Continuing Professional Education: Multiple Stakeholders and Agendas
The leaders of professions and the public have always assumed that professionals would maintain their competence by continuing to learn throughout their careers through reading, discussions with colleagues, and educational programs. Since the 1960s, one of these educational forms, formal educational programs, has increased dramatically. Most professions now embrace the importance of lifelong professional education. In the rapid growth of continuing education (CE), educational leaders have generally relied for guidance and models on the distinctive knowledge base and structure of their own profession. However, many observers (Houle, 1980; Cervero, 1988; Brennan, 1990) noted the similarities of the CE efforts of individual professions in terms of goals, processes, and structures. Thus, the concept of continuing professional education (CPE) began to be used in the late 1960s. Various terms are used throughout the world referring to this concept, including continuing professional development, staff development, and professional learning. The rationale for this movement is that the understanding of similarities across the professions would yield a fresh exchange of ideas, practices, and solutions to common problems.
As with any educational system, CPE has many stakeholders with multiple agendas.The purpose of this article is to chart the expansion of CPE and three agendas that are shaping its present and future: professional and social, institutional, and educational agendas. Although the growth of CPE is a worldwide phenomenon, the most articulated systems exist in the nations of the Global North, such as Canada, Europe, Australia, and the United States. As such, CE and training have been addressed in global contexts such as the World Trade Organization and the General Agreement on Tariffs and Trade (GATT) (Lenn and Campos, 1997). This article accordingly focuses on the development of CE efforts in these regions of the world.
Systems of CE for the Professions
A central feature of societies in the twentieth century was the professionalization of their workforces. One estimate is that nearly 25% of the American workforce, for example, is classified as professionals (Cervero, 1988). These professionals include teachers, physicians, clergy, lawyers, social workers, nurses, business managers, psychologists, and accountants. Educational systems have been a key feature of this professionalization project (Larson, 1977). An incredible amount of resources, financial and human, is used to support 3–6 years of professionals’ initial education. Until recently, however, little systematic thought was given to what happens for the following 40 years of professional practice. Many leaders in the professions believed that these years of preservice professional education, along with some refreshers, were sufficient for a lifetime of work. However, with the rapid social changes, the explosion of research-based knowledge, the growing emphasis of evidenced-based practice, and spiraling technological innovations, many of these leaders now understand the need to continually prepare people for 40 years of professional practice through CE (Houle, 1980). Beginning in the 1960s, we started to see embryonic evidence for systems of CPE. Perhaps the first clear signal of this new view was the publication in 1962 of a conceptual scheme for the lifelong education of physicians (Dryer, 1962). The 1970s saw the beginning of what is now a widespread use of CPE as a basis for relicensure and recertification (Cervero and Azzaretto, 1990). By the 1980s, organized and comprehensive programs of CPE were developed in engineering, accounting, law, medicine, pharmacy, veterinary medicine, social work, librarianship, architecture, nursing home administration, nursing, management, public school education, and many other professions (Cervero, 1988). During this decade, many professions also developed their systems of accreditation for providers of CPE.
At the present time, the picture of an instructor updating large groups of professionals about the most recent theories and findings is easily recognizable as the predominant form of CE. We do not yet have a similarly recognizable picture of a system of CE in any profession. The major reason for this lack of a unifying picture is that the professions are in a transitional stage, experimenting with many different purposes, forms, and institutional locations for the delivery of CE. These systems, as such, are incredibly primitive and can be characterized as: devoted mainly to updating practitioners about the newest developments, transmitted in a didactic fashion by a pluralistic group of providers that does not work together in any coordinated fashion.
Relatively speaking, systems of CE are in their infancy. By way of analogy, CPE is in the same state of development as preservice educationwas at the beginning of the twentieth century. It is unlikely that anyone in 1910 would have predicted the structure of medical education today. Likewise, systems of CPE are likely to grow through this transitional period to achieve an equivalent coherence, size, and stature as the preservice stage of professional education. While these systems of CPE are in a grand historical transition (Young, 1998), it is quite unclear what form they will take in the future.
Social and Professional Agendas
Within every profession, there are segments using knowledge for different social purposes. As Schon (1983: 345) argues, professionals’ ‘‘special knowledge is embedded in evaluative frames which bear the stamp of human values and interests.’’ It is not surprising that the professions have conflicting values about their role in society because professions are ‘‘loose amalgamations of segments pursuing different objectives in different manners and more or less held together under a common name at a particular period of history’’ (Bucher and Strauss, 1961: 326). For example, many social workers deliver services by means of individual casework. However, within the profession, some argue that casework is a form of conservative politics that reinforces institutions, processes, and ideologies that are destructive to human well-being (Galper, 1975). In this view, social work is considered conservative because its basic assumption is that nothing is wrong with societal arrangements, but rather with individuals who need to adjust to the status quo. The existence of internal dissension and value conflict is not new. For example, Perrucci (1973) found 18 radical movement organizations in 12 professions, including medicine, engineering, law, and psychology. These movements share the perspective that the professionals’ role is to ask for whom and for what ends their expertise should be used. As professionals’ knowledge can serve conflicting social purposes, CPE likewise can and does serve many different purposes.
CPE is being used more frequently to regulate professional practice. One of the major changes of the past 20 years has been the incorporation of CE into accountability systems for professional practice. As regulatory bodies struggled to develop accountability mechanisms, participation in CE was often the method of choice. However, these new requirements have been critiqued for ‘‘promoting the appearance of accountability but [doing] little or nothing to address the underlying issue of competence’’ (Queeney, 2000). In spite of this lack of demonstrable connection between CE and competent practice, the use of professionals’ participation in CE to regulate their practice has not abated for the past two decades. Perhaps the most obvious example is the growth of state use of CE as a basis for relicensure. What started in the 1970s is now widespread such that every profession uses some form of mandatory CE. The number of states requiring CE for relicensure has risen consistently for the past two decades. More professions are likely to follow the example of the Royal College of Physicians and Surgeons of Canada who have developed the Maintenance of Competence Program for recertification. This system allows physicians to use activities such as participation in audits of practice and a personal learning portfolio, which is a database of items of new learning recorded during the past year.
Institutions develop the second part of the agenda, shaping present and future systems of CPE. Many different kinds of institutions have a stake in the growth of CPE systems, and each of these different institutions may have different goals and different methods by which CPE is provided. In discussing institutional agendas for CPE, four components are considered:
- multiple goals,
- multiple providers,
- multiple modes of delivery, and
- Collaboration among providers and professions.
Often the primary factor in determining the institutional agenda is the goals of the organization inwhich CPE is provided. Institutions tend to view CPE in different ways and most often these views are linked to the overall mission, vision, and values of the institution. For example, some institutions may view CPE as a method of employee development. Within these institutions it is believed that an educated and well-trained workforce is essential to the services provided by the institution. Healthcare, for example, most often focuses on employee development as a way to provide high-quality client care. The view here is that education assists employees to provide services that clients need. Thus, education or CPE is an essential link in the provision of institutional service.
Other institutions may see the provision of CPE as a method by which they can generate revenue. CPE is big business, especially in those states, countries, or territories that require CPE for recertification or relicensure of professionals. Higher education and professional schools, for example, are institutions that often rely on CPE as a way to generate revenue to support the overall mission of the institution. In these institutions, CPE is offered to large populations of professionals (often alumni) within the institutions’ service area rather than to employees from one institution.As such, the revenue generated from day-long conference,multiday conferences, or short courses returns to the more centrally managed CPE unit within the university or school.
The providers of CPE include the workplace, professional association, higher education, and for-profit companies. The workplace is by far the largest provider of training and education for professionals and often this is accomplished through human resource development (HRD). Yet, each of these different providers offers unique CPE programs for specific audiences.
Dirkx and Austin (2005) help us understand the integrated nature of the multiple providers in CPE and the multiple goals of these providers. In their model of theoretical orientations in continuing professional development (Dirkx and Austin, 2005), they propose that the aims of professional development (based on Habermas, 1972) can range from technical, to practical, to emancipatory. Within the technical domain instrumental action, the scientific method and the hard sciences are addressed. In contrast, within the practical domain communicative action or human interest is most often the focus. Finally, the emancipatory domain focuses more on power and understanding our actions through self-reflection and self-knowledge.
In addition, Dirkx and Austin indicate that the goals of professional development are met in four primary contexts: HRD, CPE, faculty development, and staff development. Basically, these contexts represent the various areas in which professional development is most often provided. For example, HRD is usually provided as training in the workplace; CPE is most often provided through professional associations and higher education; faculty development is accomplished within colleges and universities; and staff development is associated with schools. What is evident in the Dirkx and Austin (2005) model is that the contexts of HRD, CPE, faculty development, and staff development may also overlap with different types of institutions. Finally, Dirkx and Austin (2005) indicate that the focus of professional development may be individual or organizational. In their view, offerings are not exclusively individual or organizational but they tend to predominately focus on one or the other.
In analyzing developing systems of CPE, Dirkx and Austin (2005) offer a model that focuses on the multiple and overlapping providers and goals.Their model, depicted in Figure 1, demonstrates the complexity of currently developing systems of CPE. As Dirkx and Austin (2005) indicate, professional development can be conceptualized around ‘‘the overall aim of or purpose for professional development; the context of professional development; and the primary focus of the professional development activity’’ (p. 3). The model, depicted in Figure 1, promotes a new understanding of institutional agendas in CPE. Each cell in this model could be considered a different type of CPE offering. Dirkx and Austin indicate:
It is possible to take any particular context and identify different kinds of professional development that represent the different cells within that overall context. For example, one kind of faculty development program (context) might seek to develop specific skills (technical aim) in the use of a particular online software, so the professors can design and delivery more independently their own online courses (focus). This might be driven either by the organization’s need to develop additional revenue in budget-tight times (organizational focus), or individual professors may freely elect to develop this new expertise as part of a re-directing of their careers (individual focus)
(Dirkx and Austin, 2005: 8).
Institutional agendas for CPE are also shaped by the multiple modes of delivery. CPE is predominately offered as limited, short-term educational programs presented in real time in a face-to-face format. These programs range from 1-day conferences, to multiday conferences, to short courses (i.e., 1–5 weeks). Most often, the mode of delivery for CPE focuses on an update of technical information so that the professional can return to their worksite with an increased understanding of new knowledge. However, increasingly distance education technologies are being incorporated into CPE programming. These technologies range from video-conferencing across multiple sites, to Internet-based courses, to Internet-based conferences, to online group discussion forums. Additionally, a relatively new form of distribution in CPE is learning objects. According to Lehman (2007) learning objects are ‘‘digital chunks of information’’ (p. 57). These digital chunks of information can be developed in the form of text, video, audio, or multimedia and they can be used to present case studies, new procedures, self-directed learning modules, or simulations. These smaller learning units can then be downloaded to hand-held devices making them easy to access and to share with other professionals.
Finally, collaboration among provider and professions is essential to present and future systems of CE. Collaborative arrangements among providers and across professions can not only help increase learning and understanding, but they can also help decrease the cost of providing CE. However, collaboration can raise issues within institutions and among providers. For example, providers of CPE at times feel that too much collaboration can demonstrate that their program is not needed. Once again, Dirkx and Austin (2005) offer us a way to consider collaboration. Within their model presented in Figure 1, areas of collaboration become evident. For example, if a healthcare employer decides that the aim of their educational programming will be technical, conducted within an HRD context at the organizational level, they may realize that they need to collaborate with universities and professional schools who can provide more emancipatory, CPE at the individual level. In this manner, different providers and different professions can analyze their own strengths and then collaborate with other providers offering different kinds of education using different methods. This type of analysis may draw on the strengths of organizations, prevent overlapping offerings, and streamline competition.
Building on professional/social agendas and institutional agendas, the educational agenda also impacts the continuing development of systems of CPE. However, for the educational agenda to be truly effective, we must include a model of learning (Cervero, 1988) at the center of these educational agendas. As Eraut (1994) explained, behind ‘‘professional education lies a remarkable ignorance about professional learning’’ (p. 40).
Early models of professional learning have relied on the ideas of technical rationality (Houle, 1980), transfer of learning (Broad and Newstrom, 1992), and adoption of innovation (Rogers, 1995). In these views, knowledge for professional practice was created in one location, often a university setting, disseminated through CPE programs, and then transferred to or adopted in professional practice.
In the 1980s however, Cervero (1988) proposed a model for learning in the professions based on an understanding of how professionals ‘‘develop knowledge through practice’’ (p. 39). Cervero (1988) advocated that CPE providers develop a critical model of the learner that integrates the development of two forms of knowledge – technical and practical.Within this model, he incorporated components of cognitive psychology, reflective practice (Schon, 1987), and studies of expertise (Benner, 1984; Dreyfus and Dreyfus, 1985).
As systems of CPE continue to be developed, expanded models of learning will need to underlie educational offerings. Recent research (Daley, 2001a, 2001b) indicates that professionals construct a knowledge base for themselves in the context of their practice by linking concepts from new knowledge learned in education programs with their practice experiences. At this point, they actively make decisions on how to incorporate new knowledge into the context of practice based on their interpretations of the environment. What this newer research adds is an enhanced understanding of how learning in CPE occurs when professionals actively link new knowledge with the context in which they work and professional practice in which they engage.
As systems of CE continue to be developed, it is essential that education providers recognize this process of knowledge construction. Professionals do not simply take information from a learning situation and incorporate it in a practice context. They go through a much more complex process of taking in the new information, analyzing the context of their work site (including the politics and the people with whom they work), and then they decide if the new information is a good fit for their work based on the nature of their professional practice. This is a much more involved and sophisticated process than early professional learning models indicated. It requires that the educational agenda of CPE providers changes to incorporate a more active and integrated type of learning.
Additionally, an area that needs further development within professional learning is the question: How does the nature of professional practice connect to the educational agenda? We know that professionals construct a knowledge base for their practice and also know that the context of their work environment impacts the process. However, in addition, we need to understand how the nature of their professional work impacts learning. For example, do social workers learn in a fundamentally different manner than lawyers? Recent work by Donaldson (2002) indicates that individuals within different professions fundamentally think in distinctive ways. Therefore, this raises the question: Does the nature of the professional’s work drive the thinking and learning process? If this is the case, then how does that shape the educational agenda of CPE in the future?
Finally, the overall purpose of learning within the professions is designed to develop expert practitioners who provide high levels of service to clients. The study of professional expertise has grown from an understanding of serial problem solving (Newell and Simon, 1972) to an understanding of the stages of career development within specific professions such as physists (Chi et al., 1980), pilots (Dreyfus and Dreyfus, 1985), nurses (Benner, 1984), and physicians (Groen and Patel, 1988). These studies identified that as professionals gain experience they move from a novice to an expert practitioner. As professionals move from novice to expert, they develop the ability to think more abstractly and to see holistic patterns within their clients. They develop a sense of salience with the context that allows them to move from seeing individual issues to seeing systems and the integrated nature of professional problems. The study of expertise is now moving toward developing an understanding of the connections between learning and expertise. For example, Daley (1999) found that novice nurses tend to learn in a contingent manner, while expert nurses learn in a more constructivist manner. This type of research has implications for the educational agenda of CPE and necessitates that program planners consider the level of professional development of their audience. Finally, studies of expertise that focus on development of collective expertise across various contexts and disciplines are also needed. The idea of collective expertise within a profession or at a workplace is an area that will again shape the educational agenda of the future and will need more research.
In addition to professional learning models, evidence on the effectiveness of CPE is an important consideration in the educational agenda for CPE systems.When professionals attend CPE programs and learn new information, the question exists ‘‘Does it make a difference in the service provided to clients?’’ Early studies showed mixed results in response to this question, with some studies indicating little impact and other indicating great impact. To clarify this variability in the results of evaluation studies, Umble and Cervero (1996) conducted a meta-analysis of 16 studies that provided a synthesis of impact studies in CPE. A major purpose of this review was to analyze and critique the methodologies of the studies, but in addition they found that a first wave of syntheses studies existed that demonstrated a general causal connection between CPE and impact on professional practice. Umble and Cervero (1996) found that CPE had an impact on knowledge, competence, performance and outcome.
In addition, Umble and Cervero (1996) found that a second wave of studies had begun to demonstrate a number of variables that moderate the impact. This second group of studies began identifying the types of programs that can promote performance change within the professions. Umble and Cervero (1996) indicate that as the development of CPE systems moves forward, more work is needed in understanding the impact of CPE on practice. They advocate for more experimental studies, more qualitative and mixed-methods studies, and the use of action research (Brooks and Watkins, 1994) as both a programming and evaluation methodology.
The educational agenda in current systems of CPE is thus shaped by the model of professional learning incorporated in education practice, by an understanding of the nature of expertise, and by the overall effectiveness of the impact of CPE programs. In the future, CPE systems will continue to be shaped by ongoing and expanding research in all three of these areas.
The task of building systems of CPE is fundamentally more complex than what faced leaders as they built the existing systems of preservice professional education. First, whereas preservice education takes place in a relatively short period of time, CE must help professionals for 30–40 years of professional practice, which is characterized not only by constant change, but also often by competing values. Second, while preservice education is predominately controlled by universities and professional schools, there are multiple institutions that offer CE, all of which stake a claim to being the most valid and effective provider. The leaders of workplaces, professional associations, universities, and governments have both a tremendous opportunity and a clear responsibility to further develop the systems of CE for the professions. As with any humanly constructed system, the building of a coordinated system of CE for any profession is a political process. While we cannot predict what these systems will look like, this process will be marked by fundamental struggles over the educational, institutional, and professional agendas and the competing interests of the multiple stakeholders for CE. As a political process, then, it is crucial that all of the stakeholders participate in a substantive way in negotiating these agendas for CE. The immediate and long-term negotiation of these struggles will define whether CE can make a demonstrable impact on the quality of professional practice.