Foundations of Continuing Education

Global Challenges for CME/CPD in Australasia

BARRY TAYLOR, FRACP

Key Words: continuing professional development, indigenous health, medical careers, professional isolation

The key professional development challenges for physiciansin Australasia arise from our colonial history, the sociocul-tural and gendered changes in our profession, expandingeducational expectations, and legal and ethical demandsplaced upon professionals. In this presentation I will focuson promoting skills to serve a culturally diverse population,supporting modern medical careers, providing access to high-quality educational resources, and instilling in Fellows a senseof their ethical responsibility for continuing professional de-velopment ~see TABLE 1!.

The medical system’s culture in Australasia derives fromthe 19th-century wave of European immigrants and the Brit-ish traditions in particular. Most physicians are monolin-gual English speakers, and our medical schools and hospitalsare modeled on the British system of health care delivery.My first challenge is that of our cultural diversity. Thereis great concern that the aboriginal people of Australia andMaori people of New Zealand are not being well servedby our health care systems. The difference in life expec-tancy between Maori and non-Maori people is 9.1 years.Indigenous Australians are expected to live 20 years lessthan the rest of the population. Aboriginal populations areoverwhelmed by the significant migration of other popu-lations from the Mediterranean, Pacific Islands, Asia, andAfrica. Medical graduates have always formed part of thatmigration, but immigrant doctors have had to conform tothe dominant medical system. In 2006, 41 percent of doc-tors in New Zealand were international medical graduates.The proportion of Maori doctors in New Zealand is 2.7

percent, while Maori form 15.5 percent of the popula-tion. The challenge for CPD is to shape our medical in-stitutions and educate our medical workforce to serveand care for the health needs of a multiethnic populationappropriately.

The second challenge is the matter of professional ca-reers. The proportion of women in the medical workforce inNew Zealand is now 36.4 percent. Women make up 53 per-cent of our junior doctors and one-third of our medical spe-cialists. It is common for medical graduates to stop practiceto raise families, assume management roles, undertakeadditional studies, or manage personal0family illness. Reg-ulatory authorities are becoming increasingly vigilant in de-manding retraining before recertification. Today’s graduateshave different expectations of their work0life balance. Thereis now evidence that doctors are spending more years inpractice and retiring at a higher age, a trend that may reflecteconomic concerns or just better health and vigor. Thesetrends raise questions: How do you maintain competence inyour practice until retirement? How do you draw your ca-reer to a close and exit with dignity?

The third challenge to CPD is professional isolation. Aus-tralia is a large continent with vast distances to travel toremote settlements. New Zealand consists of two smallerislands, with a small population distributed across townsclose to one another, but without any large cities where spe-cialty groups congregate. Private specialty practice is un-usual for New Zealand but common in Australia. Despitethese differences, both countries face problems of profes-sional isolation.

Disclosures: The author reports none.

Dr. Taylor: Director of CPD, Adult Medicine Division, The Royal Aus-tralasian College of Physicians, Wellington, New Zealand.

Correspondence: Barry Taylor, 6 Darwin Street, Karori, Wellington, NewZealand; e-mail: bbtaylor@xtra.co.nz.

© 2008 The Alliance for Continuing Medical Education, the Society forAcademic Continuing Medical Education, and the Council on CME,Association for Hospital Medical Education. • Published online in WileyInterScience ~www.interscience.wiley.com!. DOI: 10.10020chp.206

TABLE 1. The CPD Challenges for Australasia

• Skills to serve a culturally diverse population

• Professional career development factors1. Gender balance within the workforce2. Meeting needs for retraining of physicians3. Aging workforce

• Geographic and professional isolation of physicians

• Promoting participation0access in CPD

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For Australia:

• Traveling long distances to attend conferences.• Finding locums to cover absences.

For New Zealand:

• Remoteness from major centers.• Noncompetitive salaries making specialist recruitment

difficult.

The final challenge is participation rates in CPD. Al-though the Medical Council in New Zealand requires alldoctors to provide proof of satisfactory engagement in CPDeach year as a condition of practice, CPD compliance ratesare only 70 percent.

The Royal Australasian College of Physicians has re-sponded to the first challenge by entering into formal rela-tionships with its indigenous communities through theStrengthening Our Leadership through Indigenous Doctors~SOLID! Mentoring Project in conjunction with the Aus-tralian Indigenous Doctors Association. In New Zealand aMaori Health Committee of the college, with leadershipfrom Maori Fellows, guides college policy initiatives and

educational developments. The college is adopting the bestavailable communication technology to give access to ed-ucational resources and is using technology to develop in-novative CPD programs including “MyCPD,” presented atthis congress. A Rural Task Force is addressing the edu-cational needs of isolated physicians and attracting spe-cialists into rural communities. The college is reengagingits members through closer relationships with the manyspecialty societies in areas of policy, governance, educa-tion, and professionalism. The challenge of addressingaltered career pathways is being addressed through inter-national collaboration and shared experiences with likeinstitutions.

Lessons for Practice

• In Australasia, medical institutions are be-ing reshaped to educate the medical work-force to care for the health needs of amultiethnic population.

Taylor

S28 JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS—28(S1), 2008DOI: 10.1002/chp