Continuing Professional Development Knowledge Market Designing CPD for

Continuing Professional Development Knowledge Market Designing CPD for Better Practice and Outcomes Evidence, Practice and Debate 9 th May 2013

Overview: Evidence base for CPD • Literature on CPD influencing practice and outcomes. • Evidence-based CPD methods. • Combining CPD and improvement to translate knowledge into practice.

The Challenge

Knowledge-Practice Gap (1) 40 -45% defect rate in healthcare system – patients not receiving care as recommended in guidelines. • Grol, 2001; • Mc. Glynn et al, 2003; • NHS Atlas of Variation, 2012 17 years to get research recommendations into practice. (Balas et al 2000) Institute of Medicine, 2001

Knowledge-Practice Gap (2) 1. Information overload- “Seventy-Five Trials and Eleven Systematic Reviews a Day: How Will We Ever Keep Up? ” Bastian, H. et al 2010 2. Practice vs research: Overestimation of impact in research studies compared with real-life contexts. Ioannidis, 2011.

Continuing Professional Development: Bridging the Knowledge-Practice Gap?

The Literature 1. Can CPD change practice and healthcare outcomes? 2. How can we design CPD for maximum impact?

The evidence base Fragmented, partial and complex evidence base on CPD methods and theories - healthcare, education, sociology, psychology, management, organisational change. A stronger evidence base is needed – metrics, research, evaluation.

Key evidence sources Marinopoulos 2007: Overview of reviews and primary studies. Overall CPD approaches were effective in acquiring and sustaining knowledge, attitudes and skills, changing behaviours, and improving clinical outcomes. Institute of Medicine 2010: 62 evaluations; 20 systematic reviews. Evidence that CPD works, in some cases, to improve clinical practice and patient outcomes.

Effective CPD approaches Interactive learning Patient/Service Multiple methods; Time to assimilate and reflect. Need Practice orientation: Embedding & Feedback

Examples 1. Use of clinical pathways 2. Audit and feedback 3. Interactive education – meetings, workshops, online communities. 4. Educational outreach visits (“academic detailing”) 5. On-screen, point of care computer reminders 6. Local opinion leaders 7. Printed educational materials 8. Rapid-response educational technologies – access to new knowledge. Cochrane Effective Practice and Organisation of Care Group

Pathman-PRECEED Model Individual Intervention Awareness Agreement Adoption Adherence Opinion leaders Small group sessions. Educational detailing. Patient education. Small group audit and feedback. Reminders Multiple interventions System Predisposing Print materials Journals Lectures Enabling Reinforcing Davis et al 2003

CPD Outcomes Chain HEALTHCARE OUTCOMES: the resulting impact on patients and communities. PERFORMANCE……application of knowledge in practice. COMPETENCE…. . demonstrated in educational setting. KNOW-HOW……learners acquire skills and procedural knowledge. KNOW-WHAT …… learners acquire new knowledge about interventions. SATISFACTION …… learners react in these ways. PARTICIPATION…. reaches learner. Moore et al 2009

Knowledge Translation: Combining CPD and Improvement

Transformative Learning: Bridging the Knowledge-Practice Gap Translating Knowledge Into Practice and Quality Outcomes Individual change Clinical competency Healthcare performance Policy Other partners System and process System change Continuing Professional Development Adult learning principles Implementation Person-Centred Values Safety Systems Improvement & Systems Learning Principles

Educational Bridge to Quality Institute of Medicine (2003) 5 educational themes central to quality and safety in all professions: 1. 2. 3. 4. 5. Person-centred care. Interprofessional team working. Evidence-based practice. Continuous quality improvement. Health informatics - combining data and evidence to support decisions and improve quality of care.

Summary Transformative learning to bridge the knowledgepractice gap calls for a combination of: • CPD – education as intervention. • Systems improvement – implementation, patient safety and quality improvement methods. • Clinical knowledge and “improving quality” knowledge. Opportunity for NES to contribute through research and evaluation to the evolving evidence base for CPD contributing to improvement in practice and outcomes.

Discussion and debate 1. How can NES develop its leadership role in CPD, combining clinical knowledge and improvement knowledge, to improve practice and patient outcomes? 2. How can NES help to build the evidence base for continuing professional development?

Continuing Professional Development Knowledge Market Combining Education, Improvement and Knowledge for Better Practice and Outcomes Evidence, Practice and Debate 9 th May 2013