What does the evidence tell us about outcomes-focused CPD?

For some time, the effectiveness of traditional input-based CPD models has been questioned by educators, researchers and professional bodies. There has been increasing recognition that CPD records based solely on inputs (ie the ‘what was done’) do not necessarily prove that any significant learning has taken place or that this learning will be used to improve professional practice.

This recognition, coupled with an identified need to have robust and evidence-supported CPD models in place, has driven research into more outcomes-focused models of learning and development.

With research indicating that focusing on outcomes when undertaking CPD will have a positive impact on professional performance and practice, many professions are shifting to outcomes-focused models – including the veterinary professions.

Although the implementation of outcomes-focused CPD is in its infancy, numerous other professions (including human medicine and dentistry) have moved to this model. The veterinary world is still somewhat behind as a result, but upcoming changes seek to remedy this and bring the veterinary professions to a modern and evidence-based model of CPD.

What does outcomes-focused CPD mean?

Outcomes-focused CPD seeks to measure outputs, ie the impact of learning on personal and professional development, and how this improves, for example, outcomes for patients. The objective of this approach is to provide a measurement of genuine learning and professional improvement.

This places greater responsibility on participants to set out their CPD requirements and demonstrate how their activities have affected their professional practice, for example, if it has improved their performance in a certain area or had an impact on patient outcomes. In essence, it requires individual practitioners to take greater ownership of their professional development and not just consider what they have done but why they did and how it has impacted them.

What is involved in an outcomes-focused CPD model?

The majority of outcomes-focused CPD models require individual practitioners to follow four broad stages:

• Reflecting on their practice to identify their own development needs;
• Planning and undertaking appropriate CPD activities to meet these needs;
• Applying what has been learnt to their practice;
• Measuring and reflecting on the impact of CPD on their practice and patient health, identifying any further development needs.

What is reflection?

In a nutshell, reflection involves a systematic and critical analysis of the learning/development you have undertaken, thinking about if and how you will make any changes to how you work in the future as a result.

For those of us who are scientifically inclined, as many in the veterinary professions are, reflection doesn’t always come easily, as it requires more than thinking scientifically about what to focus on or standing back from events and finding flaws in our practice or arguments.

As the philosopher Donald Schon, who was responsible for developing the concept of 'the reflective practitioner', points out, reflection recognises that we are not merely observers of our work – we are participants. Crucially, it acknowledges our part in the outcome and, in this regard, our strengths, our limitations and our feelings.

As such, reflection is integral to how we develop ourselves and learn which is, ultimately, the purpose of CPD. Reflection helps us identify learning opportunities that are directly related to our professional needs and goals – and through this, professional development is maximised by being both relevant and efficient.

There have been concerns voiced by some in the profession that reflection is onerous and adds extra work to a schedule in which some practitioners already struggle to find the time to carry out CPD in addition to other professional and personal responsibilities.

While I hope this blog will make a very strong case for reflection, it is also worth noting that there is no expectation that vets or vet nurses need write an essay about every CPD activity in which they engage immediately afterwards, but rather jot down a few notes or record some thoughts about it, when it is relevant.

So, what does the research on inputs-based versus outcomes-focused CPD tell us?

The impact of many CPD activities is reduced when they are undertaken in isolation outside a defined structure of directed learning – hence the need for learning and development models to support professions.

Research across a range of professions and studies has demonstrated that CPD activities which are interactive, encourage reflection on practice, provide opportunities to practice skills, involve multiple exposures, help practitioners identify between their current performance and a standard, and are focused on outcomes, are the most effective at improving practice and patient health outcomes.

CPD activities focused on outcomes encourage professionals to reflect on what they have learned, how they will apply their learning and how it will improve their practice.

With regard to the veterinary professions, in 2013, I conducted a study with my colleague at the RVC, Dr Tierney Kinnison, who is a Lecturer in Veterinary Education, which focused on the impact of adding a reflective essay-based Professional Key Skills Module to the RCVS Certificate in Advanced Veterinary Practice where participants received feedback for their learning (May and Kinnison 2015).

We found that, at an individual level, participants who undertook reflective essay became more skilled at analysing their strengths and weaknesses, and started to be more proactive in identifying CPD opportunities to address this.

A specific example was consulting room communication, which was a dominant theme for reflection in the study. The participants adopted various models for structuring consultations and quickly recognised their value as they reflected on their deployment with clients. They found themselves more confident, particularly in challenging encounters, such as those involving complaints resulting from disappointment over treatment efficacy, and recognised superior outcomes in contrast to similar previous cases.

In addition to this, a greater focus on the meaning of professionalism (including recognition of not knowing everything and working on work-life balance), led to a reduction in the stress that many participants had been experiencing in their professional lives.

A later study, which I conducted with Tierney, in 2017 (Kinnison and May 2017), went a step further and looked at how reflection, alongside the development of non-technical skills such as communication, can make people reappraise difficult situations in a more constructive way and therefore lower stress. In this, we found that reflection (a key element in outcomes-focused CPD schemes) increased self-awareness and some participants were able to mitigate the effects of work overload through better prioritisation and distribution of labour, building on the strengths of the whole veterinary team.

These studies, along with a plethora of research from other professions, have formed the basis for the incoming changes to the College’s CPD policy.

A switch to using outcomes as evidence of professional development, is seen as giving autonomy back to professionals to adopt their own approaches to learning and helping individuals to recognise the impact of that learning on their practice.

The important shift to outcomes-focused CPD in the veterinary professions

It is crucial to evidence-based veterinary medicine that we transfer established results from other contexts into our own. This means looking at the research and what other professions have done, and transferring what is proven to work to our profession. With regards to CPD, this means a shift to focusing on outcomes and not inputs.

This has led to the RCVS decision to introduce a new outcomes-focused continuing professional development (CPD) model for vets and VNs. This new model, which will become compulsory in 2022, will include a ‘reflect’ element incorporated in in the CPD cycle – ‘plan, do, record and reflect’.

However, we want the profession to be engaging in the reflective process as soon as possible and, one thing I can report from the two-year pilot of outcomes-based CPD that we undertook, is that many of those vets and vet nurses who were initially sceptical about or even hostile towards the concept of reflection, were won over by the end.

Over the coming weeks and months the College will be publishing a number of resources and undertaking a number of activities to help guide the professions through these changes and this new CPD process.References

Kinnison, T. and May, S.A. (2017) Continuing professional development: Researching non-technical competencies can support cognitive reappraisal and reduced stress in clinicians. Veterinary Record 181, 266.

May, S.A. and Kinnison, T. (2015) Continuing professional development: learning leads to change in individual and collective clinical practice. Veterinary Record 177, 13.