Annex A > Chapter 4 - National Accountabilities and Roles > Continuing professional development (CPD) > CPD as a professional obligation
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CPD as a professional obligation
309 During the period of the Inquiry's Terms of Reference, there was very little enforcement of CPD. It was left to the individual as a moral obligation, as Sir Barry Jackson explained:
`... the question of continuing medical education or continuing professional development, during the period of our terms of reference again, I think it is accurate to say there were no formal obligations placed upon a Fellow of The Royal College of Surgeons or a Member of the Royal College of Surgeons to take part in such an exercise?
`Q. So what would the nature of the obligation to keep oneself up to date as a matter of professional competence be?
`A. It was a moral obligation. That is the short answer.
`Q. A moral obligation possibly backed up by the Code of Practice of the GMC?
`A. The answer is yes, although I have to say that I cannot remember the dates when successive GMC documents were published, but certainly, the GMC did not figure high in the minds of most surgeons throughout the time in question, the Inquiry time.
`Q. So the prime concern would be the individual moral or ethical responsibility?
`Q. Would contracts of employment or job descriptions of consultants be likely to have contained during this period any requirements to engage in continuing medical education?
`A. I think it most unlikely, but I cannot state authoritatively that that was the case, particularly towards the end of the terms of your Inquiry. Certainly, in the 1980s, that would not have been in job descriptions; it may have started creeping in in the early to mid-1990s. [374]
`Q. I appreciate it is difficult for you to answer because no doubt the practices would have varied locally from Trust to Trust, at least to some extent, but is it fair to conclude from the earlier part of your answer that even if they did, the real pressure that would be felt by consultants is likely to be the moral and ethical one, rather than whatever the job description might have said on the subject?
`A. Yes.' [375]
310 Similarly, in relation to new procedures, it was left to the individual doctor to decide what training he felt he needed to do before embarking on the procedure:
`Q. ... what would be the expectations as to the practical steps that had to be taken before a person could be confident or reasonably confident that actually they would not be harming their patient if they embarked on something relatively new?
`A. There was nothing laid down about this. It was not formalised. It was up to an individual surgeon to take what steps they considered necessary to enable them to carry out that operation with a clear conscience.' [376]
311 The Inquiry has received little evidence on what proportion of hospital doctors actually felt obliged to undertake CPD and what proportion of doctors actually did undertake CPD as recommended. Such information is available for general practice, through data on Post Graduation Education Allowance payments, but otherwise it may be impossible to find out, as no one monitored compliance with what recommendations there were:
`Q. ... what assessment would the College make of the extent to which consultants were already participating in CME prior to the introduction of a formal accreditation programme?
`Q. Nobody was formally engaged in it in so far as nobody was required to formally notify their engagement in it, but to what extent did the College believe it was all chugging along nicely with everybody doing what was expected of them, or to what extent did they regard there might be a problem in this field?
`A. I do not think the College as such took a formal position in the early 1990s that continuing medical education had to be carried out by all their fellows. [377]
`Q. ... prior to the early 1990s there was very limited awareness of the extent to which consultants were keeping themselves up to date?
`A. Yes. I think the answer to that is probably yes; there was a limited awareness. I mean, it was, as I said before, a moral obligation that consultants did keep themselves up to date and did continue to practice appropriately ... .' [378]
312 Further, there was no systematic assessment of trainers providing CPD:
`Q. ... Did I understand you previously to say that there was no systematic assessment of the trainer?
`A. I do not think I said it in those terms, but your derivation, the implication of what I said was exactly as you suggest.' [379]
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Footnotes
[374] The standard form of contract for a hospital consultant contained a clause relating to study leave, which both authorised and encouraged it
[375] T28 p.72-3 Sir Barry Jackson
[376] T28 p.112 Sir Barry Jackson
[377] T28 p.77-8 Sir Barry Jackson