The continuing professional development for health professionals ...
The continuing professional development for health professionals ...
The continuing professional development for health professionals ...
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Continuing Professional Development<br />
<strong>for</strong> Nurses and Allied Health<br />
Professionals in Musculoskeletal<br />
Settings: a National UK Survey<br />
Jo Adams; Sarah Ryan; Hannah Haywood;<br />
Helen Pain
Jo Adams<br />
Continuing Professional Development <strong>for</strong> Nurses and<br />
Allied Health Professionals in Musculoskeletal Settings:<br />
a National UK Survey<br />
Presenter Disclosure In<strong>for</strong>mation:<br />
Declarations of interest: None<br />
This speaker has no conflicts of interest
Continuing Professional Development (CPD)<br />
‣ Includes “a wide range of learning activities through which<br />
<strong>professional</strong>s maintain and develop throughout their career to<br />
ensure that they retain their capacity to practise safely,<br />
effectively and legally within their evolving scope of practice” 1<br />
‣ Conducted to provide the best possible care <strong>for</strong> patients and can<br />
include <strong>for</strong>mal or in<strong>for</strong>mal activities<br />
‣ CPD is a registration and <strong>professional</strong> requirement although<br />
recommendations <strong>for</strong> the time spent on CPD varies. No specific<br />
time requirements <strong>for</strong> UK AHPs to 35 hours over three years <strong>for</strong><br />
UK Nurses.
Profession<br />
United Kingdom<br />
Nursing<br />
Requirements<br />
35 hours every 3 years, evidenced in portfolio that may be audited.<br />
Occ <strong>The</strong>rapy/<br />
Physiotherapy/Podiatry<br />
Australia<br />
Nursing<br />
Occupational <strong>The</strong>rapy<br />
Physiotherapy<br />
No minimum requirement, but CPD portfolio must be kept by all members of register. This may be<br />
audited biannually.<br />
20 hours per year Portfolio must be kept in case of audit.<br />
No minimum requirement, but evidence of CPD must be recorded in portfolio and may be audited.<br />
20 hours per year, recorded in portfolio which may be audited.<br />
Podiatry 20 hours per year (plus extra 10 hours per year <strong>for</strong> those with medicine endorsements and extra 20<br />
hours per year <strong>for</strong> podiatric surgeons), recorded in portfolio which may be audited.<br />
USA<br />
Nursing<br />
Occupational <strong>The</strong>rapy<br />
Physiotherapy<br />
Podiatry<br />
New Zealand<br />
Nursing<br />
Occupational <strong>The</strong>rapy<br />
Physiotherapy<br />
Podiatry<br />
Individual states vary; some require Continuing Education whilst others do not<br />
Varies between states, from no mandatory CPD requirement to a minimum of 40 hours every 2 years.<br />
Varies between states, however the FSBPT recommend that every physiotherapist should obtain a<br />
minimum of 30 <strong>continuing</strong> competence units every 2 years. Unit value of activity depends on<br />
how well it meets established criteria.<br />
Requirements vary in terms of number of hours of CPD. No general <strong>professional</strong> recommendations<br />
were identified<br />
60 hours of <strong>professional</strong> <strong>development</strong> in 3 years. Yearly audit of nurses renewing their practice<br />
certificate.<br />
Continuing Competence Recertification Portfolio has to be kept and may be audited on a 5 year cycle.<br />
100 recorded CPD hours/3-year cycle; 50 practical CPD hours/3-year cycle; one<br />
<strong>professional</strong> peer review/3-year cycle<br />
Equivalent of 100 hours CPD activity (<strong>for</strong>mal and in<strong>for</strong>mal)/4-year cycle, audited.<br />
Table 1: UK, Australia, USA and New Zealand CPD requirements
Background<br />
• Musculoskeletal <strong>health</strong> care <strong>professional</strong>s have expressed<br />
concern at the increased difficulties in undertaking <strong>continuing</strong><br />
<strong>professional</strong> <strong>development</strong> (CPD).<br />
• Timely with rise in extended scope practitioner roles<br />
• Discrepancy when compared with requirements, provision and<br />
funding <strong>for</strong> medical colleagues
Arthritis Research UK:<br />
Educational Strategy Award<br />
• To explore the current situation regarding CPD amongst nurses<br />
and AHPs working with people who have musculoskeletal<br />
conditions.<br />
To include:<br />
• An exploration of the challenges faced to take part in CPD<br />
• Recommendations to be made on how to provide the best CPD<br />
opportunities <strong>for</strong> <strong>health</strong> <strong>professional</strong>s in the UK who work with<br />
people who have musculoskeletal conditions
• National UK electronic survey<br />
Methods<br />
• Phase II of a two part research project<br />
• Phase I used three focus groups and two telephone conference calls to<br />
explore patients, clinicians and managers experiences of CPD within MSK<br />
services 2 . <strong>The</strong>se findings in<strong>for</strong>med the content and <strong>development</strong> of this<br />
electronic questionnaire survey.<br />
• Survey designed using Question Mark Perception, administered from the<br />
University of Southampton and distributed via <strong>professional</strong> bodies and BHPR.<br />
• Results were collected online and analysed in SPSS PASW 17 using frequency<br />
data and χ2 analyses.<br />
2<br />
Haywood H et al (2011) An exploration of the experience of <strong>continuing</strong> <strong>professional</strong> <strong>development</strong> with nurses and<br />
allied <strong>health</strong> <strong>professional</strong>s working in musculoskeletal services in England ARD 2011;70(Suppl3):753
Recruitment<br />
• AGILE<br />
• Aquatic <strong>The</strong>rapy Association of Chartered<br />
Physiotherapists<br />
• Arthritis and Musculoskeletal Alliance<br />
• Arthritis Research UK<br />
• Association of Chartered Physiotherapists in the<br />
Community<br />
• Association of Orthopaedic Chartered<br />
Physiotherapists<br />
• Back Care<br />
• British Health Professionals in Rheumatology<br />
• College of Occupational <strong>The</strong>rapists Specialist<br />
Section – Independent Practitioners<br />
• College of Occupational <strong>The</strong>rapists Specialist<br />
Section – Rheumatology<br />
• College of Occupational <strong>The</strong>rapists website, CPD<br />
page<br />
• Extended Scope Practitioners<br />
• Functional Lower Limb Interest Community<br />
• Harrison Training<br />
• Head OTs and OT Leads in Hampshire<br />
• Leaders and Managers of Physiotherapy Services<br />
(<strong>for</strong>merly the Association of Chartered<br />
Physiotherapists in Management)<br />
• National Rheumatoid Arthritis Society<br />
• Physiotherapy Pain Association<br />
• Podiatry Rheumatic Care Association<br />
• Rheumatic Care Association of Chartered<br />
Physiotherapists<br />
• Royal College of Nursing Rheumatology Forum<br />
• Social Care Distribution from COT<br />
• Society of Chiropodists and Podiatrists Faculty of<br />
Managers<br />
• South Central SHA AHP Leads<br />
• UoS Faculty of Health Sciences, MSc Alumni
Results<br />
Total 591<br />
responses<br />
Reviewed 586<br />
responses<br />
354 complete<br />
responses<br />
analysed<br />
5 not MSK/<br />
Other<br />
193 incomplete survey<br />
39 initial in<strong>for</strong>mation<br />
only
Professional groups<br />
9.9%<br />
0.6%<br />
7.3%<br />
Nursing<br />
Occupational<br />
<strong>The</strong>rapy<br />
30.2%<br />
Orthotics<br />
Physiotherapy<br />
51.7%<br />
0.3%<br />
Podiatry<br />
Not answered
Country of work<br />
14%<br />
4%<br />
England<br />
2%<br />
Northern Ireland<br />
Scotland<br />
80%<br />
Wales
Number of responses<br />
Sector of work<br />
350<br />
300<br />
250<br />
291<br />
• Multiple responses were<br />
allowed <strong>for</strong> this question.<br />
• Many worked in more than<br />
one sector.<br />
200<br />
150<br />
100<br />
50<br />
0<br />
55 57<br />
3<br />
46<br />
NHS<br />
Local<br />
authority<br />
Private sector<br />
Sector<br />
Charitable<br />
company<br />
Self-employed
Workplace setting<br />
1% Community<br />
30%<br />
Inpatient<br />
61%<br />
8%<br />
Outpatient<br />
Not<br />
Answered
Number of responses<br />
Level of experience<br />
325<br />
300<br />
275<br />
250<br />
225<br />
200<br />
175<br />
150<br />
125<br />
100<br />
75<br />
50<br />
25<br />
0<br />
78<br />
219<br />
5<br />
1<br />
17<br />
32<br />
< 2 2 - 5 > 5<br />
Years of experience working in musculoskeletal settings<br />
Manager<br />
Nonmanager
Number of Responses<br />
<strong>The</strong> services in which people worked<br />
200<br />
180<br />
160<br />
140<br />
120<br />
100<br />
80<br />
60<br />
40<br />
20<br />
0<br />
124<br />
90<br />
70<br />
57<br />
175<br />
122<br />
• Multiple responses were allowed.<br />
• Many worked <strong>for</strong> more than one<br />
service.<br />
• 122 worked <strong>for</strong> another type of<br />
service not listed, many of which<br />
were in addition to at least one of<br />
the services listed.<br />
Rheumatology<br />
Orthopaedics<br />
Elderly Care<br />
Pain Service<br />
Musculoskeletal Outpatients<br />
Service<br />
Other<br />
• Other services reported included<br />
general podiatry (n=13) and adult<br />
services (n=33).
Number of responses<br />
CPD activities undertaken in the last 12 months<br />
350<br />
300<br />
250<br />
200<br />
150<br />
100<br />
50<br />
0<br />
225<br />
61<br />
312<br />
111<br />
164 147 138<br />
294<br />
156<br />
255<br />
20<br />
short <strong>for</strong>mal courses<br />
extended <strong>for</strong>mal courses<br />
reading <strong>professional</strong> papers<br />
shadowing<br />
conferences<br />
CPD network/group<br />
mentoring<br />
reflection<br />
e-learning<br />
in-house training<br />
other<br />
CPD Activity
Number of responses<br />
Number of responses<br />
Identifying learning and <strong>professional</strong><br />
<strong>development</strong> needs<br />
400<br />
350<br />
300<br />
250<br />
200<br />
150<br />
100<br />
50<br />
0<br />
Identify my own<br />
341<br />
253<br />
177<br />
120<br />
Supervision<br />
Per<strong>for</strong>mance review<br />
Training review<br />
Methods used to identify CPD needs<br />
Other<br />
32<br />
400<br />
350<br />
300<br />
250<br />
200<br />
150<br />
100<br />
50<br />
0<br />
Post and job description<br />
286<br />
Needs of service<br />
331<br />
Needs of local community<br />
208<br />
Anticipated future needs<br />
282<br />
232<br />
159<br />
KSF<br />
Published competencies<br />
Sources used to identify CPD needs<br />
Other source<br />
18
Number of responses<br />
Reasons <strong>for</strong> doing CPD<br />
250<br />
200<br />
200<br />
150<br />
100<br />
50<br />
132<br />
100<br />
79<br />
63<br />
60<br />
16<br />
23<br />
10 1<br />
0<br />
Improve patient care<br />
stay up-to-date<br />
maintain skills<br />
HPC/NMC requirements<br />
confidence in own practice<br />
further my career<br />
service <strong>development</strong><br />
stay enthusiastic<br />
Reasons to undertake CPD<br />
develop personal interests<br />
other reasons<br />
• 124 people gave more than<br />
the three main reasons that we<br />
asked <strong>for</strong>, there<strong>for</strong>e 230 results<br />
were analysed.<br />
• A higher proportion of<br />
managers (45%) than nonmanagers<br />
(20%) cited service<br />
<strong>development</strong> as a reason <strong>for</strong><br />
undertaking CPD (p
Number of responses<br />
Barriers to CPD<br />
250<br />
200<br />
150<br />
100<br />
50<br />
0<br />
Lack of funding<br />
207<br />
181<br />
92<br />
103<br />
13<br />
18<br />
Lack of study leave<br />
Lack of confidence in ability<br />
Commitments outside work<br />
Too many other tasks<br />
Negative attitudes to CPD<br />
Lack of appropriate courses<br />
96<br />
Other<br />
15<br />
• Other barriers identified<br />
included difficulty<br />
attending courses that<br />
were held far from the<br />
respondents place of<br />
work/residence (n=12).<br />
• Travelling costs <strong>for</strong> some<br />
may be prohibitive if<br />
there was a long<br />
distance to travel.<br />
Barriers to CPD
Specific Issues<br />
Funding<br />
Specific Issues<br />
Time<br />
Support
Funding<br />
• 12% received full funding<br />
• 56% received partial funding<br />
• 21% received no funding<br />
NHS<br />
Non-NHS<br />
• NHS vs Non-NHS<br />
– Proportions are<br />
significantly different (p
Time<br />
• Hours of own time spent on CPD:<br />
– 1-4 hours per month: 61%<br />
– 5-8 hours per month: 27%<br />
– more than eight hours each month: 12%<br />
• Employers were thought to regard in<strong>for</strong>mal CPD as a legitimate use of work time by 70% of<br />
respondents.<br />
• Pressure of other work-based and external commitments were the most commonly cited<br />
barriers to accessing CPD after lack of funding.<br />
• Self-employed vs non self-employed:<br />
– Proportions are significantly<br />
different (p
Support from employers<br />
• Negative attitudes to CPD at work was reported as one of the three main<br />
barriers to CPD by only 7%.<br />
• An employer who was very or fairly supportive of CPD activities was<br />
reported by 86%.<br />
• A higher proportion (95%) of non-NHS employees stated that their<br />
employers were fairly or very supportive, compared with 84% of NHS<br />
employees (p
Support from <strong>professional</strong> bodies<br />
•<strong>The</strong> proportions of people from each <strong>professional</strong> group who<br />
believed their <strong>professional</strong> body to help them meet the CPD<br />
requirements of the HPC or NMC was significantly different<br />
(p
Summary<br />
• To improve patient care is a frequent reason <strong>for</strong> CPD.<br />
• Managers are more likely to do CPD in order to improve service delivery than<br />
non-managers.<br />
• A lack of funding and having too many other tasks to complete at work were<br />
the two most common barriers to undertaking CPD activities.<br />
• Over half of the people who answered the survey received partial funding <strong>for</strong><br />
CPD activities and 21% received no funding at all.<br />
• Most people felt that their employers regarded the use of work-time <strong>for</strong> in<strong>for</strong>mal<br />
CPD activities was legitimate, but the pressure of too many other tasks to<br />
complete during work was a significant barrier to undertaking CPD activities <strong>for</strong><br />
many.<br />
• Overall there was a positive feeling that employers were supportive of CPD,<br />
and each <strong>professional</strong> body was seen to be helpful in meeting the CPD<br />
requirements by the majority of respondents in each profession.
Thank you to:<br />
• All participants <strong>for</strong> taking part in the focus groups and online survey<br />
• Our Expert Steering Committee<br />
• Alan Borthwick, Senior Lecturer, Faculty of Health Sciences, University of Southampton.<br />
• Mark Cole, Lecturer, Faculty of Health Sciences, University of Southampton.<br />
• Janet Cushnaghan, Research Fellow, <strong>The</strong> Medical Research Council Lifecourse<br />
Epidemiology Unit, University of Southampton.<br />
• Elaine Dawson Nurse Practitioner, <strong>The</strong> Orchard Practice, Christchurch.<br />
• Carolyn Evans, Strategic Service Manager, Hampshire County Council; COT/BAOT<br />
Council Member (elect) Social Care & Community Services.<br />
• Mandy Kness, BA, patient representative.<br />
• Arthritis Research UK <strong>for</strong> acknowledging the pressures on Nurses’ and AHPs’ CPD time<br />
and funding this study.