered part of the outcomes measure. However, in other instances, quality and outcomes may be viewed as independent variables to ensure “a workforce of health professionals who can provide high-quality, safe care and improve patient outcomes” (IOM, 2010, p. 14).
To further the discussion, Ronald Cervero of the Uniformed Services University of the Health Sciences described outcomes as being dependent on the stakeholders and what they hope to gain: “We need to know, first of all, who are the stakeholders and what are their interests?” Outcomes, like value, can be described in terms of a continuum from simple learning outcomes, in which CPD participants learn new information, to health outcomes, in which the CPD intervention has an eventual effect on health (Kirkpatrick, 2006; Miller, 1990; Moore et al., 2009). Improving quality and outcomes comes at a cost. The value proposition attempts to include all these elements into one equation in order to explore “whether an investing entity should proceed with financially supporting” a CPD intervention, said Wise.
ORIENTATION TO THE WORKSHOP
Susan Scrimshaw, co-chair of the Global Forum that hosted the workshop,2 opened with “Buenos dias!” and “Sawadee ka!” to welcome the participants who traveled internationally from countries including Australia, Mexico, the Philippines, and Thailand. She also gave a warm
welcome to the workshop participants and members of the Global Forum while recognizing those in the audience who brought varied health and education perspectives from Belgium, Canada, Greece, Puerto Rico, Scotland, and South Africa. She remarked on how the diversity of the Global Forum membership goes beyond geography to include support from associations, foundations, government, and academia. The Global Forum emphasizes an interprofessional approach to all its activities and is now actively seeking cross-sector engagement for addressing critical challenges, such as the social determinants of health and financing health professions education. Scrimshaw noted that the Global Forum is celebrating 5 years since its inception, and said “We are getting to some really difficult, gritty, important topics,” such as the one being explored in the workshop—making a business case for high-value CPD. With those few comments, Scrimshaw handed the microphone to Holly Wise to orient participants to the agenda and describe how the topic relates to the work of the Global Forum.
The Global Forum, said Wise, is composed of 56 appointed members who represent 19 different professions and hail from nine different developed and developing countries. Its guiding principles emphasize engaging students, being person and patient centered, and creating an environment of learning with and from partners from outside the United States. The workshop was planned with these principles in mind, Wise said. Workshop topics are selected and developed by the Global Forum members themselves, and then an ad hoc planning committee develops and creates an agenda of activities, she added.
Objectives for this workshop draw from the Statement of Task in Box 1-1 and begin with building a foundation for understanding the elements of a business case and what composes high-value continuing professional development. Subsequent sessions then apply the foundational understanding for participants to explore examples of high-value CPD through invited presentations, panel discussions, and breakout groups. The presentations and panel discussions covered putting the value in high-value CPD, real-world business cases for high-value CPD, and the role of accrediting and credentialing bodies.
There were four breakout groups that met simultaneously during the afternoon of the first day of the workshop. These groups were co-led by facilitators who presented brief case studies based on real-life interventions or programs. Each group considered the case study in exploring the potential business case from the perspective of the investing entity: government, workplaces, professional associations, or philanthropic organizations. The facilitators of each breakout group presented a summary of the group’s discussion to the entire workshop audience. See Appendix A for the workshop agenda.
Organization of the Proceedings
This workshop summary is made up of six chapters organized in the following structure: Chapter 2 presents background information about high-value CPD and summarizes a presentation about how to develop a business case. Chapter 3 focuses on how to define value for CPD, including nonmonetary value. Chapter 4 presents four real-world cases in which an organization undertook a high-value CPD activity. Presenters discussed the process, outcomes, and lessons learned. Chapter 5 summarizes the presentations by four representatives of accrediting and credentialing bodies, exploring the considerations and points of leverage that these bodies have. Chapter 6 presents the work of the breakout groups through summaries of each group’s case study and conversation. Finally, Chapter 7 concludes the report with the workshop participants’ reflections about the workshop and next steps.
IOM (Institute of Medicine). 2010. Redesigning continuing education in the health professions. Washington, DC: The National Academies Press.
Kirkpatrick, D. L. 2006. Seven keys to unlock the four levels of evaluation. Performance Improvement 45(7):5–8.
Leatherman, S., D. Berwick, D. Iles, L. S. Lewin, F. Davidoff, T. Nolan, and M. Bisognano. 2003. The business case for quality: Case studies and an analysis. Health Affairs (Millwood) 22(2):17–30.
Miller, G. E. 1990. The assessment of clinical skills/competence/performance. Academic Medicine 65(9 Suppl):S63–S67.
Moore, D. E. Jr., J. S. Green, and H. A. Gallis. 2009. Achieving desired results and improved outcomes: Integrating planning and assessment throughout learning activities. Journal of Continuing Education Health Professionals 29(1):1–15.
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