Mandatory CME is on the way.
I expect that half of our readers do not know what I am talking
about. In Hong Kong, there are around
14,000 registered doctors. Among them,
around 7,000 are on the Specialist Register. Only doctors on the Specialist Register need
to fulfill specified CME requirements to stay on the Specialist Register. The word “mandatory” means “made necessary,
usually by law or by some other rules”. Section
20L of the Medical Registration Ordinance (MRO) specifies that: “A registered medical practitioner whose
name is included in the Specialist Register shall undergo such continuing
medical education relevant to the specialty under which his name is included in
the Specialist Register as may be determined by the Academy of Medicine.” Details of such requirements are provided
in the “Principles and Guidelines on
Continuing Medical Education and Continuous Professional Development (CME/CPD)”
issued by the Academy of Medicine. Basically,
a doctor has to obtain a minimum of 90 points in a 3-year cycle.
There is no such statutory requirement for non-specialist. Instead, the Medical Council has implemented a
“Voluntary CME Programme for Practising
Doctors who are not taking CME for Specialists” since October 1, 2001. It states that "the purpose of the Programme is to encourage pracitisng doctors to keep themselves up-to-date on current developments in medical practice so as to maintain a high professional standard. Practising doctors who are not taking CME for specialists are invited to enroll in the Programme on a voluntary basis." Doctors who have satisfied with the CME requirements (obtaining more than 90 points in a 3-year-cycle) are allowed to use the title "CME-Certified".
In June 2017, the Steering Committee on Strategic Review on
Healthcare Manpower Planning and Professional Development released a review
report. There is a chapter on “Continuing Professional Education and/or
Development”. It recommends that: “Boards and Councils should continue to
upkeep the strong professional competency of healthcare professionals through,
among others, making continuing professional education and/or continuing
professional development a mandatory requirement.” It points out clearly that: “Non-specialist doctors and non-specialist
dentists may on their own volition voluntarily enrol in CPE/CPD administered by
MCHK and DCHK respectively, but they do not have an obligation as that of their
specialist counterparts to undertake and complete continuing professional
education.” “The Steering Committee
considers that CPE/CPD should not be just option or confined to specialists, but
should be widely promoted and ultimately become a mandatory requirement for
healthcare professionals under statutory registration.”
Recently, I heard repeatedly small talks (and big ones) on the implementation
of mandatory CME for non-specialists. I
think there is no disagreement on the need for CME for all doctors, specialists
and non-specialist alike. However,
making CME mandatory is another matter. Before we debate on whether it should or
should not be, I look at the hurdles. The
first one is about how to make CME mandatory. There is no provision in the MRO on the
requirement for and the sanction against not having CME for non-specialists. To amend the MRO is no easy job and it takes
much time.
The Steering Committee has considered this also and states that “a possible route for implementing mandatory
CPE/CPD – as an alternative to legislative amendments – is that Boards and
Councils may determine and set out the CPE/CPD requirements as part and parcel
of their professional standard requirements e.g. the code of professional
conduct and establish a mechanism to oversee whether the healthcare
professionals have satisfied the CPE/CPD requirement.” What the Steering Committee suggests is to
use the disciplinary procedures to penalize doctors who fail to satisfy CME
requirements. One way to do so is to put
it in the Code of Conduct and deem non-complying doctors fallen below expected
standards. They would be found
misconduct in a professional respect after going through the normal PIC and
Inquiry procedures. Whether this way is
feasible or desirable will be the subject of much debate.
The second hurdle would be the capacity to offer CME training. For the self-study part, it is easier. If the current voluntary requirements are
kept, 20 points a year would be from self-study. Another 10 points need to be obtained by
attending seminars. If we take 7,000
non-specialists, at least 70,000 hours/points a year would be in need. This means that around 200 hours/points a day
need to be provided. If one seminar can
provide one hour/point to 50 doctors, 4 such seminars need to be held every
day. A big step forward in solving this resource problem is the recognition of
on-line interactive seminars by the Medical Council.
Other hurdles include acceptance by stakeholders, resource
implications to doctors and to the Medical Council, legal implications and
appeal mechanisms.
It seems that the government has made up its mind on this mandatory
CME issue. It is stated clearly in the
Review that “Once the relevant Board and
Council has reached a view on how mandatory CPE/CPD should be achieved, it
should draw up an implementation plan in consultation with the profession.” I foresee that at the end of this year, we
have to face such consultation.
