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CME in the United Kingdom - All Change
Howard Young

In the United Kingdom, CME has developed in a fragmentary way over the last 5 years. Educational standards are mandated to the individual Royal Colleges and Faculties, with some being more proactive than others. The Royal College of Obstetricians and Gynaecologists (RCOG) led the way, introducing the need to accumulate CME activity points on a yearly basis, leading to the publication of a 'white list' at the end of 5 years. This list indicates those Fellows who have completed the required CME activity in that time - the nearest to a form of sanction. Other colleges have followed suit (although not all have gone so far to produce either white or black lists). In general most require that at least half the CME be external (i.e. obtained from activities outside their institution). Some include reading journals as counting towards internal CME, some do not.

The end result has been a mishmash of CME, with many consultants in the NHS paying lip service to it. It must be remembered that accumulating cognate points does not imply cognition. The whole area of CME has also been challenged by the recent Bristol affair, whereby paediatric cardiac surgery in Bristol was found to have significantly worse outcomes than elsewhere. This resulted in 2 consultants being struck off the Medical Register and one being limited to certain operations only. The public outcry from Bristol has resulted in a demand that doctors must demonstrate their on-going competency and knowledge base. Coupled with this is the desire from the government and public for revalidation of doctors.

The profession has been given 2 years to come up with a solution or risk one being imposed. At the same time, the government has indicated the need for life long learning for all (not just professionals). All the Royal Colleges and Faculties have therefore being working to develop a solution which addresses these issues.

The solution is a move from CME to CPD (Continued Professional Development) and the introduction of Personal Development Plans (PDPs) for all consultants in the NHS from 1st April 2000. PDPs are not new; general practitioners (primary care physicians) have been using them for sometime. However for NHS hospital consultants it will require a complete change of culture. Hospital managers will expect their consultant staff to demonstrate that they have achieved aims and objectives as laid down in individual PDPs.

Nobody knows if or what sanctions might be imposed with their introduction. Likewise the impact on resources, not just money but more importantly time, will be great if CPD/PDP is to be successful. Perhaps the prime challenge will be the change in culture necessary for PDPs. Mentorship, self-directed learning, setting aims and objectives are terms that all consultants will have to understand and demonstrate have been achieved. The enormity of the change cannot be underestimated, but the profession has the opportunity to make a significant change in medical education and learning. Let us hope it is not wasted.