Continuous Professional Development in Public Health

Educational programs for postlicensure health professionals can influence their practice and their patients' outcomes. These resource-intensive programs typically represent an expensive undertaking. To illustrate, the Accreditation Council for Continuing Medical Education (ACCME) has reported that providers alone have invested $2.8 billion in continuing medical education. ¹ This number does not account for investments from the other health professions. In other words, a lot of money is invested in these educational endeavors and, as the ACCME reports, 54% of this cost is borne by the participants. ¹

Educational programs for postlicensure health professionals have been categorized in many ways, including continuing professional development (CPD), continuing medical education, workforce development, and continuing education. In this review, we have adopted the term CPD to refer to all educational programs that aim to enhance health professionals' practice and improve patient outcomes; therefore, in the context of this review, CPD incorporates a wide range of learning activities—both formal and informal. Formal programs include lectures, interactive sessions, conference or seminar attendance, distance or online learning, and courses offered by accreditation bodies. ^{2 , 3} Informal learning activities include audit and feedback, educational materials/printed materials, outreach visits, academic detailing, reminders, and opinion leaders. ^{2 , 4}

In the past decade (2009–2019), health professionals, leaders, and researchers have attempted to strategically reposition CPD to be more closely aligned with the health system's needs. ^{5 , 6} Currently, the most compelling research works to address the practical need of understanding how CPD can improve professional performance. Understanding this link would strengthen the value of CPD for hospitals, health systems, and communities. As health professionals have expanded their understanding of how performance is linked to education, the following definition of CPD has taken hold: "CPD calls for clinicians to engage in the process of monitoring and reflecting on professional performance, identifying opportunities to improve professional practice gaps, engaging in both formal and informal learning activities, and making changes in practice to reduce or eliminate gaps in performance." ⁷ This broad understanding has been coupled with a greater emphasis on integrating CPD within systems of patient care, as well as with growth of CPD activities offered through new technological platforms.

Previous syntheses (reviews, see Method section) on CPD have focused primarily on continuing medical education and have given limited attention to other health professions. ^8–10 The ongoing need for research on CPD requires that studies be expanded to include all independently practicing health professionals (e.g., physicians, nurses, dentists, occupational therapists, physician assistants), multiple modalities of teaching and learning, and the various contextual (e.g., situational) factors that affect CPD. Additionally, these previous syntheses, ^8–10 which included systematic reviews and a meta-analysis, have focused more specifically on primary studies concerned only with "what works." That is, they do not provide a synthetic map of the overall landscape of the CPD literature. Such a map can provide critical guidance for educators seeking to implement educational interventions. Further, an understanding of the overall CPD discourse is increasingly necessary as organizations invest in CPD activities that are integrated into systems of care and quality improvement initiatives. ^{11 , 12} Notably, one set of investigators has recently published an article that includes multiple health professionals ¹³ ; however, it is limited to formal CPD interventions.

Because CPD calls for professionals to engage in both formal and informal learning activities, ⁷ now is the time to review the research landscape with a more comprehensive understanding of CPD and its effect on professional practice, including patient outcomes. Thus, we have conducted this study to synthesize and describe the broad range of review literature on CPD with a specific focus on knowledge syntheses that investigate the effect of CPD on health professionals' practice and patient outcomes. By focusing on knowledge syntheses, we hope to take advantage of the variety of types of analyses and researcher perspectives. This scoping review is guided by the research question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes?

Method

We conducted a scoping review of knowledge syntheses on CPD, using Arksey and O'Malley's framework, ¹⁴ as updated by Levac and colleagues. ¹⁵ We have reported our findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. ¹⁶ In this report, knowledge syntheses refers to studies that integrate the research findings of individual research studies into a larger body of knowledge on the topic. ¹⁷

In consultation with an experienced medical librarian, we designed and executed searches of PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO. We searched the databases for knowledge syntheses published between 2008 and September 2019. We focused on the last 10 years as we felt that a significant number of knowledge syntheses had been published in this time frame and because we wanted to ensure that the interventions reviewed would be of relevance to current practicing medical educators. All 4 of us discussed and determined the search parameters, and 2 of us (L.A.M. and A.S.) pilot tested the initial searches and collaborated with the librarian to refine and formalize all searches. To ensure comprehensiveness, we compared the retrieved citations against the reference lists of previous knowledge syntheses.

We conducted the initial searches in August 2018. The PubMed search included a combination of keywords and medical subject headings, including but not limited to the following: continuing education, lifelong learning, professional development, systematic review, meta-analysis, and review. We used Boolean operators to combine search terms such that we grouped CPD-related terms using "OR" and then combined these with those terms specific to knowledge syntheses using "AND." We optimized the search for each database using its controlled vocabulary. (See Supplemental Digital Appendix 1 at https://links.lww.com/ACADMED/B56 for complete search strategies for all databases.) We limited our searches to the English language. We managed citations, once collected, in Excel (Excel 365, Microsoft Corporation, Redmond, Washington), and we removed duplicates. We also used Excel to screen the retrieved records. We repeated all searches in September 2019. In addition to updating our search, we worked with the medical librarian to account for recent modifications to PubMed. ¹⁸ Additionally, at this point, we had become significantly more familiar with the CPD literature and therefore expanded our search terms (e.g., those related to knowledge syntheses [integrative review, rapid review]) to improve the sensitivity of our search.

An article was eligible for inclusion if it was a peer-reviewed knowledge synthesis published in English. To be included, knowledge syntheses needed to focus on studies of independently practicing health professionals, including nurses, dentists, pharmacists, psychiatrists, paramedical teams, or other providers. Of the knowledge syntheses that featured multiple types of participants (e.g., residents, medical students, practicing professionals), we included only those for which we could assess outcomes for independently practicing professionals.

The Kirkpatrick 4-level evaluation model ¹⁹ framed this scoping review. The research question for this scoping review focused on health professionals' behavior change and/or patient outcomes. Therefore, we included knowledge syntheses only if they featured outcomes at Kirkpatrick's level 3 (behavior) and/or level 4 (results)—per the modification for medical education, which maps level 3 to change in practitioner behavior and level 4 to performance change or patient outcomes. ^{2 , 19 , 20} We excluded protocols, meeting abstracts, commentaries, and position statements.

Two of us (A.S. and R.M.C.) reviewed the titles and abstracts of all identified citations for alignment with the inclusion criteria to determine initial eligibility. If any titles/abstracts were questionable, we included them for full-text review.

For the full-text review, we designed an initial data charting tool based on previous reviews of CPD, ^{8 , 21 , 22} and then we tested the tool with 5 articles. All of us (R.M.C., S.J.D., L.A.M., and A.S.) met to discuss the pilot. Based on our discussion, we further revised the charting tool. After 3 cycles of revision, we operationalized the charting tool as a Qualtrics survey (see Supplemental Digital Appendix 2 at https://links.lww.com/ACADMED/B56). One of us (A.S.) extracted the data from all articles, and the rest of the team (R.M.C., S.J.D., and L.A.M.) divided the articles among themselves for independent review. All of us met throughout the coding process and discussed discrepancies until we reached consensus.

Results

Here, we have provided, first, a descriptive classification of the included studies and, then, a summary of findings related to (1) CPD at the program evaluation level and (2) CPD research.

We retrieved 7,157 citations from our database search of which 1,710 were duplicates. We screened the remaining 5,447 records, and 63 satisfied our inclusion criteria (see Figure 1). ^{8 9 13.20 , 23-81} For details of all included studies, see Appendix 1. Included knowledge syntheses represent providers from an array of health care professions undertaking CPD and applying the training in a variety of patient care settings. In the next sections, we characterize the knowledge syntheses and describe the trends we identified.

Figure 1:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews (PRISMA-ScR) ¹⁶ flow diagram showing the selection process used in identifying knowledge syntheses published between 2008 and 2019 for the scoping review on CPD in the health professions. Abbreviations: CPD, continuing professional development; CME, continuing medical education.

The included knowledge syntheses represented 7 types: scoping (n = 2), systematic (n = 38), literature (n = 9), narrative (n = 3), integrative (n = 4), meta-analyses (n = 2), and review of reviews (n = 5) (see also Table 1). Supplemental Digital Appendix 3 at https://links.lww.com/ACADMED/B56 provides a description of the knowledge synthesis types. The 5 reviews were included as they focused narrowly on physicians or nurses. ^{8 , 9 , 36 , 72 , 76}

Table 1:

Characteristics of Knowledge Syntheses Identified (n = 63) in a Review of CPD Knowledge Syntheses Published in English Between 2008 and 2019

Knowledge syntheses were published in a variety of journals, including those focused on education (e.g., Journal of Continuing Education in the Health Professions) and those focused on clinical care (e.g., Journal of Affective Disorders). Publication dates ranged across the time period studied, but the majority (n = 39 [62%]) were published after 2014, and 11 (17%) were published in 2018 alone. The knowledge syntheses were written by authors representing 19 countries, with most first authors based in Europe (n = 23 [36%]), North America (n = 21 [33%]), and Australia (n = 11 [17%]) (see Table 1).

The included knowledge syntheses represented 1,786 primary studies. Each knowledge synthesis analyzed between 2 and 250 individual primary studies, which were global in nature. Fifty knowledge syntheses (79%) were limited to studies published in English; other knowledge syntheses included primary studies published in French (n = 4 [6%]), Spanish or Portuguese (n for both = 6 [10%]), and German (n = 3 [5%]). Three knowledge syntheses (5%) did not restrict studies to any specific language (see Table 1).

The authors of the knowledge syntheses used a variety of approaches to focus their work. For example, 27 knowledge syntheses (43%) took an audience-focused approach. These knowledge syntheses explored the effect of CPD on a particular group of health professionals (e.g., a knowledge synthesis concentrated on nurses or pharmacists). Physicians, the focus of 25 articles (40%), were the most represented group, followed by nurses (n = 10 [16% of articles]). In 37% of the syntheses (n = 23), multiple health professionals were represented (see Table 1 for details). The authors of 37 of the knowledge syntheses (59%) focused on a specific topic (e.g., diagnosis, management, prevention, or a nonclinical topic). Some of the knowledge syntheses on diagnosis (n = 13) also included elements of management and prevention. Twenty knowledge syntheses (32%) focused on management alone, while 1 (2%) examined only prevention strategies. Three knowledge syntheses (5%) covered topics that did not directly relate to patient care, such as the use of standardized patients or the role of simulation. ^{47 , 68 , 79}

CPD at the program evaluation level

All syntheses included primary studies that reported outcomes at Kirkpatrick level 3 (change in practitioner behavior) and/or level 4 (patient outcomes). ¹⁹ One third of the knowledge syntheses (n = 21 [33%]) reported findings only at level 3, while the majority (n = 42 [67%]) reported outcomes at both level 3 and level 4 (see Table 2). For example, knowledge syntheses reporting level 3 outcomes discussed changes in prescribing patterns ^{30 , 32 , 49 , 56} or modifications in test ordering behavior. ^{31 , 44 , 60}

Table 2:

CPD Landscape, as Identified Through 63 Knowledge Syntheses on CPD, Published in English Between 2008 and 2019

While 42 syntheses reported outcomes at level 4, only 23 of them (37% of all 63) reported statistically significant findings. Ouyang and colleagues' synthesis on the use of intrauterine contraceptive devices had the largest number of primary studies (n = 15 or 50%) reporting significant changes to patient outcomes. ⁵⁹ Given that the "effectiveness and impact of CPD are difficult to evaluate," ²⁶ fewer studies have evaluated CPD offerings at Kirkpatrick levels 3 and 4 compared with those evaluating lower-level outcomes. ³⁵

Online learning, eLearning, or computer-aided learning was reported as an effective modality for CPD; effective, as in attaining the stated goals of change in behavior and/or patient outcomes. While 5 knowledge syntheses (8%) focused solely on online learning interventions, 24 (38%) blended eLearning with traditional face-to-face interventions (see Table 2). The eLearning modality has been used with physicians, ^{23 , 36} dentists, ^{26 , 39} pharmacists, ⁵⁸ nurses, ^{48 , 51} and other health professionals. ^{28 , 46} The eLearning interventions varied to include viewing didactic recorded lectures, completing interactive online quizzes, participating in asynchronous online discussions, and participating in synchronous meetings. The effectiveness of eLearning modalities in attaining the goals of change in behavior and/or patient outcomes is no better or worse than face-to-face teaching environments; however, participants largely prefer the more traditional face-to-face learning environments. ^{58 , 75}

The knowledge syntheses reported formal learning activities or interventions such as lectures (n = 40 [63%]), interactive sessions (n = 29 [46%]), simulations (n = 13 [21%]), and engagement with standardized patients (n = 4 [6%]), as well as informal interventions such as audit and feedback (n = 20 [32%]), educational materials/printed materials (n = 13 [21%]), outreach visits (n = 9 [14%]), academic detailing (n = 9 [14%]), reminders (n = 8 [13%]), following opinion leaders (n = 7 [11%]), and implementing clinical practice guidelines (n = 5 [8%]) (see Tables 2 and 3). Three knowledge syntheses ^{43 , 69 , 78} covered, in general terms, CPD programs and courses such as postregistration education, maintenance of certification, and transfer of skills; however, they identified no specific educational intervention. A total of 38 (60%) mentioned a multicomponent approach that incorporated a variety of interventions (e.g., lectures, interactive sessions, audit, and feedback). Syntheses that focused on a specific target audience or content area included a combination of educational interventions. Syntheses on academic detailing, educational outreach, and simulations were the only ones that focused on a single intervention style.

Table 3:

Definitions for Types of CPD Interventions

Ten knowledge syntheses considered the cost of CPD. ^{23 , 39 , 44 , 45 , 63 , 68 , 72 , 73 , 80 , 81} They addressed various aspects of costs, including how the cost of CPD programs can be a barrier for some participants. ^{72 , 73} The authors of some syntheses proposed that the cost effectiveness of various interventions and implementation methods need to be considered when offering CPD programs. ^{9 , 68} One challenge is that the literature rarely reports the cost of CPD programs. ⁴⁴ The authors of some syntheses felt eLearning interventions were cost-effective options for providers, ^{68 , 72 , 81} but the cost–benefit analysis of various interventions is rarely studied. ⁶³ One suggestion was to include cost effectiveness of CPD programs as an outcome measure. ⁸⁰

Research in CPD

Through these knowledge syntheses, we identified 3 challenges in CPD research that make drawing definitive conclusions difficult: (1) the heterogeneity of primary studies, (2) the outcome measurement variables, and (3) the generally poor quality of primary studies. Learning activities could not be compared against each other since they "varied greatly in terms of type, duration and delivery of interventions, and outcome measures." ²⁰ Additionally, differences in instructional design, educational topics, and study designs and methods precluded comparing studies or interventions. ^{68 , 75} The lack of consistency in learning activities was echoed in outcome measurement, which included various methods of determining outcomes including satisfaction ratings, self-assessment questionnaires, direct observation, performance audit, and patient markers. ²⁰ A major concern was the observed lack of rigor in the design of primary studies. Evaluations of behavior change and patient outcomes depended on pre–post intervention studies that did not include comparison groups and that used unvalidated surveys, individual interviews, and focus groups. These evaluation formats depend heavily on self-reported data that can be unreliable. ^{56 , 57 , 68}

Discussion

This scoping review presents a snapshot of the current landscape of knowledge syntheses focused on the effect of CPD programs on health professionals' behavior change and/or patient outcomes. Expanding upon previous knowledge syntheses, this review includes providers from a variety of health care professions, covers informal approaches to CPD, and highlights interventions meant to influence health professionals' practice, including patient outcomes. While we identified several key findings, we have focused our discussion below on 4 findings: (1) the broadening definition of CPD interventions, (2) the rise in popularity of eLearning as a modality for CPD, (3) the limited availability of studies reporting Kirkpatrick level 4 outcomes, and (4) the cost considerations of CPD offerings.

Our analysis of the included knowledge syntheses reinforces previous observations ^{15 , 20 , 51} that CPD, across health professions, is an umbrella term for a variety of learning activities incorporating both formal and informal approaches. While formal educational interventions such as courses and workshops have been the focus historically, effecting change in physician behavior and/or improving patient outcomes requires a combination of formal and informal approaches. ¹ A multicomponent approach incorporating formal and informal interventions has been proposed in the literature ^{8 , 9 , 55 , 82} ; for example, academic detailing and reminders should be combined with formal workshops and lectures. Our review provides evidence that CPD providers are increasingly embracing this approach. Furthermore, the collective knowledge syntheses indicate the multicomponent approach is more effective than individual approaches to CPD. ^{8 , 9 , 28 , 36 , 54 , 55}

We observed that, currently, the multicomponent approach often includes eLearning interventions in combination with traditional face-to-face interventions. Our results suggest that the use of eLearning is increasing in popularity but is still an emerging technology. Traditional face-to-face and print-based resources remain the most popular delivery modalities in CPD. The benefits of eLearning relevant to CPD signal an opportunity to further increase eLearning offerings. eLearning makes CPD more accessible and offers different levels of interaction. Asynchronous eLearning allows flexibility of place and time, and synchronous eLearning allows flexibility of location. These options make eLearning an attractive alternative for busy and/or rural health care professionals. ^{68 , 75} In addition, eLearning is often not as resource intensive as traditional face-to-face programs, ²⁴ and it is scalable, thus allowing CPD to reach more clinicians any time and any place. This scalability makes eLearning an attractive value proposition for organizations offering CPD to their staff. Finally, as millennials become health professionals, CPD must adopt more digital technologies to better cater to their learning preferences. ⁸³ The skepticism surrounding eLearning can be tempered with the knowledge that eLearning is one intervention, especially within a multicomponent approach, that has been shown to be effective in achieving results at Kirkpatrick level 3 (behavior change) and level 4 (patient outcomes).

That 67% of syntheses reported outcomes that positively influenced health care practitioners' behavior (level 3) and/or patient outcomes (level 4) suggests, to a degree, that CPD is successful. However, the findings reported at Kirkpatrick level 4 were not of high quality. Few primary studies reported statistically significant positive patient outcomes resulting from CPD programs, and the lack of rigor in the studies makes drawing concrete conclusions difficult. Reporting at higher Kirkpatrick levels remains weak across the health professions education (HPE) continuum and in various HPE innovations. ^{82 , 84 , 85} If the goal of CPD is to affect practitioner performance (to include improving patient and community health), then CPD programs must be designed to address this. ³ A "backward design" approach, which entails beginning with identifying the desired physician behaviors and patient outcomes and then using those outcomes to design a CPD program, could be one way to address this gap. ^86–88 Another suggestion from the literature includes developing conceptual frameworks and theoretical models to measure effect. ^{4 , 84}

While the financial investment supporting CPD is widely acknowledged, research into CPD programs does not generally address their cost. This scoping review shows that this gap is beginning to close, and investigators are increasingly addressing the cost considerations of CPD programs. Authors of several of the knowledge syntheses raised concerns regarding both the financial and human costs of CPD offerings. In this current, more cost-aware milieu, eLearning and computer-aided learning modules are viewed as more economical alternatives to traditional face-to-face CPD offerings. ⁶⁸ Future researchers must intentionally incorporate cost considerations into their plans for CPD interventions. We believe that considering cost is imperative, especially when a multicomponent intervention approach to CPD is adopted. For example, understanding the cost of an individual intervention would allow CPD designers to make more informed decisions in selecting and/or designing CPD interventions.

Previous studies examining CPD have identified persistent challenges. Because studies of CPD vary in study design, quality, and evaluation measures, identifying successful interventions is challenging. Furthermore, the learning activities differ in both design and content, making comparative studies difficult. Other commonly mentioned challenges included varied outcome measurement, self-reported outcomes, small sample sizes, poor quality of primary studies, and varied study design.

Limitations

Our own review must be considered in light of its limitations. We restricted our review to English-only publications, which could potentially bias our data collection. We also acknowledge that despite crafting what we felt to be a comprehensive search, especially with the addition of hand searching, we may have inadvertently missed a knowledge synthesis. Nonetheless, our review provides actionable findings and offers insights for practice and research.

Implications for practice

Through this scoping review, we studied the current landscape of CPD in the health professions. The knowledge syntheses we included in our review suggest some practical strategies for CPD providers.

• CPD programs must be offered through a combination of formal learning approaches (e.g., lectures and workshops) and informal learning approaches (e.g., feedback and reminders, academic detailing). CPD programs should incorporate this combination beginning with the design phase.
• eLearning must be adopted more widely in CPD, especially in multicomponent interventions. The eLearning modality is advantageous as it can be leveraged to provide greater flexibility and make resources more widely available. For example, practitioners in rural settings may have limited access to opinion leaders. Video conferencing technology removes this barrier and makes opinion leaders more accessible.
• The design phase of CPD programs should intentionally address the cost considerations for CPD providers and participants alike. Using a multicomponent approach should not imply added costs. Rather, adopting a thoughtful approach during the design phase can alleviate or minimize cost concerns. For example, lectures can be offered through eLearning platforms and enhanced with printed materials and reminders.

Considering CPD from a wider perspective offers the opportunity for many creative approaches to designing interventions to advance health professionals' continued learning.

Conclusions

This scoping review was intended to broaden the conversation about CPD in the health professions by including all health professionals, as well as formal and informal CPD activities. While physicians still occupy a large space in CPD, other populations are also investing in continuing education. We chose not to limit the definition of CPD to formal workshops and lectures. Instead, we designed our literature search to reveal how CPD is defined in practice, and our findings show that CPD is a broad term incorporating both formal and informal learning activities. Finally, our broad approach enabled us to bring at least a portion of the international voices into this discussion. While the syntheses we reviewed were all English publications, they included global perspectives that enrich the conversation on CPD.

Acknowledgments:

The authors would like to thank Rhonda Allard, a medical librarian at the Uniformed Services University of the Health Sciences, for helping design, refine, and conduct the searches for this study.

References

1. Accreditation Council for Continuing Medical Education. ACCME Data Report: Growth and Advancement in Accredited Continuing Medical Education—2018. www.accme.org/2018datareport. Published July 17, 2019. Accessed December 3, 2020

• Cited Here

2. Davis D. Does CME work? An analysis of the effect of educational activities on physician performance or health care outcomes. Int J Psychiatry Med. 1998; 28:21–39

3. Health and Care Professions Council. Continuing professional development and your registration. https://www.hcpc-uk.org/globalassets/resources/guidance/continuing-professional-development-and-your-registration.pdf. Published 2017. Accessed December 3, 2020

• Cited Here

4. Cox M, Cuff P, Brandt B, Reeves S, Zierler B. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. J Interprof Care. 2016; 30:1–3

5. DeSilets LD. The Institute of Medicine's Redesigning Continuing Education in the Health Professions. J Contin Educ Nurs. 2010; 41:340–341

6. Rayburn WF, Turco M, Davis DA, eds. Continuing Professional Development in Medicine and Health Care: Better Education, Better Patient Outcomes. Philadelphia, PA: Wolters Kluwer, 2018

• Cited Here

7. Campbell C, Silver I, Sherbino J, Cate OT, Holmboe ES. Competency-based continuing professional development. Med Teach. 2010; 32:657–662

8. Cervero RM, Gaines JK. The impact of CME on physician performance and patient health outcomes: An updated synthesis of systematic reviews. J Contin Educ Health Prof. 2015; 35:131–138

9. Mostofian F, Ruban C, Simunovic N, Bhandari M. Changing physician behavior: What works? Am J Manag Care. 2015; 21:75–84

• Cited Here |
• PubMed

10. Mansouri M, Lockyer J. A meta-analysis of continuing medical education effectiveness. J Contin Educ Health Prof. 2007; 27:6–15

11. McMahon GT. The leadership case for investing in continuing professional development. Acad Med. 2017; 92:1075–1077

12. National Academies of Sciences, Engineering, and Medicine. Exploring a Business Case for High-Value Continuing Professional Development: Proceedings of a Workshop. Washington, DC: National Academies Press, 2018

• Cited Here

13. Allen LM, Palermo C, Armstrong E, Hay M. Categorising the broad impacts of continuing professional development: A scoping review. Med Educ. 2019; 53:1087–1099

14. Arksey H, O'Malley L. Scoping studies: Towards a methodological framework. Int J Soc Res Method. 2005; 8:19–32

• Cited Here

15. Levac D, Colquhoun H, O'Brien KK. Scoping studies: Advancing the methodology. Implement Sci. 2010; 5:69

• Cited Here

16. Tricco AC, Lillie E, Zarin W, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med. 2018; 169:467–473

17. Grimshaw J. A Guide to Knowledge Synthesis: A Knowledge Synthesis Chapter. Ottawa, ON, Canada: Canadian Institutes of Health Research. https://cihr-irsc.gc.ca/e/41382.html. Modified April 8, 2010. Accessed December 3, 2020

• Cited Here

18. Collins M. The new PubMed is here. NLM Tech Bull. 2019; 431:e3

• Cited Here

19. Kirkpatrick D, Kirkpatrick JD. Evaluating Training Programs: The Four Levels. 3rd ed. San Francisco, CA: Berrett-Koehler Publishers, 2006

• Cited Here

20. Thepwongsa I, Kirby C, Schattner P, Shaw J, Piterman L. Type 2 diabetes continuing medical education for general practitioners: What works? A systematic review. Diabet Med. 2014; 31:1488–1497

21. Umble KE, Cervero RM. Impact studies in continuing education for health professionals. A critique of the research syntheses. Eval Health Prof. 1996; 19:148–174

22. Robertson MK, Umble KE, Cervero RM. Impact studies in continuing education for health professions: Update. J Contin Educ Health Prof. 2003; 23:146–156

23. Al-Azri H, Ratnapalan S. Problem-based learning in continuing medical education: Review of randomized controlled trials. Can Fam Physician. 2014; 60:157–165

• Cited Here |
• PubMed

24. Almestehi M, Alomaim W, Rainford L, Stokes D, Stanton M, Moran M. Role of the virtual reality simulator (ScanTrainer) as a multidisciplinary training tool in transvaginal ultrasound: A systematic review and narrative synthesis. Radiography. 2019; 25:260–268

25. Barleycorn D, Lee GA. How effective is trauma simulation as an educational process for healthcare providers within the trauma networks? A systematic review. Int Emerg Nurs. 2018; 40:37–45

26. Barnes E, Bullock AD, Bailey SE, Cowpe JG, Karaharju-Suvanto T. A review of continuing professional development for dentists in Europe(*). Eur J Dent Educ. 2013; 17suppl 15–17

27. Barth J, Lannen P. Efficacy of communication skills training courses in oncology: A systematic review and meta-analysis. Ann Oncol. 2011; 22:1030–1040

28. Bluestone J, Johnson P, Fullerton J, Carr C, Alderman J, BonTempo J. Effective in-service training design and delivery: Evidence from an integrative literature review. Hum Resour Health. 2013; 11:51

• Cited Here

29. Bos JM, van den Bemt PMLA, de Smet PAGM, Kramers C. The effect of prescriber education on medication-related patient harm in the hospital: A systematic review. Br J Clin Pharmacol. 2017; 83:953–961

30. Brennan N, Mattick K. A systematic review of educational interventions to change behaviour of prescribers in hospital settings, with a particular emphasis on new prescribers. Br J Clin Pharmacol. 2013; 75:359–372

31. Chaudhuri D, Montgomery A, Gulenchyn K, Mitchell M, Joseph P. Effectiveness of quality improvement interventions at reducing inappropriate cardiac imaging: A systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2016; 9:7–13

32. Chhina HK, Bhole VM, Goldsmith C, Hall W, Kaczorowski J, Lacaille D. Effectiveness of academic detailing to optimize medication prescribing behaviour of family physicians. J Pharm Pharm Sci. 2013; 16:511–529

33. Chipps JA, Simpson B, Brysiewicz P. The effectiveness of cultural-competence training for health professionals in community-based rehabilitation: A systematic review of literature. Worldviews Evid Based Nurs. 2008; 5:85–94

34. Clausen C, Cummins K, Dionne K. Educational interventions to enhance competencies for interprofessional collaboration among nurse and physician managers: An integrative review. J Interprof Care. 2017; 31:685–695

35. Cox T, Seymour N, Stefanidis D. Moving the needle: Simulation's impact on patient outcomes. Surg Clin North Am. 2015; 95:827–838

• Cited Here |
• PubMed

36. Dadich A. From bench to bedside: Methods that help clinicians use evidence-based practice. Aust Psychol. 2010; 45:197–211

37. Davis D, Galbraith R; American College of Chest Physicians Health and Science Policy Committee. Continuing medical education effect on practice performance: Effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009; 135suppl 342S–48S

38. Dowling S, Last J, Finnigan H, Cullen W. Continuing education for general practitioners working in rural practice: A review of the literature. Educ Prim Care. 2018; 29:151–165

39. Firmstone VR, Elley KM, Skrybant MT, Fry-Smith A, Bayliss S, Torgerson CJ. Systematic review of the effectiveness of continuing dental professional development on learning, behavior, or patient outcomes. J Dent Educ. 2013; 77:300–315

40. Forsetlund L, Bjørndal A, Rashidian A, et al. Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2009; 2:CD003030

• Cited Here |
• PubMed

41. Gent P. Continuing professional development for paramedics: A systematic literature review. Australas J Paramedicine. 2016; 13:1–9

• Cited Here

42. Gijbels H, O'Connell R, Dalton-O'Connor C, O'Donovan M. A systematic review evaluating the impact of post-registration nursing and midwifery education on practice. Nurse Educ Pract. 2010; 10:64–69

43. Gjeraa K, Møller TP, Østergaard D. Efficacy of simulation-based trauma team training of non-technical skills. A systematic review. Acta Anaesthesiol Scand. 2014; 58:775–787

44. Guy RJ, Ali H, Liu B, et al. Efficacy of interventions to increase the uptake of chlamydia screening in primary care: A systematic review. BMC Infect Dis. 2011; 11:211

• Cited Here |
• PubMed

45. Hall K, Staiger PK, Simpson A, Best D, Lubman DI. After 30 years of dissemination, have we achieved sustained practice change in motivational interviewing? Addiction. 2016; 111:1144–1150

46. Jones S, Miller C, Cook J, et al. The impact of educational interventions for health professionals on stroke patient care: An integrative review. Int J Stroke. 2014; 9suppl 421

• Cited Here

47. Khanduja PK, Bould MD, Naik VN, Hladkowicz E, Boet S. The role of simulation in continuing medical education for acute care physicians: A systematic review. Crit Care Med. 2015; 43:186–193

48. Koota E, Kääriäinen M, Melender HL. Educational interventions promoting evidence-based practice among emergency nurses: A systematic review. Int Emerg Nurs. 2018; 41:51–58

49. Kunstler BE, Lennox A, Bragge P. Changing prescribing behaviours with educational outreach: An overview of evidence and practice. BMC Med Educ. 2019; 19:311

• Cited Here |
• PubMed

50. Lam-Antoniades M, Ratnapalan S, Tait G. Electronic continuing education in the health professions: An update on evidence from RCTs. J Contin Educ Health Prof. 2009; 29:44–51

51. Liikanen E, Lehto L. Training of nurses in point-of-care testing: A systematic review of the literature. J Clin Nurs. 2013; 22:2244–2252

52. Lineker SC, Husted JA. Educational interventions for implementation of arthritis clinical practice guidelines in primary care: Effects on health professional behavior. J Rheumatol. 2010; 37:1562–1569

53. Linn AC, Caregnato RCA, de Souza EN. Clinical simulation in nursing education in intensive therapy: An integrative review. Rev Bras Enferm. 2019; 72:1061–1070

54. Liu WI, Edwards H, Courtney M. Review of continuing professional education in case management for nurses. Nurse Educ Today. 2009; 29:488–492

55. Mazmanian PE, Davis DA, Galbraith R; American College of Chest Physicians Health and Science Policy Committee. Continuing medical education effect on clinical outcomes: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009; 135suppl 349S–55S

56. Moe-Byrne T, Chambers D, Harden M, McDaid C. Behaviour change interventions to promote prescribing of generic drugs: A rapid evidence synthesis and systematic review. BMJ Open. 2014; 4:e004623

• Cited Here

57. Moride Y, Lemieux-Uresandi D, Castillon G, et al. A systematic review of interventions and programs targeting appropriate prescribing of opioids. Pain Physician. 2019; 22:229–240

• Cited Here |
• PubMed

58. Obreli-Neto PR, Marques Dos Reis T, Guidoni CM, et al. A systematic review of the effects of continuing education programs on providing clinical community pharmacy services. Am J Pharm Educ. 2016; 80:88

59. Ouyang M, Peng K, Botfield JR, McGeechan K. Intrauterine contraceptive device training and outcomes for healthcare providers in developed countries: A systematic review. PLoS One. 2019; 14:e0219746

60. Paneque M, Turchetti D, Jackson L, Lunt P, Houwink E, Skirton H. A systematic review of interventions to provide genetics education for primary care. BMC Fam Pract. 2016; 17:89

61. Pastorino R, Calabrò GE, Lagerberg TBM, Michelazzo MB, Boccia S. Effectiveness of educational interventions to improve genomic competency in non-geneticist medical doctors: A systematic review of the literature. Epidemiol Biostat Public Health. 2018; 15:e12657–1

• Cited Here

62. Pauzé E, Reeves S. Examining the effects of interprofessional education on mental health providers: Findings from an updated systematic review. J Ment Health. 2010; 19:258–271

63. Pehrson C, Sorensen JL, Amer-Wåhlin I. Evaluation and impact of cardiotocography training programmes: A systematic review. BJOG. 2011; 118:926–935

64. Perry M, Drašković I, Lucassen P, Vernooij-Dassen M, van Achterberg T, Rikkert MO. Effects of educational interventions on primary dementia care: A systematic review. Int J Geriatr Psychiatry. 2011; 26:1–11

65. Phillips JL, Heneka N, Bhattarai P, Fraser C, Shaw T. Effectiveness of the spaced education pedagogy for clinicians' continuing professional development: A systematic review. Med Educ. 2019; 53:886–902

66. Piccinini CJ, Hudlun N, Branam K, Moore JM. The effects of preceptor training on new graduate registered nurse transition experiences and organizational outcomes. J Contin Educ Nurs. 2018; 49:216–220

67. Price DW, Biernacki H, Nora LM. Can maintenance of certification work? Associations of MOC and improvements in physicians' knowledge and practice. Acad Med. 2018; 93:1872–1881

68. Reeves S, Fletcher S, McLoughlin C, Yim A, Patel KD. Interprofessional online learning for primary healthcare: Findings from a scoping review. BMJ Open. 2017; 7:e016872

• Cited Here

69. Rochfort A, Beirne S, Doran G, et al. Does patient self-management education of primary care professionals improve patient outcomes: A systematic review. BMC Fam Pract. 2018; 19:163

70. Roque F, Herdeiro MT, Soares S, Teixeira Rodrigues A, Breitenfeld L, Figueiras A. Educational interventions to improve prescription and dispensing of antibiotics: A systematic review. BMC Public Health. 2014; 14:1276

• Cited Here |
• PubMed

71. Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ. In situ simulation in continuing education for the health care professions: A systematic review. J Contin Educ Health Prof. 2012; 32:243–254

72. Rouleau G, Gagnon MP, Côté J, et al. Effects of e-Learning in a continuing education context on nursing care: Systematic review of systematic qualitative, quantitative, and mixed-studies reviews. J Med Internet Res. 2019; 21:e15118

73. Satterlee WG, Eggers RG, Grimes DA. Effective medical education: Insights from the Cochrane Library. Obstet Gynecol Surv. 2008; 63:329–333

74. Sunderji N, Ion A, Huynh D, Benassi P, Ghavam-Rassoul A, Carvalhal A. Advancing integrated care through psychiatric workforce development: A systematic review of educational interventions to train psychiatrists in integrated care. Can J Psychiatry. 2018; 63:513–525

75. Thepwongsa I, Kirby CN, Schattner P, Piterman L. Online continuing medical education (CME) for GPs: Does it work? A systematic review. Aust Fam Physician. 2014; 43:717–721

• Cited Here |
• PubMed

76. van den Eertwegh V, van Dulmen S, van Dalen J, Scherpbier AJJA, van der Vleuten CPM. Learning in context: Identifying gaps in research on the transfer of medical communication skills to the clinical workplace. Patient Educ Couns. 2013; 90:184–192

77. Vöhringer PA, Castro A, Martínez P, Tala Á, Medina S, Rojas G. Healthcare team training programs aimed at improving depression management in primary care: A systematic review. J Affect Disord. 2016; 200:142–147

78. Ward KN, Byrne JP. A critical review of the impact of continuing breastfeeding education provided to nurses and midwives. J Hum Lact. 2011; 27:381–393

79. Wilbur K, Elmubark A, Shabana S. Systematic review of standardized patient use in continuing medical education. J Contin Educ Health Prof. 2018; 38:3–10

80. Wu XV, Chan YS, Tan KHS, Wang W. A systematic review of online learning programs for nurse preceptors. Nurse Educ Today. 2018; 60:11–22

81. Zaher E, Keogh K, Ratnapalan S. Effect of domestic violence training: Systematic review of randomized controlled trials. Can Fam Physician. 2014; 60:618–624, e340–e347

• Cited Here |
• PubMed

82. Stevenson R, Moore DE Jr. Ascent to the summit of the CME pyramid. JAMA. 2018; 319:543–544

83. Curran V, Matthews L, Fleet L, Simmons K, Gustafson DL, Wetsch L. A review of digital, social, and mobile technologies in health professional education. J Contin Educ Health Prof. 2017; 37:195–206

84. Car J, Carlstedt-Duke J, Tudor Car L, et al.; Digital Health Education Collaboration. Digital education in health professions: The need for overarching evidence synthesis. J Med Internet Res. 2019; 21:e12913

85. Sinclair PM, Kable A, Levett-Jones T, Booth D. The effectiveness of Internet-based e-learning on clinician behaviour and patient outcomes: A systematic review. Int J Nurs Stud. 2016; 57:70–81

86. Wiggins G, McTighe J. Understanding by design. Alexandria, VA: Association for Supervision and Curriculum Development. 2005

• Cited Here

87. Harden RM, Crosby JR, Davis MH. AMEE guide no. 14: Outcome-based education: Part 1—An introduction to outcome-based education. Med Teach. 1999; 21:7–14

88. Dave Davis DA, McMahon GT. Translating evidence into practice: Lessons for CPD. Med Teach. 2018; 40:892–895

Appendix 1:

Articles Included in a Synthesis of Syntheses on CPD Published in English Between 2008 and 2019

Supplemental Digital Content

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Source: https://journals.lww.com/academicmedicine/Fulltext/2021/06000/Effect_of_Continuing_Professional_Development_on.51.aspx