Editorial CME

Iraqi New Medical Journal July 2023, volume 9 issue 18


Continuous professional development (CPD): What, How, and When to incorporate into clinical practice? Reflections from the United Kingdom

Omar G. Mustafa 
MBChB, JMHPE, FRCP. Associate Global Director, Middle East and North Africa, Royal College of Physicians, London. 
E mail: omar.mustafa@rcp.ac.uk.

1. What is CPD?
CPD is defined as “any learning outside of undergraduate education or postgraduate training that helps you maintain and improve your performance. It covers the development of your knowledge, skills, attitudes and behaviours across all areas of your professional practice. It includes both formal and informal learning activities.”[1]
Continuing Medical Education (CME) refers to the development of the same but is only applicable to doctors.[2] The terms CME and CPD are often used interchangeably in literature and during educational events. It is important to recognise the difference. The term CPD is more inclusive and has a wider reach to develop multidisciplinary and multi-professional teams. CPD is going to be used here in this article as it incorporates wider developmental domains than CME. 
The purpose of CPD is to maintain high-quality care for patients, the public and ensure high standards of teams and services. Knowledge and expertise in medicine is increasingly developing at a faster pace than ever. Therefore, what is a known practice today may not be relevant tomorrow.[1]
In the United Kingdom, the doctors’ regulator, the General Medical Council (GMC), requires doctors to undertake CPD that covers the whole scope of their professional practice. This includes NHS work, independent practice, voluntary work that involves patients and professional activities such as education, management and research. It is not expected that CPD should cover every area every year but spread throughout the five years revalidation cycle. Therefore, doctors should ensure all aspects are covered adequately over the five-year cycle. Each doctor’s CPD should be reviewed and discussed at their annual appraisal.[1]

2. Medical practice framework
Medical practice is subject to satisfactory registration and oversight of a regulator. Doctors must be able to demonstrate the relevant knowledge, skills and behaviours in order for patients to trust them with their lives and health. Therefore, doctors must be expected to adhere to practice standards. The GMC has set four broad domains that involve:[3]

1)   Knowledge, skills and performance
2)   Safety and quality
3)   Communication, partnership and teamwork
4)   Maintaining trust

3. Types of CPD
There are three types of CPD based on the sources of the activity:[4] 
1)  External CPD: Any CPD from outside the employing organisation. This includes but is not limited to conferences (regional, national, international), whether streamed live or attended in person. E-learning can be included in this category. 
2)  Internal CPD: activities designed and delivered by the employing organisation, for example, grand rounds, local governance meetings, update meetings (including journal clubs), and mandatory training. 
3)  Personal CPD: this includes reading journals, preparing for educational activities (e.g. talks, lectures, tutorials, problem-based learning sessions etc.) and writing articles. 
In some countries, there are minimum requirements and limits to each type of CPD. In the UK, The Federation of Royal Colleges of Physicians of the United Kingdom sets the annual credit recommendations as follows:[4]
Minimum total credits 50 hours
Minimum external clinical credits 25 hours
Recommended external non-clinical credits 5 hours

4. Principles of incorporating CPD into professional practice
Steps of undertaking the relevant CPD can follow the following framework (Figure 1):
1)  Identify the scope of practice: this involves medical work (public and/or private), voluntary work, and any other roles, for example, education and leadership/management. 
2)  Identify learning needs based on the scope of practice. When setting those learning needs remember to use SMART learning needs (Specific, Measurable, Achievable, Relevant/Realistic, Time-bound).
3)  Create a plan for reflection for each event/activity attended. This will in turn generate themes to discuss and present at the annual appraisal. 
4)  Incorporate the above into an annual appraisal to ensure the scope of practice and learning needs are assessed regularly. This, in turn, will feed into the revalidation cycle mandated by the regulator. This cycle is mandated by the GMC every five years in the UK. 

5. Worked example
Below is an example of a consultant job plan that involves clinical, educational and governance roles. The learning needs have been identified at the annual appraisal and require achievement in 1 year. The framework in Table 1 illustrates how to design a plan for CPD based on this example. 
You are a consultant physician with a special interest in gastroenterology. The scope of practice includes supervising postgraduate trainees (you have been newly appointed as an educational supervisor). Weekly clinics in gastroenterology. Endoscopy lists weekly. The principal clinician on the gastroenterology ward. This year, the endoscopy unit at your hospital is involved in the process of accreditation, which is happening for the first time in the history of the unit. A new technique is also being implemented in conducting colonoscopies at the unit. 

6. Where to record CPD
It is essential to record CPD in a diary that is accessible and easy to use. There are a number of software and websites that record that. For example, as a member of the Royal College of Physicians, access to the Federation Online CPD diary is free and keeps a record of the total number of hours. There is also an app that can be installed on smartphones/tablets to ease the capture of CPD. Figure 2 illustrates how the CPD is calculated per year. Link https://www.rcplondon.ac.uk/education-practice/assessment-and-cpd.

CPD is essential in driving the quality of clinical care provided to patients. It ensures the development of own and team skills to fulfil requirements for professional practice bound by the regulatory framework of practice. This article illustrated an example based on the current UK regulatory framework of practice and CPD requirements. Learning should be viewed as a continuous cycle of development. 

Note: figures and tables are present in the PDF file


  1. General Medical Council (GMC) UK. Continuing professional development: Guidance for all doctors. Manchester: GMC 2012. https://www.gmc-uk.org/-/media/documents/cpd-guidance-for-all-doctors-0316_pdf-56438625.pdf (Accessed 13/6/2023)
  2. National Institutes of Health. What is CME Credit? https://www.nih.gov/about-nih/what-cme-credit#:~:text=CME%20is%20the%20abbreviation%20for,the%20public%2C%20or%20the%20profession. (Accessed 13/6/2023)
  3. General Medical Council (GMC) UK. Good Medical Practice. Manchester: GMC 2020. https://www.gmc-uk.org/-/media/documents/good-medical-practice---english-20200128_pdf-51527435.pdf (Accessed 13/6/2023).
  4. Federation of the Royal Colleges of Physicians of the United Kingdom. CPD Diary guidelines for Physicians. Updated April 2023. https://www.federationcpd.org/_files/ugd/db6d6a_537b4d19696041179862c140bf13a55d.pdf. Accessed 13/6/2023. 

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