Practice and professional development plans (PPDPs): results of a feasibility study

Background  

Dissatisfaction with uniprofessional education structures as a means of improving the quality of healthcare has led to proposals to develop ways of integrating professional learning and organisational development.     

Continuing professional development (CPD): GPs' perceptions of post-graduate education-approved (PGEA) meetings and personal professional development plans (PDPs)

BACKGROUND: Conventional post-graduate meetings-typically 'lunchtime' meetings outside practices-have been heavily criticized. Revalidation is also impending, and there has been associated pressure for the widespread introduction of personal development plans (PDPs). However, there is very little empirical evidence about the usefulness to GPs of different kinds of educational meeting or of PDPs. OBJECTIVES: Our aim was to assess the utility to GPs of different types of post-graduate meeting and PDPs. METHODS: A postal questionnaire was sent to 921 GP principals in three health authorities, who were asked to recall their most recent post-graduate education-approved (PGEA) meetings (practice-based and 'outside') and the latest major learning 'undertaken' in their PDP. RESULTS: A total of 698 GPs (76%) returned questionnaires. A substantial minority (208; 30%) had a PDP. Most had undertaken education recently [median time elapsed (weeks): meeting 'outside' practice, 4; 'practice-based', 5; PDP, 3]. Education had not changed clinical practice for many GPs ('practice-based' 39% reported no change; 'outside' meetings 50% and PDPs 57%). A change in practice after a practice meeting was related to relevance to everyday practice [disagree/neutral, agree, strongly agree odds ratios: 1.00, 4.22 (95% CI 2.1-8.6) and 5.9 (2.6-13.3), respectively], to lecturer factors (enthusiasm, summarizing important points, handouts) and to social enjoyment. PDPs were less likely to be perceived relevant to practice (practice-based meeting, 'outside' meeting, PDPs: 89, 87 and 72%, respectively), as a break from practice (54,72 and 18%), good socially (63, 72 and 15%), good for professional networking (54, 70 and 19%) and glad to have done it (84, 86 and 44%). Being glad to use a PDP was more likely if the learning was clinically relevant, a break from practice, and incorporated professional networking. CONCLUSION: Changes in practice after post-graduate meetings are not only related to clinical relevance and lecturer factors, but also to professional and social factors. PDPs may not be providing better learning opportunities or enjoyment than traditional meetings, although GPs who are glad to use PDPs incorporate clinical relevance, a break from practice and networking. Post-graduate tutors should probably continue to support and monitor the lecturer quality and clinical relevance of a balanced portfolio of both practice-based and 'outside' meetings.     

The development of practice professional development plans from the postgraduate education allowance: a discussion of the causes and implications

Practice professional development plans (PPDPs) began to replace the Postgraduate Education Allowance (PGEA) for general practitioners in England and Wales from April 2000. The origin of this change lies with those with educational expertise who have been concerned that the PGEA fails to encourage GPs to define their own learning needs, fails to encourage practice-based learning and fails to influence their working behaviour. The policy has been influenced however, by wider political developments which view PPDPs as a means to ensure national standards are met, to reassure the public, provide uniformity and deal with underperforming doctors. This mixture of influences has resulted in conflicting areas within PPDPs. There are different emphases on whether learning needs should be defined from the perspective of the individual or from the perspective of wider needs within the NHS. There are conflicting views about the desirability of multi- or uniprofessional learning and conflicting views about whether PPDPs are appropriate for dealing with failing doctors. PPDPs are based on a particular theory of adult learning - andragogy - which arguably fails to account for wider, richer and more significant forms of learning.     

Dollars, debts and duties: lessons from funding Australian general practice

This study investigated changes in resource allocation and activities of Australian Divisions of General Practice associated with new funding procedures which link monies to nominated outcomes. The study involved analysis of annual reports and strategic plans, and semistructured telephone interviews with key personnel from 27 divisions of general practice. The main outcome measures were: number of activities in various nominated health areas; total and median expenditure per activity in each area; and methods of resource allocation. Despite a modest increase in funding to the total general practice divisions program over the two year period, expenditure decreased in the National Health Priority Areas of mental health, diabetes, cardiovascular disease, injuries and cancer. There was increased expenditure in the priority area of immunisation, which received dedicated funding. There was greatly increased expenditure in the areas of information technology and services to GPs (including continuing medical education, professional development and workforce issues). The ease of defining and measuring outcomes influenced the choice of activities. In 1996, activities were linked to formal needs analyses in approximately 20 per cent of cases. The most frequent driving force for projects was enthusiastic GPs. In 1998, resource allocation decisions were more explicitly linked to formal needs analyses; however, the standard of the needs analyses varied widely between divisions. Changes in funding procedures which use nominated outcomes as the major accountability mechanism may produce unexpected, and unintended results, including significantly decreased expenditure in areas with outcomes which are hard to define and measure but which are important for health improvement.     

Professionalism in general practice: development of an instrument to assess professional behaviour in general practitioner trainees

INTRODUCTION: The aim of this study is to develop a new tool to assess professional behaviour in general practitioner (GP) trainees: the evaluation of professional behaviour in general practice (EPRO-GP) instrument. METHODS: Our study consisted of 4 phases: (1) development of a model of professionalism in general practice based on a literature review on professionalism, competency models of general practice and the overall educational objectives of postgraduate training for general practice; (2) development of the EPRO-GP instrument in collaboration with a sounding board; (3) establishing the content validity of the EPRO-GP instrument using a nominal group technique; and (4) establishing the feasibility of the EPRO-GP instrument in 12 general practice trainees and their general practice trainers. RESULTS: The model of professionalism in general practice encompassed 4 themes within professionalism: (a) professionalism towards the patient; (b) professionalism towards other professionals; (c) professionalism towards the public; and (d) professionalism towards oneself. These 4 themes covered 26 elements of professionalism. This model provided the framework of the EPRO-GP instrument, which we developed further by operationalising the 26 elements in 127 behavioural items. The expert ratings confirmed the content validity of the instrument with one exception: the element "altruism" was removed as a stand-alone category but it remained throughout the tool in items giving primacy to patient welfare. The results on the feasibility of the EPRO-GP instrument were very encouraging. All tutorials yielded professional behaviour learning points. DISCUSSION: Our results support the content validity of the EPRO-GP instrument as well as its feasibility as a tool to educate for professionalism in general practice.     

Organisational determinants of production and efficiency in general practice: a population-based study

Objective

Shortage of general practitioners (GPs) and an increased political focus on primary care have enforced the interest in efficiency analysis in the Danish primary care sector. This paper assesses the association between organisational factors of general practices and production and efficiency.

Methods

We assume that production and efficiency can be modelled using a behavioural production function. We apply the Battese and Coelli (Empir Econ 20:325–332, 1995) estimator to accomplish a decomposition of exogenous variables to determine the production frontier and variables determining the individual GPs distance to this frontier. Two different measures of practice outputs (number of office visits and total production) were applied and the results compared.

Results

The results indicate that nurses do not substitute GPs in the production. The production function exhibited constant returns to scale. The mean level of efficiency was between 0.79 and 0.84, and list size was the most important determinant of variation in efficiency levels.

Conclusions

Nurses are currently undertaking other tasks than GPs, and larger practices do not lead to increased production per GP. However, a relative increase in list size increased the efficiency. This indicates that organisational changes aiming to increase capacity in general practice should be carefully designed and tested.

     

Organisational capacity and chronic disease care: an Australian general practice perspective

Although we are rapidly improving our understanding of how to manage patients with chronic illness in Australian general practice, many patients are still receiving suboptimal care. General practices have limited organisational capacity to provide the structured care that is required for managing chronic conditions: regular monitoring, decision support, patient recall, supporting patient self management, team work, and information management. This requires a shift away from episodic, acute models. Overseas research has shown that areas such as team work, clinical information systems, decision support, linkages and leadership are also important in managing chronic illness, but we do not know which of these are most important in Australia.     

Organisational change theory and the use of indicators in general practice

General practices are making greater use of indicators to help shape and develop organisational arrangements supporting the delivery of health care. Debate continues concerning what exactly such indicators should measure and how they should be used to achieve improvement. Organisational theories can provide an analytical backdrop to inform the design of indicators, critique their construction, and evaluate their use. Systems theory, organisational development, social worlds theory, and complexity theory each has a practical contribution to make to our understanding of how indicators work in prompting quality improvements and why they sometimes don't. This paper argues that systems theory exerts the most influence over the use of indicators. It concludes that a strategic framework for quality improvement should take account of all four theories, recognising the multiple realities that any one approach will fail to reflect.     

Continuing professional development of physicians in Uruguay: lessons from a countrywide experience

This article describes the advancement of continuing professional development (CPD) for physicians in Uruguay and explains the motivations for a CPD system, the role of the faculty of medicine and the other stakeholders, the strategic goals, and current results, including strengths and weaknesses. The work described here had three strategic objectives: (1) initiate a CPD accreditation program, (2) train physician leaders in CPD, and (3) promote the creation of a national system for CPD. By the end of 2006, the accreditation program had 34 accredited institutions. Over a 10-year period, 150 physician leaders from different regions of the country and with different specialties had been trained in the framework and methodological issues of CPD. Legislation is expected to be introduced into parliament during 2007 for coordinating CPD efforts at a national level.     

Clinical governance and professional restratification in general practice

Examines the professional stratification in general practice in the UK National Health Service. Looks in particular at the reforms implemented by New Labour--the introduction of primary care groups and their transition to primary care trusts. Concludes that the key to restratification lies in understanding the agenda being pursued.     

Errors of alternative medicine: lessons for general practice

Abstract

Background: Due to the importance of family medicine and a relative shortage of doctors in this discipline, it is important to know how the decision to choose a career in this field is made.

Objective: Since this decision is closely linked to students’ attitudes towards family medicine, we were interested in identifying those attitudes that predict intended career choice in family medicine.

Methods: A cross-sectional study was performed among 316 final-year medical students of the Ljubljana Medical Faculty in Slovenia. The students filled out a 164-item questionnaire, developed based on the European definition of family medicine and the EURACT Educational Agenda, using a seven-point Likert scale containing attitudes towards family medicine. The students also recorded their interest in family medicine on a five-point Likert scale. Attitudes were selected using a feature selection procedure with artificial neural networks that best differentiated between students who are likely and students who are unlikely to become family physicians.

Results: Thirty-one out of 164 attitudes predict a career in family medicine, with a classification accuracy of at least 85%. Predictors of intended career choice in family medicine are related to three categories: understanding of the discipline, working in a coherent health care system and person-centredness. The most important predictor is an appreciation of a long-term doctor–patient relationship.

Conclusion: Students whose intended career choice is family medicine differ from other students in having more positive attitudes towards family physicians’ competences and towards characteristics of family medicine and primary care.     

Continuing professional development for general practitioners: supporting the development of professionalism

Medical Education 2010: 44 : 412–420 Objectives The profession of medicine has long been characterised by virtues such as authorisation, specialisation, autonomy, self‐regulation and adherence to an ethical code of practice, and its complexity has granted it the privilege of self‐regulation. Studies have shown continuing professional development (CPD) for general practitioners (GPs) to be most effective when it is set up within a multi‐method design. This paper reports a research‐based evaluation of a 2‐year educational CPD project for 21 GPs. Methods The project focused on the issue of ‘children in need’ and was delivered through group supervision, teaching days, an e‐portfolio, literature, newsletters and a desk checklist. A mixed‐methods evaluation design was used. Results The GPs demonstrated an overall preference for supervision as an authentic method for self‐directed professional development because it facilitated the creation of a common platform for relevant and useful knowledge in the context of general practice. Other methods were perceived as less valuable for GPs’ CPD. Conclusions The results suggest that general practitioners need to establish a common platform of shared experiences before engaging in multi‐professional CPD. Participation in the supervision allowed the three groups of GPs to develop their professional skills, but left them with a desire for more training in establishing cooperative practices with their partners in care. The professional challenges discussed during the supervision sessions were important elements of the national GP Curriculum, but not all elements of professionalism were covered.