Continuing medical education: Quality issues in continuing medical education

Series editors: Hans Asbjorn Holm and Tessa Richards This is the fifth in a series of seven articles looking at international trends and forces in doctors' continuing professional development The need for continuous learning as part of a doctor's professional career is evident. The best ways of introducing and nurturing this learning have been the subject of much controversy, and the quality of medical education at all levels is being questioned and debated in many countries. This article looks at some trends and issues that are being addressed in order to improve the effectiveness of doctors' continuous learning. Innovations in undergraduate medical education are influencing the whole spectrum of medical education. So too is the growing literature on adult learning1-4 and the doctor as learner. 5 6 The works of Schon especially clarify the importance of the professionals' reflection on their everyday practice as a means of continuous change and learning. 7 8 Clinical problem solving has been identified as the core activity of how doctors learn and keep developing their competence. Creating an environment that provides practitioners with opportunities to explore and understand the personal theories underpinning their own practice is crucial for continuous professional development at all stages.9 Although a division of medical education into stages—undergraduate, postgraduate, and continuing medical education (CME)—seems sound from a regulatory and legal perspective, there are no fundamental differences in the way people learn across the continuum. The student often is told what to learn, but the qualified doctor is responsible for directing his or her own (lifelong) learning.10 #### Self directed learning “A process in which learners take the initiative … for increasing self and social awareness; critically analysing and reflecting on their work … defining their learning needs … formulating goals … identifying human and material resources for learning … choosing appropriate …