COMMENTARY

Continuing Professional
Development in Pharmacy
Michael J. Rouse

Received April 13, 2004, and in revised form May 5,

ABSTRACT 2004. Accepted for publication May 7, 2004.
Michael J. Rouse, BPharm (Hons), MPS, is Assistant
Objective: To summarize a resource document that explains the concept and Executive Director, International and Professional
components of continuing professional development (CPD) for pharmacists, Affairs, Accreditation Council for Pharmacy Education,
Chicago, Ill.
describes some of the drivers behind the reevaluation of current systems of con-
tinuing pharmacy education (CE), defines relevant terms, and outlines some Correspondence: Michael J. Rouse, BPharm (Hons),
MPS, Accreditation Council for Pharmacy Education,
experiences with CPD in selected countries that have already adopted the 20 North Clark Street, Chicago, IL 60602-5109. Fax: 312-
model. 664-4652. E-mail: mrouse@acpe-accredit.org
Summary: CPD is an approach to lifelong learning being discussed as a Disclosure: The author is employed by the
potential model for pharmacists in the United States. CPD does not replace CE, Accreditation Council for Pharmacy Education, which
but quality-assured CE is an essential component of CPD. Evidence is mount- accredits the professional degree programs of schools
and colleges of pharmacy, and providers of continuing
ing, however, that traditional methods of CE do not adequately meet the life- pharmacy education. The author declares no other
long learning and professional development needs of health care professionals conflicts of interest or financial interests in any product
(HCPs) and are not always successful in affecting practice behavior and or service mentioned in this article, including grants,
employment, gifts, stock holdings, or honoraria.
improving patient outcomes. The Institute of Medicine has concluded that the
Acknowledgments: To Peter H. Vlasses, PharmD,
education and training of HCPs is in need of major overhaul. CPD, which is BCPS, Executive Director, Accreditation Council for
based on sound principles and adopts educational strategies that have been Pharmacy Education, and other directors of the Council
shown to be effective, potentially offers a quality improvement to the current on Credentialing in Pharmacy (CCP), for their valuable
systems for pharmacist CE. assistance in reviewing this article.

Conclusion: Interest in and support for the concept of CPD is growing. Case Previously published by: This article is a summary of a
resource document on continuing professional devel-
studies of successful implementation in the United States and other countries opment posted on the Web site of the Council on
now exist. Further discussion on the implications of widespread implementa- Credentialing in Pharmacy, www.pharmacycredentialing.
tion for pharmacists in the United States is needed. org/ccp/cpdprimer.pdf

J Am Pharm Assoc. 2004;44:517–520.

Vol. 44, No. 4 July/August 2004 www.japha.org Journal of the American Pharmacists Association 517
COMMENTARY Continuing Professional Development in Pharmacy

The Continuum of Education

I
n a changing, increasingly complex profession, and with rapid
medical and technological advances, the need for lifelong
learning for pharmacists is irrefutable. Patients have a right to While an appropriate, competency-based education can prepare
be confident that professionals providing health care remain com- a pharmacist to enter practice, no professional program can pro-
petent throughout their working lives. Regulatory bodies assume vide or develop all the knowledge, skills, attitudes, and abilities
the responsibility to assure this as much as possible. Some people that a pharmacist will ever need. These require a combination of
have questioned whether current systems provide a satisfactory an appropriate pre-service educational foundation, in-service train-
level of assurance and have advocated change, including the intro- ing, hands-on work experience, and lifelong learning. For profes-
duction of a relicensure examination or other methods of direct sionals, education is a continuum. The educational strategies, and
assessment of competence. There is, however, movement among competency- and outcomes-based approaches that are successful-
health professions within the United States and in other countries ly used for pre-service training must be maintained and expanded
to create an alternative process to relicensure examination. throughout the practitioner’s career.
Continuing professional development (CPD) is a framework, or an Unlike medical practitioners, most pharmacists do not obtain
approach, for lifelong learning that is being discussed as a poten- postgraduate qualifications and/or specialty certifications,
tial model for pharmacists in the United States. although a variety of such programs are offered. Certificate pro-
A resource paper written to describe the concept of CPD and grams, national standards for which were introduced in 1999, are
some of the drivers behind the reevaluation of the current systems longer than the average CE program (minimum of 15 hours of CE)
of continuing education (CE) for pharmacists, to define relevant and are designed to develop knowledge and/or skills in a specific
terms, and to outline the experiences of selected countries that area (e.g., immunization, diabetes management). To date, partici-
have already adopted a CPD model is summarized in this article.1 pation in certificate programs by pharmacists has been limited.
The resource paper is intended to provide a basis for further dis- Emphasizing the professional development of practitioners, CPD
cussions regarding CPD and what it could mean for the pharmacy expands (in breadth and depth) the traditional models of lifelong
profession and pharmacists if widely implemented in the United learning, thereby offering, some believe, a quality improvement to
States. current systems of CE. CPD is not a replacement for CE; quality-
assured CE and certificate programs are essential components of
CPD.
CPD is self-directed and practitioner centered, and it empha-
sizes the importance of practice-based learning. Its purpose is to
ensure that pharmacists maintain their knowledge, skills, and com-
AT A GLANCE petencies to practice throughout their careers in their specific area
of practice, to improve the pharmacist’s personal performance,
Synopsis: The Council on Credentialing in Pharmacy and to enhance the pharmacist’s career progression. CPD is out-
(CCP) has developed a resource document on continuing comes based, and is designed to meet specific goals and objectives
professional development (CPD), available on its Web site of the individual pharmacist and his or her organization, and ulti-
(www.pharmacycredentialing.org/ccp/cpdprimer.pdf), that mately to improve patient and public health outcomes.
sets forth a model of CPD, describes reasons for its devel-
opment, and outlines experiences with CPD in select coun-
tries. CCP’s document is summarized in this Commentary. Planning Personal Portfolios
Analysis: Traditional approaches to continuing educa-
tion (CE) are designed to provide assurance that licensed Although variations of the model have been adopted or dis-
practitioners maintain and update their professional com- cussed, CPD essentially involves a cycle in which individual prac-
petencies. While CE is effective in improving some aspects titioners reflect on their practice and assess their knowledge and
of professional competency, it does not fully address the skills, identify learning needs, create a personal learning plan,
required competencies identified by the Institute of implement the plan, and evaluate the effectiveness of the educa-
Medicine. CPD endeavors to address this issue by provid- tional interventions and the plan in relation to their practice.
ing a framework for lifelong professional learning. While it Documentation is an integral aspect of CPD, and a personal port-
includes CE as one component of the model, CPD is self- folio is used for this purpose. A five-step cycle was used in a state-
directed and practitioner centered and emphasizes prac- ment on CPD adopted by the International Pharmaceutical
tice-based learning. CPD is outcomes based and designed Federation (FIP) in 2002,2 and an adaptation of that five-step cycle
to meet specific goals, with the ultimate goal of improving (Figure 1) has been used as the basis for some of the discussions
public health outcomes. in the United States.
A further modification of the above cycle, in which “documen-
tation”—the portfolio—is shown as a central component (but not

518 Journal of the American Pharmacists Association www.japha.org July/August 2004 Vol. 44, No. 4
 Continuing Professional Development in Pharmacy COMMENTARY

a separate stage) of the cycle, is offered here for consideration pharmacist. Meaningful assessment of learning is difficult and in
(Figure 2). many cases is not even attempted.
The principles of CPD can be summarized as follows: A growing body of evidence (primarily from the medical litera-

CPD is a systematic, ongoing cyclical process of self-directed ture) demonstrates that while CE can be effective in improving
learning. knowledge, skills, attitudes, behavior, and patient heath outcomes,

It includes everything that practitioners learn that enables them traditional approaches to CE are not usually curricular in nature,
to be more effective as professionals, that is, both traditional CE do not optimally address all required competencies, and are not
and other forms of professional development. always successful in affecting change in practice behaviors. Many

CPD includes the entire scope of the practitioner’s practice and factors can influence the effectiveness of CE and its impact on per-
it may include activities both within and outside the usual work formance, practice, and patient outcomes. Previous studies have
setting. perhaps not adequately taken into account this complexity and

CPD is a partnership between the practitioner and his or her investigated all factors. More research is needed to improve our
organization, meeting the needs of both. understanding in this regard. Ample studies, however, indicate that

Practitioners are responsible for their own professional devel- use of multiple educational methods and participation in learning
opment. Organizations have a responsibility to help practition- activities are more likely to achieve sustainable learning and prac-
ers meet development needs that relate to performance in their tice change when these efforts:
current jobs.
Are self-directed
Many factors are driving a critical reevaluation of the systems
Are based on identified learning needs and/or personal goals
currently used to provide a satisfactory level of assurance that
Are relevant to practice, interactive, and ongoing
licensed practitioners, especially in the health professions, are
Have defined outcomes for the practitioner and the organization
maintaining and updating their competencies to practice. Using the
Can be reinforced through practice
approach most common for health professions, virtually all state In essence, these elements form the basis for the CPD approach.
boards of pharmacy rely on pharmacists’ participation in a defined
number of hours or CEUs (defined as 10 contact hours of partici-
pation in an organized CE experience under responsible sponsor- Health Professional, Heal Thyself
ship, capable direction, and qualified instruction) of accredited, or
otherwise board approved, CE to provide this assurance. Since the Pressure to change is coming from outside and within the phar-
mid-1970s, when the number of states requiring mandatory CE macy profession. Providers of health care services are being
started to grow, the number of accredited providers offering a required to be more focused on quality and quality improvement.
broad range of quality CE programs has expanded significantly. In a series of reports, the Institute of Medicine (IOM) has high-
These programs are offered in a variety of formats to accommo- lighted deficiencies in the health system, identified key factors
date different learning needs and preferences. However, few spe- contributing to the state of affairs, and made a number of recom-
cific requirements (by state boards) monitor or mandate the con- mendations. Of concern, IOM notes that the knowledge and skills
tent of CE or its relevance to the specific practice of the licensed of health care professionals (HCPs) are often not optimally used,

Figure 2. CPD Cycle Centered Around a Portfolio

Figure 1. Adaptation of Five-Stage Cycle Used by
FIP

Abbreviation used: FIP, International Pharmaceutical Federation.

Vol. 44, No. 4 July/August 2004 www.japha.org Journal of the American Pharmacists Association 519
COMMENTARY Continuing Professional Development in Pharmacy

and that problems arise because HCPs work in a system that does An Opportunity for Flexibility
not adequately prepare them, or support them once in practice, to
achieve the best for their patients. IOM concludes that the educa- In the United States, interest in CPD is growing, as is support
tion and training of HCPs are in need of major overhaul, advocates for the concept, evidenced by recent statements and resolutions by
that education and training (both pre-service and lifelong) need to several national pharmacy organizations. Not all stakeholders,
be competency based, and identifies five core competencies however, will feel the need for change and, while CPD appears
required by all HCPs (provide patient-centered care, work in inter- logical and straightforward as a concept, if adopted, implementa-
disciplinary teams, employ evidence-based practice, apply quality tion would certainly bring challenges along with opportunities. If
improvement, and use informatics). CPD advances, a different approach will be required by CE
IOM has gone further by recommending that all health profes- providers, practitioners, and their employers or institutions. New
sions should move toward requiring licensed health professionals skills and competencies will need to be developed. For example,
to demonstrate periodically their ability to deliver patient care identifying individual learning needs and developing a personal
through direct measures of technical competence, patient assess- learning plan are areas in which few currently have expertise.
ment, evaluation of patient outcomes, and other evidence-based Based on the experiences of other countries, a system that includes
assessment methods. This latter recommendation has profound some flexibility is likely to achieve better “buy in” by pharmacists.
implications, but it is unlikely that a system of direct assessment Evidence from Great Britain and Canada also indicates that a
(already in use in some countries) is feasible or considered desir- majority of pharmacists have been able to demonstrate that they
able by the pharmacy profession in the United States at this time. can self-direct their learning at the required level, that personal
A white paper on pharmacy’s future roles, responsibilities, and adoption of CPD was not as “burdensome” as expected, and that
manpower needs, published in 2000, noted that while the philoso- CPD was, overall, well accepted by pharmacists.
phy of pharmaceutical care was broadly endorsed in the early The full implications of widespread adoption of a CPD model
1990s as the new vision for pharmacy, progress toward need further discussion, and responses to this Commentary are
widespread implementation of the practice model had been frus- welcome in JAPhA’s Letters column. Many questions remain
tratingly slow.3 The importance and enormity of the change unanswered. Do pharmacists believe that the current CE system
involved have probably been underestimated. While several fac- satisfactorily meets their knowledge and skill needs? Are pharma-
tors have affected the rate of implementation of pharmaceutical cists going outside the pharmacy profession to have these needs
care, the fact that many practicing pharmacists were not originally met? Do pharmacists participate in valuable learning experiences
trained for such a practice model—and may lack some of the that are not formally recognized? Would pharmacists favor a re-
required knowledge and skills—must be considered. For many licensure examination? Are there other mechanisms that would
pharmacists, a retooling is probably required, and it would appear provide the public with the assurance that pharmacists are meeting
that current CE systems, which primarily focus on improving and the required competencies?
updating practitioner knowledge, are unlikely to adequately A perfect solution—simple, effective, inexpensive, and accept-
address this need. able to all—does not exist, and is unlikely ever to be realized.
Neither CPD nor CE alone can assure competence, and CPD per However, it appears that a quality improvement of the existing sys-
se is, as yet, a largely unproven model in pharmacy. However, can tem for pharmacist CE can be achieved and needs to be purpose-
CPD, based on sound educational principles, provide a better fully explored by the profession in a timely manner.
model to support effective lifelong learning for pharmacists? Early
adopters of the concept believe so, and some good examples of
CPD are emerging in pharmacy and in other professions. Great References
Britain and the province of Ontario, Canada, provide good case 1. Council on Credentialing in Pharmacy. Resource document on continu-
studies from programs initiated for pharmacy in the mid-to-late ing professional development in Pharmacy, 2004. Accessed at:
www.pharmacycredentialing.org/ccp/cpdprimer.pdf, May 5, 2004.
1990s.
2. International Pharmaceutical Federation. Statement of professional
standards on continuing professional development. September 2002.
Accessed at: www.fip.org, February 11, 2004.
3. American College of Clinical Pharmacy. White paper. A vision of phar-
macy’s future roles, responsibilities, and manpower needs in the United
States. Pharmacotherapy. 2000;20:991–1022.

520 Journal of the American Pharmacists Association www.japha.org July/August 2004 Vol. 44, No. 4