Methodology for assessing the appropriateness of Continuing Professional Development for pharmacy professionals’ revalidation

From April 2010, the General Pharmaceutical Council (GPhC) will be responsible for the statutory regulation of pharmacists and pharmacy technicians in Great Britain (GB).[1] All statutorily regulated health professionals will need to periodically demonstrate their fitness-to-practise through a process of revalidation.[2] One option being considered in GB is that continuing professional development (CPD) records will form a part of the evidence submitted for revalidation, similar to the system in New Zealand.[3] At present, pharmacy professionals must make a minimum of nine CPD entries per annum from 1 March 2009 using the Royal Pharmaceutical Society of Great Britain (RPSGB) CPD framework. Our aim was to explore the applicability of new revalidation standards within the current CPD framework. We also wanted to review the content of CPD portfolios to assess strengths and qualities and identify any information gaps for the purpose of revalidation.

CPD records for revalidation: assessing fitness-to-practise using ‘revalidation standards’ and an Outcomes Framework

Background: Currently, all pharmacists and technicians registered with the Royal Pharmaceutical Society of Great Britain must complete a minimum of nine Continuing Professional Development (CPD) record (entries) each year. From September 2010 a new regulatory body, the General Pharmaceutical Council, will oversee the regulation (including revalidation) of all pharmacy registrants in Great Britain. CPD may provide part of the supporting evidence that a practitioner submits to the regulator as part of the revalidation process. Gaps in knowledge necessitated further research to examine the usefulness of CPD in a pharmacy revalidation Project aims: The overall aims of this project were to summarise pharmacy professionals’ past involvement in CPD, examine the usability of current CPD entries for the purpose of revalidation, and to examine the impact of ‘revalidation standards’ and a bespoke Outcomes Framework on the conduct and construction of CPD entries for future revalidation of pharmacy professionals. We completed a comprehensive review of the literature, devised, validated and tested the impact of a new CPD Outcomes Framework and related training material in an empirical investigation involving volunteer pharmacy professionals and also spoke with our participants to bring meaning and understanding to the process of CPD conduct and recording and to gain feedback on the study itself. Key findings: The comprehensive literature review identified perceived barriers to CPD and resulted in recommendations that could potentially rectify pharmacy professionals’ perceptions and facilitate participation in CPD. The CPD Outcomes Framework can be used to score CPD entries Compared to a control (CPD and ‘revalidation standards’ only), we found that training participants to apply the CPD Outcomes Framework resulted in entries that scored significantly higher in the context of a quantitative method of CPD assessment. Feedback from participants who had received the CPD Outcomes Framework was positive and a number of useful suggestions were made about improvements to the Framework and related training. Entries scored higher because participants had consciously applied concepts linked to the CPD Outcomes Framework whereas entries scored low where participants had been unable to apply the concepts of the Framework for a variety of reasons including limitations posed by the ‘Plan & Record’ template. Feedback about the nature of the ‘revalidation standards’ and their application to CPD was not positive and participants had not in the main sought to apply the standards to their CPD entries – but those in the intervention group were more likely to have referred to the revalidation standards for their CPD. As assessors, we too found the process of selecting and assigning ‘revalidation standards’ to individual CPD entries burdensome and somewhat unspecific. We believe that addressing the perceived barriers and drawing on the facilitators will help deal with the apparent lack of engagement with the revalidation standards and have been able to make a set of relevant recommendations. We devised a model to explain and tell the story of CPD behaviour. Based on the concepts of purpose, action and results, the model centres on explaining two types of CPD behaviour, one following the traditional CE pathway and the other a more genuine CPD pathway. Entries which scored higher when we applied the CPD Outcomes Framework were more likely to follow the CPD pathway in the model above. Significant to our finding is that while participants following both models of practice took part in this study, the CPD Outcomes Framework was able to change people’s CPD behaviour to make it more inline with the CPD pathway. The CPD Outcomes Framework in defining the CPD criteria, the training pack in teaching the basis and use of the Framework and the process of assessment in using the CPD Outcomes Framework, would have interacted to improve participants’ CPD through a collective process. Participants were keen to receive a curriculum against which certainly CE-type activities could be conducted and another important observation relates to whether CE has any role to play in pharmacy professionals’ revalidation. We would recommend that the CPD Outcomes Framework is used in the revalidation of pharmacy professionals in the future provided the requirement to submit 9 CPD entries per annum is re-examined and expressed more clearly in relation to what specifically participants are being asked to submit – i.e. the ratio of CE to CPD entries. We can foresee a benefit in setting more regular intervals which would act as deadlines for CPD submission in the future. On the whole, there is value in using CPD for the purpose of pharmacy professionals’ revalidation in the future.

General care of the older cancer patient.

With increasing age, there are greater numbers of older people who will be diagnosed with cancer. It must be remembered that such individuals have increased frailty and have a number of geriatric syndromes and conditions particularly pertinent to older age, including incontinence, poor cognition and impaired nutrition. It is often difficult to define the effects of cancer and its treatment or complications, and separate these from the effects of normal ageing and geriatric syndromes. The documentation of poor nutrition and its management must combine knowledge from both geriatric medicine and oncology. Nutrition serves to identify key healthcare professionals who are all essential in any patient at risk or suffering from malnutrition. Incontinence must be actively sought, its cause identified and efforts made to either 'cure' it or, in certain circumstances, 'manage' it. Older patients with cancer are cared for predominantly by older relations and informal care mechanisms and special consideration of their physical and practical needs are paramount. In this area, nurses, doctors, therapists and social workers should work to identify formal and informal mechanisms to support particularly the older carer.

Carreiras de estado e cargos em comissão no Brasil pós-1994 pela perspectiva teórica de Silberman: a consolidação de uma burocracia do tipo profissional

O trabalho procura identificar a variável que tem condicionando, desde 1994, o processo de fortalecimento das carreiras de estado da Administração Direta do governo federal brasileiro. Além disso, busca levantar as razões pelas quais a consolidação destas carreiras não estaria ocorrendo no sentido de formar uma burocracia tipicamente weberiana. Para proceder esta análise, recorreu-se à obra de Bernard Silberman intitulada Cages of Reason: the Rise of the Rational State in France, Japan, the United States and Great Britain. Silberman parte do pressuposto de que há dois tipos de burocracia: a profissional, presente nos Estados Unidos e na Grã-Bretanha, e a organizacional, constituída em países como a França e o Japão. Sua teoria sugere que a variável que teria propiciado o surgimento destes modelos burocráticos é o tipo de incerteza enfrentado pelos governantes para assegurar sua permanência no poder. O primeiro capítulo é dedicado à apresentação e crítica desta perspectiva teórica. O segundo capítulo procura adaptar a teoria ao caso brasileiro, a fim de subsidiar o estudo de caso sobre o processo de formação de uma burocracia meritocrática na Administração Direta do governo federal. A hipótese considerada é a de que o presidencialismo de coalizão tem sido determinante para o aumento da incerteza no Brasil a partir de 1994, o que estaria levando os políticos a reavaliar a estratégia de montagem do governo por meio da patronagem. Para verificar sua validade, tentou-se relacionar o contexto político com as medidas administrativas relativas às carreiras de estado e ao provimento dos cargos em comissão desde a década de 1930 até o presente. Concluiu-se que a hipótese levantada não é inteiramente válida para explicar o processo de fortalecimento das carreiras de estado. Contudo, há indícios de sua coerência para justificar as medidas adotadas pelo governo do Presidente Lula para disciplinar as nomeações dos cargos comissionados. Em relação ao formato das carreiras burocráticas, constatou-se, a partir da teoria de Silberman, que a presença no Brasil do que ele denominou de baixa incerteza, resultou na formação de uma burocracia mais assemelhada ao modelo profissional.