Perceived need and barriers to continuing professional development among doctors

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ARTICLE IN PRESSG ModelEAP-3212; No. of Pages 8

Health Policy xxx (2014) xxx–xxx

Contents lists available at ScienceDirect

Health Policy

journa l h om epa ge: www.elsev ier .com/ locate /hea l thpol

erceived need and barriers to continuing professionalevelopment among doctors

ivine Ikenwilo ∗, Diane Skåtunealth Economics Research Unit, University of Aberdeen Scotland, United Kingdom

r t i c l e i n f o

rticle history:eceived 29 January 2014eceived in revised form 1 April 2014ccepted 9 April 2014

eywords:cotlandational Health Serviceontinuing professional developmentevalidationonsultantpecialty and associate specialist

a b s t r a c t

There is growing need for continuing professional development (CPD) among doctors, espe-cially following the recent introduction of compulsory revalidation for all doctors in theUnited Kingdom (UK).

We use unique datasets from two national surveys of non-training grade doctors workingin the National Health Service in Scotland to evaluate doctors’ perceptions of need andbarriers to CPD. We test for differences over time and also examine differences betweendoctor grades and for other characteristics such as gender, age, contract type and specialty.

Doctors expressed the greatest need for CPD in clinical training, management, and infor-mation technology. In terms of perceived barriers to CPD, lack of time was expressed as abarrier by the largest proportion of doctors, as was insufficient clinical cover, lack of funding,and remoteness from main education centres. The strength of perceived need for particularCPD activities and the perceived barriers to CPD varied significantly by doctors’ job and
personal characteristics.
An understanding of the perceived needs and barriers to CPD among doctors is an impor-tant precursor to developing effective educational and training programmes that cover theirprofessional practice and also in supporting doctors towards successful revalidation.

© 2014 Published by Elsevier Ireland Ltd.

. Introduction

The importance of continuing professional develop-ent (CPD) among doctors is well recognised by medical

egulatory bodies and medical associations. The Unitedingdom (UK) regulatory body, the General Medical Coun-il (GMC), states as part of its good medical practice

Please cite this article in press as: Ikenwilo D, Skåtun D. Perceivment among doctors. Health Policy (2014), http://dx.doi.org/10

uidance that doctors must keep their “professionalnowledge and skills up to date” and “regularly takeart in activities that maintain and develop competence

∗ Corresponding author at: Health Economics Research Unit, Univer-ity of Aberdeen, Aberdeen AB25 2ZD, Aberdeenshire, Scotland, Unitedingdom. Tel.: +44 0 1224 437178.

E-mail address: [email protected] (D. Ikenwilo).

http://dx.doi.org/10.1016/j.healthpol.2014.04.006168-8510/© 2014 Published by Elsevier Ireland Ltd.

and performance”. This reflects the role of CPD in main-taining or improving physician performance and ultimatelyimproving patient outcomes (for a review of the effects ofCPD see Bloom [1]). In the United States for instance, thevast majority of State regulatory medical boards requirea set number of continuing medical education credits peryear as a requirement of licensure renewal. The Amer-ican Board of Medical Specialities (ABMS) also providesa voluntary system where physicians can demonstratecompetency within a speciality area. The Maintenanceof Certification (MOC) programme includes a “LifelongLearning and Self-Assessment” process. This outlines

ed need and barriers to continuing professional develop-.1016/j.healthpol.2014.04.006

specialty specific continuing medical education recerti-fication requirements. In Canada, the Royal College ofPhysicians and Surgeons lead the standards for spe-cialty post-graduate medical education. Their Maintenance

dx.doi.org/10.1016/j.healthpol.2014.04.006


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of Competency (MOC) programme is a mandatory pro-gramme of continuing professional development for itsmembers which sets out minimum number of CPD activitycredits within a 5-year cycle. The College of Family Physi-cians of Canada offer a similar membership scheme withevidence of CPD a requirement. The Medical Council ofNew Zealand is the body charged with registering doctorsand include CPD as part of their requirements for renewalor recertification of the practicing certificate. The MedicalBoard of Australia also require participation in CPD for reg-istration renewal. In the U.K. compulsory revalidation forall doctors has been recently introduced (renewable everyfive years) as further assurance to patients and the gen-eral public that doctors are “up to date and fit to practice”.1

Within this new revalidation framework, CPD is one keytype of supporting information used to demonstrate howdoctors are maintaining good practice, and where CPD isnot only concerned with the updating of clinical knowledgebut the need to maintain competence across the wholerange of behaviours including management, research andteaching activities.

With the importance of CPD as a means to achieve bet-ter patient outcomes and as a practical requirement forlicensing or revalidation there also exists a growing bodyof literature looking at perceived barriers to continuingmedical education [2–6]. Researchers identify several keybarriers to professional development, which can generallybe grouped in terms of organisational, logistic and fundingissues. Commonly perceived barriers to CPD have includedlack of time, funding or motivation, or lack of access eitherdue to the paucity or unavailability of CPD opportunitiesor insufficient organisational support for CPD (e.g. throughsufficient clinical cover). Most researchers have howeverconcentrated on reporting perceived barriers to CPD, with-out necessarily reporting what the (level of) perceived needfor CPD are. There are exceptions but these studies are gen-erally based on small samples [6].

It should be noted that the concentration on doctors’perception of their needs and barriers to CPD assumesthat doctors are able to accurately identify or self-assesstheir own CPD needs. The “unskilled and unaware of it”phenomenon, as outlined albeit in a non-medical setting[7], suggests that subjects who were unskilled in an area,tended to overestimate their own ability, make errors andthen do not have the ability to recognise these failings.Within the medical area there has been research thatconsiders clinicians and medical students self-assessmentabilities [8,9] with a review of the accuracy of physi-cian self-assessment concluding physicians have only alimited ability for accurate self-assessment [10]. WhetherCPD needs may be identified by individuals’ own assess-ment or set to some extent as mandatory requirements,it is important to document this need from the perspec-


tive of doctors, not only as a planning tool, but also asa reference guide for other (especially new or younger)doctors.

1 Revalidation is set out in line with the Good Medical PracticeGuide, which is available through the following link www.gmc-uk.org/GMP-framework for appraisal and revalidation.pdf 41326960.pdf.

PRESSlicy xxx (2014) xxx–xxx

The objective of this paper is to analyse perceived needand barriers to CPD among doctors as a way of providinginformation necessary to support doctors towards success-ful revalidation newly introduced in the UK. We test fordifferences between doctor grades and also consider differ-ences in other characteristics such as gender, age, contracttype and specialty. Such information (on need and barriersto CPD) is not routinely collected or published by secondarydata sources for the U.K., hence this analysis is expected tohelp advice policy makers and practitioners about iden-tifying and dealing with potential barriers to CPD amongdoctors, especially following to the roll out of compulsoryrevalidation in the UK.

2. Methods

2.1. Sample

Data for this analysis were obtained from two nationalpostal surveys of non-training grade doctors working inNHS Scotland in the periods 2005/06 and 2011/12. Bothsurveys gathered a wealth of information relating to work-ing conditions including specific questions relating tocontinuing professional development. Data are availablefor two types of doctors; specialty and associate special-ist (SAS) doctors and consultants. Consultants are seniorphysicians who have completed all relevant specialisttraining and are entered on a specialist register. SAS doc-tors include staff grade, speciality doctors and associatespecialists and are fully qualified but non-consultant gradedoctors and as such are not entered on a specialist regis-ter. Response rates from these surveys were 60% and 39%for specialty doctors and 56% and 41% for consultants in2005/06 and 2011/12 respectively. Although there wereoverall lower response rates from the second surveys, thesamples were generally representative of the populationof doctors working in NHS Scotland in terms of age andgender. More details about the surveys including the repre-sentativeness of the samples are reported elsewhere [11].2

Within both surveys, one set of questions asked doctorsto state the areas they felt they needed (further) educa-tion/training. Another set of questions sought to assess thefactors that restrict doctors’ participation in CPD activities.Doctors were presented with a wide range of training areasas well as various factors that could potentially restricttheir participation in CPD activities. The training areasmap well to the areas outlined in the GMC good medicalpractice guidance which form the basis of the appraisal andrevalidation process within the U.K. The guidance sets outhow clinicians should be meeting their professional val-ues where, along with the need to maintain and develop


in all aspects of work including management and teach-ing and the need to be able to communicate effectivelyare also referred to. The inclusion of the general area of

2 See the following link for details about the 2011/2012 surveyhttp://www.aomrc.org.uk/publications/reports-a-guidance/doc details/9507-the-impact-of-revalidation-on-the-clinical-and-non-clinical-activity-of-hospital-doctors.html.


http://www.gmc-uk.org/GMP-framework_for_appraisal_and_revalidation.pdf_41326960.pdf

http://www.gmc-uk.org/GMP-framework_for_appraisal_and_revalidation.pdf_41326960.pdf

http://www.aomrc.org.uk/publications/reports-a-guidance/doc_details/9507-the-impact-of-revalidation-on-the-clinical-and-non-clinical-activity-of-hospital-doctors.html



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Table 1Specific areas of perceptions of need and barriers to CPD among doctors.

Perceived CPD need Perceived CPD barriers

Clinical Lack of timeManagement Insufficient clinical coverCommunication Insufficient study leaveTeaching Lack of fundingTime Management Lack of good quality CPD activitiesInformationTechnology (IT)

Information overload

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Table 2Summary characteristics of sample of doctors in NHS Scotland.

n 2005/06 n 2011/12% %

ConsultantsMale 1861 70.18 1690 64.62Full time 1803 87.63 1717 80.20Age group 1920≤40 16.88 1716 19.2341–45 22.50 1716 22.2646–50 21.72 1716 22.0351–55 17.50 1716 19.99Over 55 21.40 1716 16.49Specialty group 1916Medicine 26.41 1718 19.97Surgery 16.96 1718 18.22Psychiatry 13.83 1718 12.51Anaesthetics 17.43 1718 12.28Others 25.37 1718 37.02Specialty doctorsMale 456 28.51 374 32.89Full time 463 52.27 322 48.14Age group 474≤40 17.72 374 22.7341–45 18.35 374 17.3846–50 18.14 374 21.1251–55 22.36 374 16.84Over 55 23.42 374 21.93Specialty group 473Medicine 23.89 370 20.81Surgery 12.68 370 10.81

Remoteness from main education centresLack of motivationFatigue

nformation technology reflects the continuing increase inhe use of electronic tools to support clinicians in the prepa-ation for revalidation and appraisals. A summary of theseeed and barrier factors questions are presented in Table 1.

For each need factor, respondents were asked to tickne of four response options, depending on whether theytrongly agreed, agreed, disagreed or strongly disagreedith requiring the specific CPD. In addition, doctors were

nvited to state whether they strongly agreed, agreed, dis-greed or strongly disagreed with each of the CPD barriersresented. For analysis, the survey responses were trans-ormed into two categories, one for agreement (‘stronglygree’ and ‘agree’) and another for disagreement (‘stronglyisagree’ and ‘disagree’) with specific needs and barrierso CPD presented in the questionnaires and summarised inable 1.

We first consider doctors views on how perceived CPDeed and barriers to CPD have changed between the twourvey dates using a simple two sample proportions test.

e then test for differences in perceived need and bar-iers to CPD between SAS doctors and consultants usingultiple regression analysis to control for differences in

ther characteristics such as gender, age, contract type andpecialty for the more recent 2011 sample. To do this, weecognise the possibility that doctors may perceive a needor more than one CPD activity. For example, a doctor mayerceive a need for clinical training as well as IT training,hile another doctor may perceive the need for all six CPD

raining activities elicited. In a similar way, a doctor mayerceive more than one barrier to CPD.

.2. Estimation technique

We estimate the following multivariate probit model12] of probabilities that doctors would like further trainingn one or more of the CPD activities elicited (m).

PDneedim∗ = ˇ′mXim + εim, m = 1, . . ., 6

CPDneedim = 1 if CPDneedim * >0 and 0 otherwiseεim, = 1, . . ., 6 are error terms distributed as multivariate nor-al, each with a mean of zero and variance-covarianceatrix V, where V has values of 1 on the leading diagonal

nd correlations �jk = �kj as off-diagonal elements.


The X’s represent a vector of explanatory variableshat define differences between doctors, age, gender,ontract type and specialty group. For simplicity, wenclude the same set of explanatory variables in all

Psychiatry 16.91 370 13.78Anaesthetics 8.03 370 4.86Others 38.48 370 49.73

six equations. The model is then analysed using theGeweke–Hajivassiliou–Keane (GHK) smooth recursiveconditioning simulator to estimate the maximum likeli-hood of the mvprobit model. We also employ the mvprobitmodel to evaluate differences (if any) that may existbetween doctors in their perceptions of barrier to CPD. Inother words,

CPDbarriersim∗ = ˇ′mXim + εim, m = 1, . . ., 9

The sample characteristics are presented in Table 2 andshow a total sample of 848 specialty doctors and 3636 con-sultants over the two time periods (2005/06 and 2011/12).The proportion of male SAS doctors increased by 4 percent-age points, while there was an almost 6 percentage pointsreduction in the proportion of male consultants over thetwo surveys. There were general reductions in the propor-tion of full time doctors from both grades, more so amongconsultants. The most represented specialty group (for alldoctor grades) was medicine (the ‘others’ category is madeup of specialties such as accident and emergency, gynae-cology, paediatrics, for which the sample of respondentswere too small to be analysed as separate categories).

All analyses were performed in Stata 12.

3. Results

3.1. Comparison over time


Doctors expressed the most perceived need for furthereducation and training in clinical areas in both survey years,as shown in Table 3. A total of 71% of SAS doctors perceived



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Table 3NHS Scotland doctors’ perceived CPD needs.

2006 2011 Change

n Proportion n Proportion

ConsultantClinical 1856 66.06% 1614 68.90% 2.84*

Management 1847 64.86% 1598 63.77% −1.09Communication 1825 30.25% 1553 29.81% −0.43Teaching 1831 51.56% 1564 52.24% 0.68Time management 1832 47.60% 1573 41.83% −5.77**

IT 1558 63.48% 1312 59.45% −4.03**

SASClinical 450 71.33% 333 80.48% 9.15**

Management 447 64.88% 305 64.26% −0.61Communication 437 29.29% 291 36.77% 7.48**

Teaching 437 61.78% 288 59.38% −2.41Time management 443 48.76% 305 53.44% 4.68
IT 365 70.96%
* Two sample proportion test significance at 10%.** Two sample proportion test significance at 1%.

a need for clinical training in 2006 compared 66% of consul-tants with corresponding figures of 69% and 80% in 2011.Agreement with the need for further education and trainingin management and IT are the next highest proportions inboth years for consultants and SAS doctors where generallyover 60% of respondents indicated that further educationand training were needed in these areas. The need forfurther training in communication was clearly the leastdesired among both doctor grades, both in 2006 and in2011, with proportions of respondents indicating a needfor further training ranging between only 29% and 40%.

In terms of changes in perceived CPD training need overtime, the largest significant increase (at the 1% level) among


SAS doctors was for clinical training where the propor-tion increased by 9 percentage points compared to lessthan 3 percentage points increase for consultants althoughthis was still significant at the 10% level. There was also

Table 4NHS Scotland doctors’ perceived barriers to CPD.

2006

n Mean

ConsultantsLack of time 1865 79.36%

Insufficient clinical cover 1839 60.96%

Insufficient study leave 1824 25.44%

Lack of funding 1832 41.38%

Lack of good quality CPD 1817 27.63%

Information overload 1802 39.79%

Remoteness 1812 30.02%

Lack of motivation 1811 14.80%

Fatigue 1689 33.98%

SASLack of time 445 72.81%

Insufficient clinical cover 443 51.92%

Insufficient study leave 436 25.46%

Lack of funding 443 40.63%

Lack of good quality CPD 436 42.66%

Information overload 417 22.54%

Remoteness 436 45.41%

Lack of motivation 430 22.09%

Fatigue 399 30.33%

* Two sample proportion test significance at 10%.** Two sample proportion test significance at 1%.

234 67.52% −3.44

a significant reduction in those consultants desiring train-ing in time management and IT. For SAS doctors the onlyother significant change was an increased agreement onthe need for CPD in communication. However even afterthis increase, the proportion of SAS doctors agreeing thatthere was further need for education and training withinthis area still remained the smallest of all areas in 2011.

The most perceived barrier to CPD was lack of time, bothamong SAS doctors and among consultants and in eachyear of survey (Table 4). Indeed the position as the mostperceived barrier for consultants was strengthened withthe largest increase between 2006 and 2011 of 7 percentagepoints. The second highest proportion related to insuffi-


cient clinical cover as a perceived barrier to CPD, again forboth doctor groups, with this barrier exhibiting the largestincrease for SAS doctors of over 11 percentage points. Therewere also other significant increases (over time) in the

2011 Change

N Mean

1668 86.81% 7.45*

1610 63.66% 2.711552 20.81% −4.63*

1589 47.51% 6.14*

1563 30.33% 2.70**

1561 38.69% −1.101589 36.63% 6.60*

1569 18.48% 3.68*

1482 33.87% −0.11

340 84.12% 11.31*

321 67.29% 15.37*

296 30.41% 4.95311 50.48% 9.85*

306 44.77% 2.11292 30.82% 8.28*

318 45.91% 0.50302 20.20% −1.89274 31.39% 1.06


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roportion of doctors perceiving different types of CPD bar-iers. For example among consultants, there were increasederceptions of remoteness from main education centresnd also of lack of funding. Among SAS doctors, there wereignificant increased perceptions of lack of funding andnformation overload. Consultants indicated a significanteduction in the proportions perceiving insufficient studyeave as a barrier to CPD. Lack of motivation was the leastikely barrier to restrict participation in CPD activities foroth doctor groups in both years of survey.

.2. Model results of differences in perceived need andarriers to CPD

We now consider where variations arise in the percep-ions of need and barriers to CPD using multivariate probitegression methods. We investigate differences betweenAS doctors and consultants and for other characteristicsuch as gender, age, contract type and specialty for theore recent 2011 sample. The full results are provided inppendix A with significant characteristics summarised inable 5.

.2.1. Doctor gradeConsultants were significantly less likely to perceive the

eed for CPD in clinical training and education, compared toAS doctors (Table 5). There is some evidence that consul-ants were also less likely to perceive the need for furtherducation and training in the areas of teaching and timeanagement (significant at the 10% level) compared with

AS doctors. Consultants were significantly less likely to


erceive insufficient study leave or the lack of good qualityPD as a barrier to further education and training comparedo SAS doctors. There was also some weak evidence (10%evel) that consultants were less likely to perceive the lack

able 5 summary of statistically significant differences in perceived need andarriers to CPD among doctors in NHS Scotland (full model results arevailable as Appendix A, Tables 6 and 7).

Perceived CPD need Positive effects Negative effectsClinical Age 51–55,

medicine,psychiatry

Consultant

Management Full time, age ≤50 AnaestheticsCommunication Age 41–45Teaching Age ≤55 ConsultantTime management Age ≤50 ConsultantIT Male, age ≤40Perceived CPDbarriersLack of time Age ≤55, medicine Male, anaestheticsInsufficient clinicalcover

Full time, age ≤40,medicine

Consultant,psychiatry

Insufficient studyleave

Full time, age ≤40 Consultant,anaesthetics,psychiatry

Lack of funding Surgery AnaestheticsLack of goodquality CPD

Consultant

Informationoverload

Consultant, male Age ≤40

Remoteness Anaesthetics Male, medicineLack of motivation Anaesthetics Age ≤40Fatigue

PRESSlicy xxx (2014) xxx–xxx 5

of clinical cover and more likely to perceive informationoverload as barriers to CPD than their SAS counterparts.

3.2.2. GenderThere was little evidence of differences across gender

in the perceived need for CPD apart from in IT where maledoctors were significantly less likely to report perceivedneed for further training. However there were some sig-nificant gender differences in perceived barriers to CPDwhere males were significantly less likely to perceive alack of time or remoteness from a main education centreas a barrier to their professional development compared tofemale doctors but were significantly more likely to agreethat information overload restricted their participation inCPD activities.

3.2.3. Contract typeThere was little evidence of differences in perception of

the need for CPD between fulltime and part-time doctorswith only weak evidence at the 10% level that full-timedoctors were more likely to perceive a need for furthertraining in management. In terms of perceived barriers toCPD, full-time doctors were significantly more likely to seethe lack of clinical cover as a barrier to their further educa-tion and training than their part-time counterparts. Therewas some evidence (at the 10% level) that full-time doctorswere more likely to indicate that insufficient study leaverestricted their participation in CPD activities compared topart-time doctors.

3.2.4. Age groupsThere were a number of significant age group differ-

ences in perceptions of CPD need. Compared to doctorsaged over 55 years, doctors in the 51–55 age group wereassociated with a significant additional perceived need forfurther education and training in the clinical area. Doctorsaged up to 50 indicated significantly higher perceived needfor CPD in the areas of management and time managementcompared to those over the age of 55 years. Doctors up toage of 55 years indicated a higher need for CPD in teach-ing compared to those over 55 years. Finally the youngestgroup of doctors indicated a significantly smaller need forCPD (at the 10% level) for further education and training inIT.

Doctors aged up to 55 years indicated that a lack of timeposed a significant restriction on their participation in CPDactivities compared to colleagues aged over 55 years. Therewas evidence that the youngest group of doctors felt that alack of study leave significantly restricted their participa-tion in CPD but were significantly less likely than their oldercolleagues to see a lack of motivation impacting on theirCPD activities. There was also weak evidence (at the 10%level) that this youngest age group’s lack of clinical coversignificantly restricted their participation in CPD, but theywere less likely than their older colleagues to see informa-tion overload restricting their CPD activities.


3.2.5. SpecialtyThere was little evidence of significant differences in

perception of CPD need across the specialty groups withonly weak evidence at the 10% level that doctors within


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the medicine or psychiatry specialties were more likely toperceive a need for clinical CPD. Similarly there was onlyweak evidence that anaesthetists were associated with areduced perception of the need for further managementtraining.

In terms of perceived CPD barriers, there were signifi-cant variations across specialty groups over a wide varietyof perceived barriers to professional development. Anaes-thetists were significantly less likely to indicate that lackof time, study leave or funding restricted their participa-tion in CPD but more likely to indicate that remoteness tomain education centres or lack of motivations were barriersto CPD activities than the non-specified “other” specialtygroup, made up of specialties such as accident and emer-gency, paediatrics, gynaecology, etc. Doctors within themedical specialty were significantly more likely to indicatea lack of time and lack of clinical cover as barriers to CPDactivity but less likely to indicate that remoteness from amain education centre was a barrier. Doctors within thesurgical specialty were significantly more likely to indi-cate a lack of funding restricted their participation in CPDactivities than those in the unspecified group of special-ties. Finally those within psychiatry were significantly lesslikely to indicate insufficient clinical cover or study leaveas restricting their CPD activity.

4. Conclusions

This is the first paper to evaluate both doctors’ perceivedneed and barriers to CPD within the same context in Scot-land. Such analysis, also comparing differences betweenspecialty doctors and consultants, male and female doc-tors, age and specialty groups, as well as differences overtime, is an important precursor to developing effective edu-cational and training programmes in supporting doctors toremain up-to-date especially with the introduction of com-pulsory revalidation for all UK doctors. The most expressedCPD need was for clinical training, while lack of time wasthe most reported barrier to CPD among all doctors.

Our results mirror some other findings in the literatureon barriers to CPD. For example, our results showing lackof time as the most identified barrier to CPD (by 81.24%of all doctors) is similar to 85% reported among hospital-based prevocational doctors in Australia [3]. In addition,Price et al. [13] also find that the most frequently reportedbarrier to implementing learning, among a group of healthcare professionals in Colorado, was lack of time (26% of allresponses).

In terms of policy, especially as it relates to the roll out ofrevalidation in the UK and other issues with appraisals andCPD, the results of this paper highlight the need to con-sider these differences in perceived need and barriers toCPD when formulating policy. The perceived barriers couldhelp in designing CPD activities, especially in ensuring ade-quate funding for doctors, the provision of good quality CPDactivities and instituting flexible working practices to allowdoctors time to engage and participate in available CPD


activities. CPD planners should be aware that, with lack oftime being the largest perceived barrier for both consul-tants and SAS doctors, CPD activities should be organisedas efficiently as possible to make the best use of the time

PRESSlicy xxx (2014) xxx–xxx

available. CPD planners should also ensure that time withindoctors job plans that is identified for activities such asCPD are protected. Doctors within the UK currently havejob plans which identify blocks of activity relating to directclinical care time and other activities such as supportingprofessional activities (SPAs) which includes CPD activi-ties. The results suggest that it is vital that time allocatedwithin the contract for these supporting professional activ-ities is maintained and protected. The consultant contractwithin the UK specifies a 75:25 split between direct clini-cal care and SPA time. However there is increasing pressurefor newly appointed consultants to accept job plans witha 90:10 split representing a reduction in time for SPA andCPD activities. In addition SAS doctors have no specific pro-portion of their time within their job plans allocated tosupporting professional activities. CPD planners need tomonitor and support doctors in finding protected time fortheir activities.

Our results suggest that while on aggregate there is aclear message that there is a perceived need for further edu-cation and training in clinical areas with lack of time a clearrestriction on participation in CPD activities, that there arealso significant differences across doctor grades and char-acteristics of doctors. This finding supports the GMC standthat CPD activities should be shaped by assessment of spe-cific professional needs and the needs of the service andthe people who use it. Consequently, this means that onesize does certainly not fit all, and these differences shouldbe taken into account when rolling out revalidation. Whilethere is no reason as to question the respondents’ ability toassess the barriers to CPD, the perceptions of CPD need aretempered by the findings in the literature that physicianshave a limited ability to correctly self-assess and self-directtheir continuing professional development needs. This maybe reflected by the fact that some countries operate a moreprescriptive requirement of a minimum number of hoursof CPD activity or where specific CPD courses by specialtyare required for continued medical registration. In the UKthere is no such prescriptive requirement on CPD activityas part of the revalidation framework. If self-assessmentis indeed limited in its ability to identify CPD needs, thissuggests that CPD planners within the UK should evalu-ate through independent assessment the areas in which toencourage CPD.

This analysis is not without its limitations. Firstly,despite a real possibility of repeat respondents over thetwo surveys, we were unable to determine these due tothe anonymity of the datasets used. There is also a possi-bility of bias in that those doctors with specific CPD needswere more likely to respond to the questions and to providestrong views about CPD, hence our findings may reflectthese rather than the general views.

Funding

We would like to acknowledge the support of thePay Modernisation Team at the former Scottish Execu-


tive Health Department who funded the 2005/06 survey,and the UK Academy of Medical Royal Colleges andFaculties who funded the 2011/12 survey.HERU is sup-ported by the Chief Scientist Office (CSO) at the Scottish


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Table 6 (Continued )

CPD Need Coefficient Std. error P > |z|Surgery 0.048 0.109 0.658Psychiatry 0.189 0.118 0.111cons −0.155 0.142 0.275

Time managementDoctor grade (consultant) −0.188* 0.111 0.091Male −0.070 0.084 0.401Full time 0.014 0.095 0.880Age ≤40 0.220* 0.123 0.074Age 41–45 0.342** 0.123 0.005Age 46–50 0.278* 0.125 0.027Age 51–55 0.200 0.126 0.110Anaesthetics −0.023 0.120 0.845Medicine −0.057 0.098 0.562Surgery −0.145 0.112 0.195Psychiatry −0.110 0.119 0.356cons −0.326* 0.143 0.023

ItDoctor grade (consultant) −0.080 0.113 0.480Male −0.329** 0.084 0.000Full time 0.039 0.095 0.680Age ≤40 −0.232* 0.120 0.052Age 41–45 −0.194 0.121 0.107Age 46–50 −0.176 0.123 0.151Age 51–55 −0.071 0.122 0.564Anaesthetics 0.082 0.120 0.493Medicine −0.121 0.097 0.212Surgery 0.081 0.109 0.460Psychiatry 0.035 0.119 0.768cons 0.604** 0.144 0.000

Sample 1251.00Wald Chi2 (prob > chi2) 270.11**

Log likelihood −4450.38LR test of Rho’s (prob) 568.72**

* ̨ < 0.10.

** ̨ < 0.01.

Table 7mvprobit model results of differences in perceived CPD barriers amongdoctors.

CPD barriers Coefficient Std. Error P > |z|Lack of timeDoctor grade (consultant) 0.141 0.130 0.280Male −0.277** 0.103 0.007Full time 0.043 0.114 0.706Age ≤40 0.436** 0.137 0.001Age 41–45 0.586** 0.141 0.000Age 46–50 0.409** 0.135 0.002Age 51–55 0.223* 0.135 0.099Anaesthetics −0.539** 0.129 0.000Medicine 0.334** 0.127 0.008Surgery 0.133 0.129 0.302Psychiatry −0.058 0.132 0.662cons 0.761** 0.159 0.000

Insufficient clinical coverDoctor grade (consultant) −0.195* 0.109 0.073Male −0.086 0.081 0.287Full time 0.216* 0.091 0.017Age ≤40 0.225* 0.117 0.056Age 41–45 0.175 0.117 0.133Age 46–50 0.187 0.117 0.110Age 51–55 0.052 0.120 0.665Anaesthetics −0.064 0.117 0.586

**

ARTICLEEAP-3212; No. of Pages 8

D. Ikenwilo, D. Skåtun / H

overnment Health and Social Care Directorate. All viewsre of the authors alone.

cknowledgements

We would like to thank all the doctors who responded tohe surveys and all temporary staff who helped in manag-ng the questionnaires and entering the data. Special thankslso go to Ms Fiona French and Professor Gillian NeedhamNHS Education for Scotland) who were part of the researcheams for both surveys and all others involved with eitherhe first or second survey.

ppendix A.

See Tables 6 and 7.

able 6vprobit model differences in perceived CPD need among doctors.

CPD Need Coefficient Std. error P > |z|ClinicalDoctor grade (consultant) −0.334** 0.123 0.007Male −0.041 0.086 0.632Full time −0.162 0.100 0.104age≤40 0.074 0.121 0.543Age 41–45 0.183 0.122 0.134Age 46–50 0.187 0.125 0.136Age 51–55 0.368** 0.127 0.004Anaesthetics 0.192 0.123 0.120Medicine 0.197* 0.102 0.054Surgery 0.060 0.112 0.593Psychiatry 0.238* 0.125 0.058cons 0.664** 0.151 0.000

ManagementDoctor grade (consultant) 0.155 0.115 0.177Male −0.080 0.086 0.357Full time 0.165* 0.097 0.089Age ≤40 1.213** 0.127 0.000Age 41–45 0.954** 0.124 0.000Age 46–50 0.670** 0.124 0.000Age 51–55 0.180 0.123 0.144Anaesthetics −0.232* 0.123 0.060Medicine −0.048 0.102 0.640Surgery −0.057 0.114 0.618Psychiatry 0.004 0.123 0.973cons −0.520** 0.145 0.000

CommunicationDoctor grade (consultant) −0.165 0.115 0.153Male 0.045 0.088 0.608Full time −0.073 0.099 0.460Age ≤40 0.182 0.127 0.150Age 41–45 0.247* 0.126 0.050Age 46–50 0.018 0.131 0.892Age 51–55 −0.070 0.132 0.598Anaesthetics 0.124 0.124 0.320Medicine 0.102 0.102 0.318Surgery −0.111 0.117 0.343Psychiatry −0.119 0.127 0.348cons −0.537** 0.148 0.000

TeachingDoctor grade (consultant) −0.220* 0.113 0.051Male −0.087 0.083 0.291Full time 0.120 0.094 0.202Age ≤40 0.582** 0.120 0.000

**


Age 41–45 0.462 0.120 0.000Age 46–50 0.356** 0.122 0.004Age 51–55 0.285* 0.122 0.019Anaesthetics 0.132 0.118 0.264Medicine −0.054 0.098 0.583

Medicine 0.308 0.097 0.001


Surgery 0.032 0.103 0.758Psychiatry −0.285** 0.108 0.008cons 0.228* 0.137 0.096

Insufficient study leaveDoctor grade (consultant) −0.304** 0.115 0.008




8 D. Ikenwilo, D. Skåtun / Health Policy xxx (2014) xxx–xxx


CPD barriers Coefficient Std. Error P > |z|Male 0.080 0.090 0.371Full time 0.174* 0.105 0.096Age ≤40 0.285* 0.131 0.030Age 41–45 0.063 0.134 0.641Age 46–50 −0.061 0.136 0.657Age 51–55 0.088 0.138 0.523Anaesthetics −0.379** 0.145 0.009Medicine −0.095 0.105 0.364Surgery 0.083 0.112 0.458Psychiatry −0.312* 0.131 0.017cons −0.793** 0.153 0.000

Lack of fundingDoctor grade (consultant) −0.055 0.104 0.596Male −0.008 0.079 0.917Full time 0.068 0.089 0.444Age ≤40 0.080 0.116 0.490Age 41–45 0.053 0.115 0.647Age 46–50 −0.050 0.116 0.663Age 51–55 0.005 0.119 0.969Anaesthetics −0.402** 0.119 0.001Medicine −0.015 0.092 0.875Surgery 0.255* 0.102 0.012Psychiatry 0.154 0.107 0.150cons −0.130 0.134 0.332

Lack of good quality CPD activitiesDoctor grade (consultant) −0.377** 0.106 0.000Male 0.098 0.083 0.238Full time 0.014 0.094 0.885Age ≤40 0.055 0.122 0.651Age 41–45 0.075 0.121 0.532Age 46–50 0.011 0.121 0.926Age 51–55 0.070 0.124 0.575Anaesthetics 0.186 0.119 0.119Medicine −0.146 0.099 0.139Surgery 0.123 0.106 0.245Psychiatry 0.030 0.114 0.795cons −0.331* 0.138 0.017

Information overloadDoctor grade (consultant) 0.207* 0.111 0.061Male 0.206* 0.081 0.011Full time −0.077 0.092 0.402Age ≤40 −0.218* 0.118 0.066Age 41–45 −0.187 0.117 0.110Age 46–50 0.073 0.116 0.531Age 51–55 0.060 0.120 0.615Anaesthetics 0.179 0.115 0.121Medicine −0.044 0.095 0.642Surgery 0.044 0.104 0.668Psychiatry −0.131 0.113 0.247cons −0.548** 0.139 0.000

Remoteness from main education centresDoctor grade (consultant) −0.163 0.105 0.122Male −0.210** 0.081 0.009Full time −0.114 0.090 0.206Age≤40 0.097 0.119 0.415Age 41–45 0.137 0.119 0.248Age 46–50 0.129 0.119 0.275Age 51–55 −0.049 0.124 0.694Anaesthetics 0.298* 0.116 0.010Medicine −0.200* 0.097 0.038Surgery 0.023 0.105 0.825Psychiatry 0.069 0.110 0.534cons −0.083 0.137 0.544

Lack of motivationDoctor grade (consultant) −0.143 0.124 0.248Male 0.128 0.095 0.175Full time −0.022 0.106 0.837Age ≤40 −0.282* 0.137 0.039Age 41–45 −0.089 0.132 0.499Age 46–50 −0.067 0.131 0.608Age 51–55 −0.174 0.137 0.203


CPD barriers Coefficient Std. Error P > |z|Anaesthetics 0.260* 0.131 0.047Medicine −0.067 0.112 0.547Surgery 0.156 0.117 0.183Psychiatry −0.042 0.132 0.753cons −0.832** 0.153 0.000

FatigueDoctor grade (consultant) 0.070 0.110 0.523Male −0.087 0.081 0.282Full time 0.099 0.092 0.283Age ≤40 0.086 0.121 0.475Age 41–45 0.166 0.120 0.167Age 46–50 0.197 0.120 0.101Age 51–55 0.165 0.123 0.181Anaesthetics −0.173 0.120 0.152Medicine −0.064 0.095 0.500Surgery 0.037 0.103 0.719Psychiatry −0.187 0.114 0.101cons −0.638** 0.140 0.000

sample 1391Wald Chi2 (prob > chi2) 281.01**

Log likelihood 6719.33LR test of Rho’s (prob) 857.90**

[

[

[

[

* ̨ < 0.10.

** ̨ < 0.01.

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Perceived need and barriers to continuing professional development among doctors