Continuing Professional Education

UNITED STATES
Robert D. Fox

INTERNATIONAL CORPORATIONS
Brian Holland

UNITED STATES

Continuing professional education (CPE) may be thought of as the planned and systematic attempt to introduce, review, or alter the competencies and thereby the professional performance of professionals. Cyril Houle refers to CPE in observing that "whether it designates the improvement of professional competence or any other goal, (it) implies some form of learning that advances from a previously established level of accomplishment to extend and amplify knowledge, sensitiveness or skill" (p.77). The term continuing professional education contains three separate concepts, each worthy of definition as a means to understand the overall concept.

Education is a systematic process that seeks to alter knowledge and skill by engaging learners interactively with teachers or other knowledge resources, using a considered strategy to achieve an effect in the altered knowledge, skill, or attitudes of the learner.

Professional refers to people who engage in work based on a large, complex body of knowledge usually gained in professional schools. Professions include law, medicine, architecture, engineering, education, and other disciplines that codify practice. Professionals are thoughtfully engaged in the development and ongoing review of a body of applied knowledge, control over practices and the practice environment, membership criteria, ethics, and the economics of the delivery of services to clients. Although autonomy is an issue for all professions, it exists on a continuum from those with little self-control to those with expansive self-regulatory authority and autonomy.

In this three-part term, continuing refers to the post-preparatory phase of professional development. In this phase the professional is engaged in practice on a regular basis and is learning in ways that adjust practice to correct errors, expand or adjust performance, and introduce new or reformed practices and perspectives on practices. This process is continuous in that learning new or better ways of fulfilling professional roles is an everyday occurrence. Self-directed learning is used by professionals to manage their practice performance, therefore it is also considered to be part of the system of ongoing development that is the object of continuing professional education.

When all who participate in the CPE enterprise are considered, the costs are high. It is estimated that CPE costs approximately $60 billion per year and that when indirect costs are included the annual total may exceed $210 billion. The degree to which society is likely to invest in CPE is based on the extent to which people depend upon the performance of professionals to solve problems and improve the quality of life. As professional services expand, costs for ongoing development and education will likely follow.

Constituents of Continuing Professional Education

Although it would seem self-evident that continuing professional education systems direct their energies to professionals, CPE also serves the needs of a variety of groups and organizations that are concerned with the performance of professionals. For example, some professionals practice in partnership organizations, like clinics or firms. Others practice in large and small businesses where an employer may see CPE as means to alter services and therefore improve the prospects for profit. The quality of CPE may also be a high priority for organizations that do not employ professionals but depend on them and their performance to achieve their organizations' purposes. These organizations are concerned with quality control and coordination of resources. They sponsor or offer CPE in an attempt to influence the performance of the professional in a specific manner. Often these purposes are contrary to the interests of a given profession or reflect an influence that does not necessarily reflect the priorities of the profession in terms of the problems or solutions that are endorsed by the community of practitioners as a whole. This cataract of forces on professional performance creates conflicts that have led to a variety of regulatory and quality control systems to insure that CPE programs sanctioned by a profession are appropriate for the purposes and needs of the practice community.

Sources of Continuing Professional Education

Continuing professional education programs are offered by a variety of organizations, each with a particular set of purposes, some shared and some discreet. Universities, as the homes of most professional training programs, are a major provider of CPE. Often these programs are within the control of the faculty. They may be broadly based updates of an area of practice, or the programs may be designed to introduce new knowledge and skill emanating from research or scholarship in the discipline base of the profession.

Professional associations are also engaged in the planning and delivery of CPE, most often at annual meetings offered over several days at one location or at special sessions, topical in nature, offered nationally or at regional sites. These programs focus on issues the profession has identified as important to the well-being of the profession and the success of its practitioners, or useful in securing desirable outcomes for the profession's client systems.

Practice organizations are the firms, groups, hospitals, or other collections of practitioners who offer professional services in a specific field. Examples of practice organizations include a law office, an architecture or engineering firm, a managed health care organization, or a hospital. The CPE programs offered by these organizations often reflect the problems they encounter in the delivery of services to clients.

There are also private companies that offer CPE as a primary product in an effort to make a profit. These companies are engaged in the production of CPE programs directed toward the perceived needs of the marketplace. Often they work in concert with an industry that supports a particular profession or its client systems. These companies contract with other CPE organizations or directly offer CPE to address the educational needs and interests of the profession when these interests are congruent with the business interests of the industry and the corporation.

Government agencies are also important sponsors and providers of CPE, offering a variety of continuing professional development programs. These programs may be embedded in other initiatives, such as attempts to improve access to services for indigent populations by educating social workers or teachers in the screening and recruitment of clients. They may be offered for the direct purpose of introducing new techniques and methods, such as the efforts of the National Institutes of Health to improve health care worker practices in the area of HIV infections. Or they may be developed in support of new regulations that have changed the nature of professional practices in a particular area, such as new requirements for documentation or delivery of services to a new clientele.

Forms of Continuing Professional Education

Continuing professional education takes a variety of forms, some more common than others and some that are used often in one profession but almost never in another. One of the most common forms of CPE is in-service or on-the-job training. This may be very formal or almost undetectable to the observer but it is always directed toward introducing, updating, or modifying the way the profession is practiced in the work setting. It is characterized by an emphasis on practice and coaching. It may be loosely organized and episodic, arising as practice problems arise and disappearing as the need disappears. It is an important part of the learning community in any profession.

A more common form of CPE is a formal organized program built around definite objectives such as conferences, institutes, workshops, and lectures. Collectively, these methods represent only a small portion of the learning that occurs continuously for professionals. They are usually short-term in duration and may be focused on a general refresher of professional competencies, an overview of a new issue or collection of practices, or an effort to introduce new technique, skill, or practice protocols. Short courses are similar to these methods of educating professionals but occur over several meetings with time for preparation or practice between sessions.

Distance education has made a serious impact in most professions, but its success has varied according to the way the profession is practiced. In technical and scientific professions, computer assisted and web-based CPE has grown more rapidly than in fields like teaching and social work, where the practice setting is not as friendly to the insertion of computers and technological solutions. Nevertheless, the notion that education can be delivered at the time and in the setting where the work occurs promises a wider application of distance education in most professions.

The most effective strategies at changing professional performance are those that involve multiple methods of CPE and account for the needs of learners. Emphasis on motivation and needs in successful CPE reflects the role of experience in learning and the belief that the acquisition of new knowledge, skills, and professional practices is facilitated and enhanced when learning efforts are based on existing knowledge and skills and existing practices. This emphasis on knowledge of real and perceived needs as a basis for the design of education is widely accepted as essential for success in CPE.

An emphasis on complex strategies for facilitating learning in the professions is based on the complexities of adopting or modifying practices. Professionals develop means of performing their work based on extensive training and the ongoing evaluation of these practices in their work with clients. They grow confident in these practices and are reluctant to change them without evidence that different practices are better. Professionals desire a sense that new ideas are compatible with overall practice patterns and client needs, and sometimes they want to observe new practices before they incorporate them into their own work. They depend on consistency of information from many different sources, including colleagues, literature from their disciplines, and CPE programs. They often need to solicit feedback on their proficiency before they actually incorporate new knowledge or skill in the performance of their professional duties. A professional may require multiple learning opportunities and multiple methods of education to satisfy these expectations for information, practice, and feedback.

By far the most frequent means employed by professionals to enhance their professional growth is self-directed learning. Self-directed learning refers to the projects that professionals engage in to learn without the formal direction or organization of materials, methods, and educational strategies of a formal program of CPE. In this method of learning, the learner identifies his or her needs, sets objectives, develops strategies, and evaluates success. It is self-education and it is at the heart of the concept of the "learned" professional.

Foundations of Continuing Professional Education Practice

The practice of providing CPE programs and services depends on research and scholarship in several areas of adult education. It includes a focus on the theories and principles of planned change, adult learning and development, program and curricular design, applied research, consultation, and of course, the methods and materials of education. Masters and doctoral level programs of study are available to those who want to develop a concentrated knowledge of adult education and curriculum development. However, the majority of practitioners of CPE develop their areas of competency while "on the job" and have little formal preparation in adult education. Nevertheless, the literature and scholarship of CPE in each of the professions is connected to the literature and scholarship of adult education.

Accreditation of Continuing Professional Education Programs

In some fields there is a high level of interest in quality control over the professional educational process. This is manifest in complex systems that have developed for awarding credit to learners and extensive efforts to ensure the quality of CPE through systems of accreditation. In the United States, Canada, and Australia, the American Medical Association, the American Academy of Family Physicians, and the Royal Colleges of Physicians and Surgeons of Canada and Australia are among the many organizations that allow physicians and surgeons to receive documentation of learning from programs intensively reviewed for compliance with minimum standards for assuring quality. These organizations also record and certify participation by physicians in these programs.

Systems for quality assurance apply standards that focus on such attributes as qualifications of faculty, relevance to practice needs, adequacy of educational strategy, and documentation of outcomes. They may certify programs individually, or they may certify the organizations that offer the programs. Many professional practitioners depend on receiving career education credits as evidence of their continuing competence to their professional associations, licensing bodies, or client systems.

Issues and Trends

One of the most important recent trends in CPE has been the growing emphasis on developing a body of knowledge about how professionals learn and how they change their performance. Books and research articles in medicine have focused heavily on this topic as this and other professions struggle with how to make education a more effective tool for influencing the practice of the professions. Related to the need for more research and more effective procedures is the problem of how knowledge is handled across professions. Each profession has developed and implemented a system of CPE without tapping the experience or expertise of other professions. Some have annual research conferences and research journals that report the studies in their field. Most devote attention to the issues of CPE at annual meetings or conferences. It is rare that one profession will cite, or in other ways refer to, the knowledge and experience related to CPE that is gained in another profession. This gap in communication and collaboration on the issues of CPE has resulted in redundancy where coordination of the development of general knowledge and principles of CPE may have been beneficial. This may change as professionals are asked to work in teams more often to solve interdisciplinary societal problems.

Another issue important for the ongoing development of CPE is the growing pressure from society to document and certify professional competence. Two primary approaches have been taken to solve this problem: test on a regular basis or document participation in CPE. Different professions, different political jurisdictions, and even different specialties within professions have adopted one or both of these approaches to assure competence. Both approaches depend upon the continued growth of a competent system of CPE. This encourages research and development of the field as well and accountability from the providers of CPE to clients and client systems.

Continuing professional education is a requirement for professional competence as professionals encounter new problems and professional schools develop new knowledge and new ways of performing professional roles to meet the problems of practice. The practices of disseminating information, correcting errors in professional performance, and renewing the fund of knowledge and skills of professionals are essential if professionals are to maintain a high level of proficiency over thirty or forty years of practice beyond their formal, pre-professional education programs. For CPE to succeed it must continue to focus on providing learning opportunities that meet professional needs and practice problems while promoting the adoption of new knowledge and skills.

The United States, western Europe, and Japan all face a common set of economic restructuring and demographic changes. Each is in transition away from a manufacturing and industrial-sector base, and moving toward a postindustrial, information-based economy. Each is also encountering labor-market population changes as the overall population is aging and birth rates remain relatively low. The effects of these changes have been felt in labor shortages in some sectors. Yet for all the similarities among America, Europe, and Japan, there are striking differences in the coordination of labor markets for private companies to train employees. To explain why these differences exist, it is helpful to look at the history and structure of workforce training efforts in Europe (particularly Britain and Germany) and Japan designed to bring about public-private cooperation for skills development and human capital investment.

Workforce Training in Britain

Britain has been marked by a more voluntary connection between the public and private sector in workforce development policy. Initially, training policy until 1963 was characterized by a limited state intervention in labor markets–except for occasional efforts during the interwar years and the first decade after World War II to provide training as a means of remedying unemployment. The establishment of industrial training boards (ITBs) in 1963 was the first government recognition that economic growth was slipping in Britain, as compared to other European countries. The ITBs, while developing a compulsory levy/grant system to finance training efforts, did little to raise awareness of the linkage between economic growth and investments in human capital.

The ITBs were weakened by the 1973 Employment and Training Act, which set up the Manpower Services Commission (MSC). Unlike the ITBs, the MSC's main focus (until the rise of Thatcherism in 1981) was on job creation programs, although the legislative intent was to develop a comprehensive manpower strategy. The New Training Initiative (NTI), which was introduced in a 1981 white paper, returned MSC to its adult-training mission and moved to integrate youth into the workforce. The NTI again promoted a volunteer connection between employer training needs and the public sector, but shifted focus to stress portable skills for identified labor shortages and as a bridge for school-to-work connections. But the MSC failed to change the paradigm of employer involvement in training, and the National Audit Office was critical of the MSC's fiscal accountability and its failure to address the high-level course needs of employers.

Borrowing from the American model of private industry councils, the MSC was replaced by Training and Enterprise Councils (TECs) in 1988. While still being a more voluntarist model of cooperation between the public and private sectors, TECs are designed to be locally based and include private employer representation to set policy direction, although they are publicly funded through the Department of Employment. The charge of TECs, announced in the 1990 white paper Employment forthe 1990s, was not to deliver training, but rather to transfer responsibility for skills-development investment to employers, who would identify needs and administer public funds. In so doing, Britain embarked on the creation of a true training market, compatible with a limited government role in industrial policy.

Germany

By contrast, the mark of the German training system is the role of strong financial incentives that promote and enhance the coordination of the public and private sectors, primarily through the apprenticeship training initiatives for younger workers. As early as 1908, industrial employers in Germany recognized the need for a systematic training process to meet their shortage of skilled workers. In response to these problems, a committee called DATSCH (Deutschen Ausschuss für Technisches Schulwesen) was formed. In 1909 DATSCH recommended that all apprentices in the areas of industry and commerce be trained at an equivalent level. Following World War I, DATSCH worked with companies such as AEG and Siemens to design an apprenticeship program for these employers, and by 1925 a working committee set out to define industrial trades and distinguish between skill requirements in the labor force.

During the 1930s, before the rise to power of the Nazis, the apprenticeship content developed by DATSCH was recognized more globally by industry and chambers of commerce, and the principles of apprenticeship were refined by industry associations. Accordingly, training was geared toward, and reflected the needs of, employers. Following the war, there was concern that industrial apprenticeships would become fragmented and disorganized, and by 1953 the ABB (Arbeitsstelle für Betriebliche Berufsausbildung) had been organized to carry out similar functions as DATSCH. In the 1960s apprenticeship training met with criticism, as it was viewed as not meeting the needs of employers, and as being neglectful of an organized, tailored curriculum for industry.

The discontent behind the apprenticeship system eventually led to an expansion of the government's role in training. Passage of the 1969 Vocational Training Act shifted the orientation of the apprenticeship system from macroeconomic concerns, such as reducing unemployment, to a set of standards for testing procedures that would ensure that apprenticeships met employer needs. In fact, the law set up the contemporary vertical system of secondary school education with the design of the Hauptschule (general secondary school) and Real-schule (intermediate secondary school) system. Following the passage of the law, any person age eighteen or younger who completes Haptschule, Realschule, or level one of Gymansium and does notpursue an Abitur (a university education track) is required to attend the apprenticeship system, which combines part-time vocational education with work experience. Accordingly, the German approach is far more interventionist and has been able to achieve higher labor participation rates. These higher labor-force participation rates allow employers to have a stronger labor force with diminished turnover.

Japan

As a hybrid of both the British and German models, the Japanese tradition of hierarchical mentoring is a pattern that seems to have been replicated in industrial and skills training, although with less formal government support. In Japan, two unique features are present in the implementation of workforce preparation. First, there is an extensive level of onthe-job training that is required to be conducted between senior workers and new, less-experienced workers. Indeed, it has been documented that the ability to teach one's coworkers is a key criterion for promotion within a Japanese firm. These new workers are recruited from schools, where employers have established relationships for identifying and selecting high-performing students. New hires receive orientation sessions in safety and corporate culture (fudo) and informal on-the-job-training led by a senior worker.

The second critical element of Japan's investment in human capital is that employers engage their workers in a rotation system over their lifetime in employment. By engaging in the rotation system, the employee gains firm-specific skills that are commensurate with a career-ladder approach. Accordingly, the employee is trained in both technical skills and employment relations, and the employer is able to provide some measure of lifetime job security. But while job training is conducted formally in classroom settings to complement existing knowledge, the homogeneity of Japanese labor markets within firms encourages private employers to tailor programs that are more firm-specific than industry-specific in focus.

United States

On the federal government level, a sweeping set of workforce development reforms were implemented with the passage of the Workforce Investment Act (WIA) in 1998. WIA marked a radical departure from past federal workforce/employment policy for adult workers–a patchwork quilt of categorical, tailored responses–to the consolidation of some seventy separate programs under WIA into three funding streams.

In a significant development, policymakers made a conscious decision not to provide WIA with an open-ended authorization as was the case under the Job Training Partnership Act (JTPA). In repealing the JTPA, WIA sought to expand the role of the private sector with a more active voice to ensure that the workforce development system incorporates their input to prepare people for current and future jobs. In addition, WIA recognized that meeting individual needs in the workforce development system was paramount and resulted in a move toward greater decentralized delivery of training services.

Workforce Investment Boards (WIBs) under WIA replace the former Private Industry Councils (PICs) that existed under JTPA and implement the public-funded workforce development strategy of their geography. In so doing, the federal formula dollars are disbursed to WIBs to provide a comprehensive set of services at some 1,500 One Stops across the United States. These services include: a preliminary assessment of skills and support-service needs; information on a full array of employmentrelated services, including listings of training providers, job search and placement assistance, career counseling, access to up-to-date labor market information (which identifies job vacancies), and skills necessary for in-demand jobs; and information about local, regional, and national employment trends.

By the same token, the American workforce development system is decentralized for employers. Yet there can be connections between employers and potential employees at the One Stop Centers. In fact, One Stops enable employers with a single point of contact to list job openings and to provide information about their particular company's hiring needs and requisite skills for occupational openings. This emphasis on using market forces to enable customers to get the skills and credentials required in their local economies makes accountability among training providers a paramount concern.

In sum, the differences among Britain, Germany, Japan, and the United States fall along a continuum between individual autonomy and compulsory codetermination for employers in the provision of workforce training. The design of a genuine training market that reflects both employer demands and the existing labor supply (or the potential labor supply) is evolving. However, to encourage employers' investment in their employees will require a set of financial incentives and strategic planning to ensure the connection between school, work, and lifelong learning, rather than a policy approach that solely addresses unemployment and job creation.