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Should CPD/CME be compulsory?

Discussion in 'Teaching and Learning' started by Craig Payne, Dec 12, 2007.

  1. Craig Payne

    Craig Payne Moderator

    Articles:
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    On many previous occasions I have made known my views opposing continuing education being compulsory (...usually every chance I get :rolleyes: ) . My primary reasons for that is that the evidence shows that it does not work. You simply can not force people to learn.

    The reason I raise it again here is following the implementation of the CPD Points software here at Podiatry Arena, it raised more than a couple of eyebrows about how does that gel with my views?

    Think about how many conferences you went to and got CPD points or CME credits for, but come Monday morning nothing changes and your patients are not better off! Sure, you had a fun weekend, networked with colleagues etc, but what impact did it have on your patient outcomes?

    The policing of these events in some places has become so ludicrous in that you need to sign in and out. I have even had a bar code on my name badge scanned in and out of every lecture I attended at one conference! How much resources and money was spent on that when come Monday morning it did not affect my patients one bit (unless I had a hangover from socialising :dizzy: )

    I do recall seeing some data from the USA, that those who got sued the most had more CME points .... to me that suggests that CME of the form used in the USA should be banned and not made compulsory in order to protect the public!

    I am a realistic and realise that regulatory authorities will impose it as their political masters and the public expect to see it (even though I think they are misguided).

    So if it is to be compulsory, then CME or CPD or whatever its is called, should be awarded for activities that actually improve patient outcomes. Bums on seats at conferences do not generally improve patient outcomes (there are lots of other good reasons for having conferences). What does improve patient outcomes? I recall a really good piece of research from the physical therapy literature on the impact that inter-practice visits (ie spending a day with a colleague) had on improving patient outcomes. Other research has shown the value of clinical audits on improving outcomes. We talk about evidence based practice, why do we ignore evidence based continuing education? How many of those in decsion making positions are even familiar with the evidence in the contiuin education literature? (does that not scare you?)

    How many CPD/CME programs around the world actively encourage and award points for activities that are directly related to improvements in patient outcomes? The APodC (Australia) and HPC (UK) schemes are big steps in that direction, but IMHO they still have way to much emphasis on the 'bums on seats' activities that are not necessarily related to outcomes.

    The adult education literature clearly shows that it is the self identification of deficits or weaknesses and taking steps to address those deficits in a self directed way is the best way for adults to learn (thats why the APodC scheme requires an initial filing identifying the plan to address self identified learning needs; ie its based on the evidence!). The Podiatry Arena CPD Points scheme is obviously self directed (think about your patient outcomes relative to the time spent on Podiatry Arena and other forums; esp if you ask a question about a particular patient you are having a problem with). Many regulatory authorities do not accept this kind of self directed learning as credit to their requirements, yet the evidence supports this kind of activity as actually changing patient outcomes (talk about mis-guided!)

    I still see too many people in decision making positions in regulatory authorities who are clearly unfamiliar with all the evidence and literature on this then making decisions on the nature and scope of these compulsory CME/CPD schemes. All they need to do, is ask, what is it that improves patient outcomes? - afterall, is not protecting the public the primary role of the regulatory authority?

    Some, I would go as far as calling 'control freaks' in what they are prescribing for different schemes. For eg, why all the policing at conferences/seminars etc to make sure people actually attend? Why do some regulatory authorities require accreditation of conferences/seminars etc under the guise of some sort of quality control of them? Given that the points that should be obtained from these types of activities don't contribute much, if anything, to patient outcome, the points/hours available should be a low proportion of the possible total points/hours, why waste peoples time and money on accrediting conferences and seminars? Its so stooopid and the words 'control freaks' pop up when thinking of the reasons. Let the market decide what is a good course. It has done really well so far. Afterall, how many bad ones are there? (people don’t go back!)

    Enough of my rant, what say you?
     
    Last edited: Dec 12, 2007
  2. Dave Cluderay

    Dave Cluderay Welcome New Poster

    Hi Craig,
    I agree, lots of people are jumping on the CPD bandwagon and much of it is poor quality and poor value for money. Reflective practice however, cost nothing but requires some thought and effort.
    The HPC are looking into re-validation (fitness to practice) examination every couple of years, have you any thoughts on this.
    Dave Cluderay
     
    Last edited: Dec 12, 2007
  3. Admin2

    Admin2 Administrator Staff Member

  4. Craig Payne

    Craig Payne Moderator

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    The reason that it is proliferating is the misguided belief that 'hours on bum in a lecture theatre' = CPD. So providers are jumping up to meet that misguided need, when it does not necessarily change patient outcomes.
    Which is exactly what I am arguing as it is this that leads to better patient outcomes. Those hell bent on facilitating the compulsory side of it should be requiring that it is this side of the equation that gets emphasised.
    The HPC scheme is a huge step in the right direction as it allows you to get points from a range of activities, some of which have been shown to improve patient outcomes. So its not all about 'bums on seats for x hours'. Its just there needs to be a mindset change as to what CPD actually affects patient outcomes and what does not and rewarding more of teh activities that do actually improve patient outcomes.

    BTW - I have nothing against conferences and seminars etc being part of CPD (on some occasions people do actually learn something that changes behaviour on Monday morning); there are lots of other reasons why we should have them and I run my far share of them. The maximum points that anyone should be able to claim from them towards the minimum total should be a small fraction of the total.
     
  5. DTT

    DTT Well-Known Member

    Hi Craig, Dave, et al



    The HPC gives us no way of counting CPD only that we must keep a record of all CPD completed and if we are audited they will send a form for us to fill out.

    Below is a quote from the HPC site

    As far as I am aware there is no laid down Quantity , points or otherwise of CPD only that it must cover the whole range of your scope of practice.

    But they do state that whatever we do it must benefit the end user:)

    I think it is slightly ambiguous inasmuch as the levels are now open to interpretation and what that means will be found out by some in next years audit :rolleyes:

    My personal take on it is , if there is something that I think will be good for my practice I go for it and steer well clear of irrelevancies that don't, which for me if great but whether that will satisfy ?:confused:


    Cheers

    Derek;)
     
  6. Cameron

    Cameron Well-Known Member

    netizens

    I am divided on CPD and whilst I think it is very important to maintain abreast of current professional developments by all manner of means I would also agree, much of the available CPD is poorly conceived if real behavioural attitudinal change is the goal. Most parochial examples seem to be there to generate income soley for the organisation or indidviduals responsible for the programs.

    >re-validation (fitness to practice) examination every couple of years
    This is a more likely scenario in my opinion but as to what function this will actually provides I remain open minded. What is clear form now on in is to maintain on-going registeration in progessional organisation(s) will cost more money.


    As Bob Kiddused to caution' in an age of change, sometimes staying still, requires you run much faster.

    toeslayer
     
  7. DTT

    DTT Well-Known Member

    Hi Cameron

    I think forums such as this are an excellent source of doing just that :)

    My time is at a premium as an IPP so anything I do must be relevant to my practice and cost effective so CPD on CD rom's forums internet all thing I can do "in between Pts" will do for me.


    I think that would be a mistake .

    Talking to several senior consultant a short time ago about this very thing and they were totally opposed to it because as they all admitted they could never pass an entrance exam again the crossed T's and dotted i's have been replaced by experience:cool:

    They said in their opinion if such a scheme was brought in three quarters of your existing hospital consultants would disappear, which solves ??:confused:

    Exams are simply a memory test nothing more. They do not prove safe effective practice which conversely continual assessment does.

    I hope that a "what size fits you" mindset will continue as we seem to be going down the "individual specialty" route in the profession generally which will mean eventually we will all have to tailor our CPD /FTP to that part in which we have the chosen specialty.

    We should all remember at whatever level we practice it is our employment / living and that is something that should never be put at risk unnecessarily.

    Just my thoughts

    Cheers
    Derek;)
     
  8. My 0.02$

    I think that the present mechanism of CPD is flawed for several reasons. As Craig observes its the easiest thing in the world to trot along to a conference and dose off for a few days without actually learning anything.

    For me CPD is not so much something which you should do twice a year when you go to seminars. Its more an attitude. Its the bit that makes you think, when you come across something you don't know about, how can i find out about this?

    The Forums are one of several ways to do this because they expose you to the ideas everyone else are using. This is a good way of highlighting areas you need to work on because as my old boss once pointed out, You don't know what you don't know.

    In the NHS we are supposed:rolleyes::pigs: to have Reviews every year where we discuss the previous years learning and learning requirements with a senior colleague, highlight learning oppertunities and discuss how we wish to target next years development. This is a good idea so far as it goes although i think a year is too long.

    My team do this as part of a monthly or 2 monthly meeting. We discuss what we've been looking at in the past month and share it around. In this way we both help and motivate each other. Think weight watchers but with CPD instead of weight.

    This is the problem which exists in many forms of education. Tha national curriculem was brought in to standardise what was learnt at school. It did mean everyone learned the minimum basics but also stifled creativity in teachers and many think it missed the point.

    I Don't like the points system, i just cannot think of a better one. Unless the HPC employed senior clinicians to tour the country to do a version of the Peer review development plans with every HPC member every year to ensure that nobody was stagnating. And whilst that would probably be welcomed by those with a genuine desire to learn it would never be stood for by the "old guard" who already know everything they need to know thankyou very much!

    You can take a Pod to education but you can't make them learn!

    Regards
    Robert
     
  9. footman1972

    footman1972 Active Member

    I have experience of conducting peer reviews from my time with Boots Footcare. The first few were a nerve-wracking experience for both my colleagues and myself until we all worked out that this was a genuine attempt to provide support and mentoring, and not the company using the stick to make sure people were following clinical protocols. Some (more experienced) colleagues took exception to their clinical practice being examined in this way, and I agree that this can be a very intrusive process. However, I found that I learned far more about what I can do to improve my own practice by having a colleague watch what I do and how I interacted with my patients than from any self-assessment tool you care to mention.
     
  10. DTT

    DTT Well-Known Member

    Hi Robert et al

    I don't think the HPC run a points system (see earlier post) we don't have a set "quantitative" CPD or any way to measure it only that "whatever we do must cover all aspects of your practice" .

    I am in private practice and work alone. I target this week,month ,year next year and all future development because if I don't or I get it wrong them suddenly I don't have a practice !!. That is a hard fact of life for all IPP's:eek:

    As you know we discuss various view on various topics on podiatry forums which I learn a lot from and therefore reflects in my practice.

    I attend various seminars ,meetings and discuss with my peers and again bring it back and kick it around to see how / if it would fit into my protocols.

    That is one fundamental problem with CPD that we all have different practice needs and I see no point in doing any CPD that that frankly is useless to me in my situation which costs lots of money ( I pay for the cost and lose the income whilst I do the seminar ) which will ultimately reflect in my fee, so has to be balanced.

    So visiting peer review?

    I don't think that is a realistic proposition ?

    Unless you want to take a trip down the M25 ??:D

    Cheers
    Derek;)
     
  11. Craig Payne

    Craig Payne Moderator

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    Which is my point. The evidence is that it is these kind of activities that actually work better at changing patient outcomes. If CPD points systems are to be compulsory, it is this that should be more rewarded.
     
  12. DTT

    DTT Well-Known Member

    Hi Craig

    Please will you show me where the HPC says it is or is even suggested that "points" are required by anyone except "by the SCP" who do not represent all podiatrists in the UK.

    If that is the case then the HPC method must be the chosen path??:confused:

    Cheers
    Derek;)
     
  13. Craig Payne

    Craig Payne Moderator

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    When I use the term "points", I am really using that generically to refer to any quantification of CPD -- if you look around the world at all the differnet systems, they use different terminolgy. Could be points, credits, hours, etc. It does make it a bit difficult to write about when each country has its own set of terminolgy.
     
  14. DTT

    DTT Well-Known Member

    Hi Craig

    That is my "point":)

    Read my earlier posts please.

    The HPC has not laid down ANY quantifiable measure for CPD in this country ONLY that " any cpd must cover all aspects of your practice" (or words to that effect direct quote earlier)

    They have given us free license to take on CPD at our own level to suit our own practice BUT

    Have not set a quantifiable level.

    I hope this makes sense ?

    Cheers
    Derek;)
     
  15. Craig Payne

    Craig Payne Moderator

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    I assume the reasoning behind that is that as long as people are developing, then it must be doing some good.

    Another approach I take to this and it touches in toeslayers point above, is ...lets consider competence to be on a bell shaped curve. There will be people who's competence is more than 2 standard deviations below the mean. Allegedly these are the people that perhaps put the public at risk.

    What can we do with this group 2SD's below the mean?:
    1. The stick approach. Get rid of them by some sort of flawed assessment system
    2. The carrot approach. Work at shifting the mean to the right and they will be dragged along.

    The carrot approach assumes that there will always be people 2SD's below the mean and if you get rid of them, then a new group of people will be 2 SD's below the mean (what shall we now do about them?).... so why not accept this and as long as the mean is kept being moved to the right, then what is the issue? This is much more inclusive rather than the exclusive stick approach.

    A problem I see is that those 2SD's above the mean want to impose their standards on those who are at the other end of the curve by excluding them. Is that appropriate?

    As long has everyone is developing, the mean will be moving right. Does it really matter how many hours are spent on it?
     
  16. DTT

    DTT Well-Known Member

    Hi Craig

    I agree with you BUT

    I was making the point that a POINTS system ( which has been the norm with the SCP for may years is now defunct.
    I'm not sure reading many posts on various sites including the arena that point has been fully understood.


    I am happy with the HPC attitude toward CPD but I do have concerns that there is no quantifiable measure laid down for audit.

    I will be more than happy to include my 10,000 points from here in my CPD log:rolleyes: if I am unfortunate enough to get the fickle finger of the HPC choose me for the first audit , but in my position I still have a cynical outlook as this could be yet another stick to beat me with if they feel like it ?:hammer:

    Cheers
    Derek;)
     
  17. a.mcmillan

    a.mcmillan Guest

    Greetings to Craig and all members :eek:,

    Though I’m a 4th yr student (Melbourne), I have an interest in CME and would like to throw out an idea on the topic:

    Perhaps mandatory CME could be considered from an ethical perspective; that it may have more relevance to non-maleficence, and less relevance to beneficence. Afterall, our ability to ‘do harm’ may be a significant reason why we must be registered to practice.

    Perhaps CME could be a mandatory requirement for podiatrists who wish to provide those interventions in our scope of practice that are most likely to cause harm to the patient. For example, is CME as important to the prescription of foot orthoses, as it is to the prescription and injection of betamethasone ?

    In my view, CME that is relevant to physical therapies and other low-risk forms of treatment may serve to provide ‘gold-standard’ interventions, while CME that is relevant to nail surgery, diabetic wound management and prescription of restricted medications would serve to protect patients. It could be argued that the latter objective of CME should be compulsorary (to protect patients), while the former could be voluntary (to enhance efficacy).

    Those clinicians who wish to prescribe and inject restricted medications would be required to undertake compulsorary CME relevant to this scope of practice. Those who wish to debride diabetic ulcers must also demonstrate relevant CME, and likewise for those who perform skin and nail surgery.

    It could be enforced separately under 3 major categories of ‘higher risk practice’:

    1. Prescription and injection of medications
    2. Diabetic wound management
    3. Surgery

    Therefore, a podiatrist who wishes to debride ulcers, prescribe and inject medications, and perform nail surgery would need to accept that compusorary CME will need to be demonstrated for all three practices.

    The higher your risk of (inadvertently) doing harm, the higher your responsibility for CME.

    Just some thoughts, and I would greatly appreciate feedback from those with real experience (as I have none :D !!) Also, please find below the abstract of a systematic review of CME published last year:

    What do others think :rolleyes: ?

    Regards,

    Andrew
     
  18. betafeet

    betafeet Active Member

    Yes I agree Andrew CPD should be directed to ones own relivance to pactice which I feel it is heading in that direction and yes we must always reflect on what we have learnt. As a Private Practioner and have to pay for any courses myself, so I endevour to highlight my personal weaknesses (which there are many). I have personally found some courses are of poor quality but have still not gone home without learning something.

    My main problem with this though is I'm on a continual learning rollercoaster and its hard to find time to climb off and record it (enjoying the journey).

    Research, reflect and self audit we all must otherwise we would just continue to tread water and never move foreward. Although there will always be those in any profession that need to be beaten with a stick to get to the finish line. You won't find those in forums like this though!

    I would like now to thank you one and all for your part in my Continual Professional Developement.

    Jude
     
  19. Tuckersm

    Tuckersm Well-Known Member

    Andrew,

    Prescription of medications: it will be required by the registration board in Victoria to maintain endorsement, though process still in development

    Diabetic Wound Management: Hard to enforce at a base level, as who knows what goes on in an individual practice, but if a specialist diabetes, pod group/college does get established (we are trying) it is proposed that CE/peer review/audits etc. will be required to maintain membership/fellowship

    Surgery: The ACPS is reviewing its CME process at present to include a true quality improvement framework.
     
  20. Craig Payne

    Craig Payne Moderator

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    Thats the point I keep making! Its not all about 'bums' on seats for hours; it about activities that lead to improvements in patient outcomes.

    Stephen - of those in the decision making roles for the above, how many are familar with the research evidence on continuing professional development and adult learning?
     
  21. Tuckersm

    Tuckersm Well-Known Member

    Craig,

    As I am involved in 1 and 2, I have some understanding (mainly thanks to your posts here). The board is looking at a mixture of traditional CE through a variety of delivery methods (probably with some form of post CE "quiz", that must be passed, similar to what the APS offers in its journal to pharmacists) as well as requiring endorsed podiatrists to conduct some form of prescribing practice audit, with the board, randomly checking this completion. What the board wants to achieve is safe prescribing practice, so the process can be adapted to ensure that occurs.

    The Advanced Practicing podiatrists-High Risk Foot are looking at a range of options, but 1st need to develop competencies to measure against.
     
  22. Craig Payne

    Craig Payne Moderator

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    I have had discussions with a number of people in 'decision making roles' who want CPD compulsory, purely becasue of how much money they or their organisation can make from running courses for the 'bums on seats'..... (nothing to do with the evidence!)

    I would bet that if we were to think about our own clinical practices and what we did to that lead to better patient outcomes, that most of it probably came from something that wasn't paid for and didn't have a quiz associated with it.
     
  23. Ella Hurrell

    Ella Hurrell Active Member

    To play devil's advocate a little - do we not think that CPD/CME is just as important for ALL areas of practice. If it were not necessary in all relevant areas within an individual's practice, (ie orthoses) then potentially there could be a situation where a pod qualifies and never looks at the literature again, and continues producing orthoses that are outdated and superceded (ie. our profession's previous thoughts on the basis of STJ neutral in orthoses design). I realise this can be the case whether CPD is compulsory or not, but at least there is a constant reminder to keep up to date. Could it be considered as potential 'harm' to prescribe discredited orthoses designs? What say you?
     
  24. DTT

    DTT Well-Known Member

    Hi Craig et al



    Here in the UK that type of situation is springing up at an alarming rate and an alarming cost to the practitioner:eek:

    We have a group that has started just that with everyone giving their expertise on a variety of subjects at no charge = in house CPE

    No "Quiz's" just discussion , demonstration ,reflection and presentation take from it what you will even if its just the enthusiasm to learn:D

    IT WORKS !!:cool:

    Cheers
    Derek;)
     
  25. Craig Payne

    Craig Payne Moderator

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    I have nothing against courses/conferences etc; as there is a lot of other reasons for holding them (eg networking) (and I will be in the UK early next year running some courses!) ... its just the emphasis that gets placed on them when earning 'points' or 'hours'. Participants do get something from them, but that pales into insignificance when you look at what else can be done to improve patient outcomes.
    All of the subjects I teach at the UG level have NO exams associated with them. They are taught and assessed based on what the evidence tells me is the best way that people retain things for the long term. 'Quiz's' and 'exams' test nothing more than how good someones short term memory is. "Discussion , demonstration, reflection and presentation" are what gets retained and changes practice .. and as you said it costs nothing. The problem is that the majority of the decision makers just don't get it (or don't want to get it) when designing their CPD/CME schemes.
     
  26. Tuckersm

    Tuckersm Well-Known Member

    Craig,

    I agree with you that that is the best way to ensure best practice etc., but a system also has to be workable, available across the state and affordable, and accountable. As the board develops its presciption endorsment CE package the educational institutions will be given an opportunity to be involved, and we do listen (sometimes):D
     
  27. DaVinci

    DaVinci Well-Known Member

    I think a lot depends on the course and how its run. Your Biomechanics Boot Camps are legendary and I have heard some participants call them something like "life changing". So those kinds of courses do change clinical practice, whereas things like the national conference are just filled up with a lot of clinically irrevalent academic research.
     
  28. Craig Payne

    Craig Payne Moderator

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    I don't want to take that much credit :D ... but again, is it the course ('bums on seats') or was the course the catalyst for "Discussion , demonstration, reflection and presentation" ?? ... in that when they went back to their practice on Monday, they tried a few things; they discussed it with those they work with; they looked up a few things in books; on Podiatry Arena; (or they emailed me for clairifcation); etc; they reflected on what was said in the context of their current clinical practice .... when did the learning take place? Which part of this process is given the credit in the CPD schemes? How much did the work collegues (who did not go on the course) benefit from the "Discussion , demonstration, reflection and presentation" ???
     
  29. Boots n all

    Boots n all Well-Known Member

    l look at CPD's as away of giving me an Edge over the others, l have clocked up about 180 hours for the year of going to lectures/workshops and other.... if you can continue to learn you can continue improve the service/outcomes for your clients.

    How do enforced CPD's fit into that? some need to be dragged into the light so they can see:hammer:

    The whole thing is under review for us at the moment, l have put forward that things like Clinical reviews and shared clinic time with others from outside your clinic be included as CPD's, as Craig quite rightly pointed out it is often after the Lecture when you are sharing your experience with others that the real learning begins, the sharing of knowledge
     
  30. Craig Payne

    Craig Payne Moderator

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    Let me play the devil's advocate ...who are these people?

    There are a group of people who have never done CPD (or at least not done anything for years); they are the people that you and I think are not up-to-date; they have probably practiced the same way for 100 years (or at least since they first qualified); they may practice podiatry in a way that you and I do not like; they may practice podiatry in a way that you and I think presents a detrimental image of the profession (and therefore impacts on you and I).

    BUT, they are generally safe in their practices (if they stay within their skill level); their patients are happy; they enjoy what they are doing (at least I assume they do, as they have stuck with it); and they are doing no harm; they are putting no one at risk (except your and my professional status)?

    SO, why should CPD be enforced on them? They are, generally, putting no one at risk and the CPD masters tell us that this is needed to protect the public :confused:

    A counter argument, is that those who do CPD a lot are more likely to step outside their safety zone and use procedures, method and techniques that are more than likely to put the public at risk because they did a 'weekend' course on them :confused:

    SO why do we want these people to comply with your and my standards?? (in other contexts, this sort of attitude is called racism, agism, sexism, etc). Is it purely because you and I think that they way they practice is not the image that we want for the profession. Is it more about "us" and not the public safety?
     
  31. DaVinci

    DaVinci Well-Known Member

    Paynie, always the provocateur!

    This thread should be compulsory reading for all those on Associations and Registration Boards or anyone contemplating this. Agree or disagree, I would feel much more comfortable if decisions were made in knowledge of the issues discussed in this thread.
     
  32. a.mcmillan

    a.mcmillan Guest

    Hi Ella,

    I agree that it’s important to keep up with the evidence for all treatments. I also agree that it is possible to do harm with an orthosis (eg paediatric applications). However a patient can stop using an orthosis if their condition is worsening rather than improving, while the same solution may not be available for higher risk practices.

    In the case of prescription medications, wound management and surgery, a patient may begin with a relatively benign complaint, and end up with a much more serious iatrogenic condition (ADR, osteomyelitis etc).

    Just my views :rolleyes:!

    Cheers,

    Andrew
     
  33. Craig Payne

    Craig Payne Moderator

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    I started this thread almost 4 yrs ago
    Look what just got published:

    Continuing professional development: The missing link

    Lucy S. Chipchase, Venerina Johnstona, Phillip D. Lon
    Manual Therapy (in press)
     
  34. fishpod

    fishpod Well-Known Member

    not a truer word was ever said. if you cut toe nails and earn 100 grand why do you need all this cpd crap nothing has changed in scraping callus and cutting nails in my 30 years in practice. biomechanics has changed diabetic care has changed i try to keep up. nail surgery has not changed in 30 years why do i need cpd in it i do 4/5 per week they all go pretty smooth just like the 1st one i did at salford tech 30 years ago if its not broke dont fix it, we all work at different levels if you want to be a trailblazer good luck and bonvoyage but as craig says some of us are happy and keep plodding on.
     
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