Continuing education in pain management: using a competency framework to guide professional development

Much has been written about the importance of formally integrating pain management education into undergraduate and professional preparation programs to adequately prepare beginning practitioners for clinical practice. In recent years, a competency-based approach has been put forward as a mechanism for achieving this outcome. In the main, these developments have been primarily directed at prelicensure pain education, and relatively little has been published on how competence in painmanagement over time ismaintained and the role of continuing professional development (CPD) in a postlicensure. Whether CPD is mandated or not, by a professional body or regulatory authority, participation in such activity is viewed as a necessary component of competent professional practice: from an individual perspective in terms of keeping up to date with knowledge advances and changes to clinical practice and an institutional perspective in terms of improved health outcomes for patients. In relation to managing something as common as back pain, for example, it has been found that practising physicians who simply reported an interest in the topic were significantly less knowledgeable about the best evidencebased approaches compared with those who had recently completed formal CPD on the topic. Furthermore, results from systematic reviews in recent times, examining the impact of formal CPD courses in both face-to-face and online formats, reveal that while these education activities are effective in terms of imparting knowledge and developing skills, there is little evidence about whether or not they result in improved clinical performance and patient outcomes. This situation indicates that a more competency-based approach (competency-based medical education [CBME]) should be included within the rubric of CPD. To situate the discussion, we draw on the work of Boud and Hager who highlight the limitations of common current conceptualisations of CPD, which seem more about input (eg, topics covered), than outcomes. They suggest that the metaphors of “acquisition,” “possession,” and “transfer,” which are commonly associated with CPD, are problematic for 2 reasons. First, these metaphors fail to capture the complexities of work practice and the specific learning needs of professionals. Second, they encourage a reductionist, overly simplistic and individualistic approach to CPD, which is often divorced from work practice (p. 20–21). Boud and Hager propose an alternative conceptualisation for thinking about professional development using the metaphors of “participation,” “construction,” and “becoming.” This perspective, they argue, is more productive, in that it recognises the intricate relationship between work practice and learning, and it positions CPD as an ongoing (lifelong) process: one that is situated in practice and is collaborative in nature. This alternative viewpoint need not apply only to learning that occurs as a result of engagement in work and work practices. It also has application for the design of learning Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.