GP CME : Challenges and Opportunities
Do you enjoy your cme (continuing medical education)? I, like many GPs (general practitioners), enjoy learning but find cme a pain! This article discusses some of the challenges of modern day general practice continuing medical education, along with some opportunities to make it more efficient, more enjoyable and easier to get done.
GP cme is stressful and costly!
When the date for my annual appraisal is looming I still find myself getting stressed while scrabbling to find all the cpd (continuing professional development) certificates from the various local protected learning time (PLT) gp update meetings I’ve attended or the primary care cme conferences or gp cpd courses I’ve been to. For our annual appraisal we need a minimum of fifty cpd credits, and these need to be collated, documented and evidenced. Modern day UK GP appraisal requires submission to an online gp appraisal toolkit site and so all these documents have to be scanned and then uploaded. And not just the certificates, learning points and reflection notes are required to join the online collection in my appraisal folder. To be honest it’s a real pain, every year, and it takes many precious hours to get done.
It’s not just organising the evidence of adequate cpd activity that’s a nuisance, actually collecting the required quantity of general practice cme /cpd credits can be a real challenge for many GPs including myself at times. In an ideal world we would have planned our cpd wish-list at the time of the last appraisal. For me this list even if achieved in full will not usually span 50 gp cpd credits so we need to collect the rest with a variety of relevant learning experiences that will have an impact on our day to day clinical practice. Well that’s the idea anyway; I’ve certainly been guilty of attending some meetings out of convenience or because they are free, rather than their actual value to my work as a freelance locum medical GP. Sadly sometimes collecting the cpd certificate /evidence seems to overshadow the issues of the quality of the cpd experience and /or relevance to my practice.
I’m not alone with these failings and challenges relating to gp cme and cpd, from conversations I’ve shared with colleagues over the years. We learn to ‘play the game’ and get the gp cpd evidence for appraisal, and yet keeping up to date with medical advances and best practices with cme is a genuine challenge. There are real risks to not keeping up to date with general practitioner continuing professional development. One obvious risk is that by falling behind with gp cme medical colleagues simply add to the stresses of our already demanding, under-resourced, and stressful, if rewarding vocation. Patients may suffer, we may suffer, referral rates and prescribing can mushroom and the tendency to over investigate can often occur.
GP cme choices
However there are various opportunities to get our cpd in a more modern and efficient manner. Firstly many colleagues overlook the fact that we can do our own personal cme study and write up our learning points and reflections. This may be triggered by a patient’s unmet need (PUN) in one of our surgery consultations, or we identify our own doctor’s educational need (DEN) again from something arising from our daily work. Noting down these PUNs and DENs can give a valueable, and personally relevant list of gp cpd ideas. With modern ease of access of online resources we can look up the relevant information, do our learning and write our notes. No certificate is required, merely the written evidence of the personal self-directed cpd learning. This is possibly one of the most valuable forms of gp cme.
One of the challenges with self-directed learning, in isolation, is checking that one has ‘got it’ and properly understood the material. With no colleague, or expert to refer to how does one ‘know’ that what is being mentally digested is valid. Sometimes it’s simple and obvious, but not always. Learning with colleagues in ‘self-directed learning groups’ can overcome some of these challenges, but there is still the risk of group ignorance that may go unrecognised.
Online GP cme
There’s been a steady growth of online medical webistes and many offering gp cpd resources and there are a good number of cme medical webistes offering access to free or paid for online gp cpd as e-learning modules for collecting those valuable gp cpd points. So the choices for general practice continuing medical education UK and globally has changed completely from when I began my GP career! One challenge pretty much all of these online GP update resources face is that there’s no interaction, and so yet again this is learning without the ability to ask a question and get an answer if something’s not clear, or if one has a particular medical clinical case in mind.
The ability to ask questions of someone who has expertise in a particular subject area is a valuable aspect of the more traditional forms of continuing medical education such as gp update conferences and other physical primary care cme meetings. However here is another challenge, the personal internal challenge known as the ‘raising of the hand’. I usually get a pounding in my chest from the adrenaline release that always seems to occur when I prepare to ask a question. Those internal voices and thoughts that come uninvited, however fleeting they are: ‘will I seem stupid for asking this?’, ‘did I miss a part of the talk where this was already covered and so annoy the speaker’, ‘what will my colleagues think of me for asking this?’ Even though I’ve heard the phrase ‘there’s never a stupid question’ many times, knowing that doesn’t change my body’s reaction in that setting. As a result there’s always the chance that I will not raise my hand, will not ask that question that’s important to me, and that may impact my personal cme experience, and hence my clinical practice.
GP cme webinars – more efficient?
Yet there is now another choice for gp cme where there is the ability to learn from an ‘expert’ and ask questions, but without the awkwardness and exposure of ‘the raised hand’. Live and interactive web based cme seminars (cme webinars) are a modern way to take part in cpd sessions, using internet and a connected device such as smartphone or i-pad (other tablet devices are available!), laptop or desktop computer. Other professions such as vets and those in finance and accounting having been using webinars and webcasts for some years now, for the delivery of some or most of their continuing professional development. The use of webinars for cpd is growing and although the medical profession have appeared rather late to embrace cpd webinars, there is growing awareness and opportunity to use webinars for gp updates online.
Webinars are usually easy to access. Host, speaker and attendees all join a ‘virtual’ meeting room online, the speaker’s desktop screen is shared with all attendees, they can hear the presenter, and see the speaker via a webcam if used. All attendees effectively have a front row seat, but without any of the associated awkwardness that occurs at physical cme medical meetings when colleagues usually try to avoid that relatively empty front row. So seeing the slides is never a problem, they’re on your screen. There’s also the ability for audience members to type in their questions, as they arise. These are then read out for all to hear by the host at the appropriate time, and all hear the speaker’s response. Live poll questions and surveys help audience interaction. As access to the medical cpd webinars is online it is location independent saving travel time and travel costs. And no driving home in the dark after a meeting feeling guilty for being absent from family on a weekday evening, as most gps access cme webinars from the comfort of home.
In summary there are ongoing challenges that we each face regarding the discipline of partaking in the important and necessary general practice continuing medical education. Challenges include choice of gp cpd topics, ensuring it’s relevant for us, the form the cme takes, and where to access the learning. The time required for gp cme is also a big challenge for many of us. Not just time required to collect the gp cpd credits, but also the time required to collate and organise and upload evidence of our cme activities to an online gp appraisal folder. These challenges for gp cpd are not helped by increasing work demands and time pressures, and yet modern technology is affording us new opportunities to save time and money with gp cme using interactive web based seminars, cme webinars and webcasts. These new emerging platforms offer more time and cost efficient access to gp cme and would seem to have a healthy future enabling myself and colleagues to not only keep up with our cpd and cme but also achieve better work life integration.