Professionals can be characterized into five groups.  Four of the groups are comprised of active practitioners.  The fifth group has withdrawn wholly or partially from active practice in order to fulfill various roles that advance or reinforce the profession. The five groups are innovators, pacesetters, middle majority, laggards, and facilitators.

Innovators are professionals who continuously seek to improve their performance. They are attracted to ideas and practices that are untested. They are not closely bound by the established ways of their profession and may oppose its institutions and leaders.  They do not comprise a large percentage of the professional population.

Innovators have definite attitudes about education. They are likely to participate extensively in educational activities and favor sophisticated learning pursuits. Independent learning and undertaking investigations are their preferred learning styles, while formal programs of continuing education are not favored by these individuals. Innovators usually belong to groups with restricted memberships, and take pride in being more advanced in their practice. They cherish part-time teaching positions, read highly specialized journals, and leave work to engage in full-time study. Usually they become experts in a second field of study.

Pacesetters feel the need to be progessive but are not eager to be the first to try new ideas like the Innovators. They will wait until an idea has been tested before adopting it and their judgmental character tends to win them respect, thus exhibiting a conservative approach to practice.

Like the Innovators, Pacesetters also seek membership in restricted societies, cherish part-time teaching positions, and exhibit similar learning styles. Unlike the Innovators, Pacesetters are concerned about the profession itself and feel a need to take part in its structure and functions. They support group learning and will act as leaders in these endeavors and chief sponsors of newer technologies of learning.

The Middle Majority gradually adopts new ideas and has a broad range of differing characteristics. Their rate of participation in educational activities varies. The Pacesetters are usually the ones responsible for organizing continuing education activities for these individuals. As the level of continuing education decreases for the Middle Majority, the reasons (or excuses) for lack of participation increases.

Laggards learn only what they must know to stay in practice. Performance is poor and they are a menace to clients and an embarrassment to colleagues. They do not respond properly to their privileged positions and skills have deteriorated with little concern for learning or adopting new ones. If problems arise, others may help the Laggards to solve them, but the Laggards usually find a difficulty for every solution.  There is a high resistance to learning with complaints of the high cost of education and the amount of time needed. They do not realize ignorance is more expensive. The chief source of information for Laggards is sales and service representatives.

Facilitators are those individuals who have withdrawn wholly or partially from active practice in order to fulfill various roles that advance or reinforce the profession. Their work lies outside the mainstream of practice and is designed to uphold and strengthen the profession. Facilitators are often criticized for not having a true understanding of practice since they no longer participate in the practical aspect of the profession.

Facilitators are influential in the profession for determining what research, investigations, and teaching will occur within the profession. They conceive themselves as innovators or pacesetters but in reality they come from all four levels of practice, including laggards. Even as facilitators, they still maintain their characteristics of the groups from which they came.

Consumers, government agencies, and officials are demanding better health care for all consumers. Concerns for professional competency and the exploding knowledge and technology in health care are cited as valid reasons for the need of continuing education.

Continuing education is defined as systematic efforts to provide educational opportunities beyond formal education and initial entry into a profession. It enables practitioners to maintain competence, become aware of new developments in their field, and helps to provide responsible, quality health care services.

The continuing education system is a system submerged within a larger system. First it is a component of adult education since it is concerned with the spread of general, social, vocational, and professional knowledge for all adults.  It is also a subsystem of the health care system since the participants support or deliver health care services. And adult education and continuing education are subsystems fo the total education system.

In traditional education, the role of the teacher is to deposit knowledge, skills, and attitudes into their students. The health care profession usually determines what is to be taught and how it is to be taught. However, when it comes to continuing education, health care professionals should determine their own learning, at their own pace, and on their own terms.  The learning must be relevant to the profession and useful in the workplace.

Continuing education methods should reflect life-like situations. Competencies must reflect life tasks of the health care professional such as diagnosing health problems, establishing priorities in care, planning and organizing health actions, and evaluating results. Delivery strategies for continuing education programs should include informal and formal methods such as self-paced study, independent study, small groups, tutorials, problem based learning, computer-assisted instruction, and distance learning. The learning environment should include special facilities set up for education within the workplace since the most important learning environment will be the world where health care professionals live and work, not where they went to school.

The continuing education unit (CEU) is the system of measuring continuing education in terms of the extent of participation. One CEU is defined as ten contact hours of participation in an organized continuing education experience under responsible sponsorship, capable direction, and qualified instruction. The CEU concept was developed during the late 1960's to establish a method or recording participation that would parallel athe credit course at institutions of higher learning.

The CEU was designed to be easily measurable, flexible as to method, transferrable from one record keeping system to another (standardized), able to meet content requirements of degrees and certificates, and usable as a metering device for measuring teaching load. Although used by many professional organizations, the CEU has never gained full acceptance. Some reasons cited aare that CEU's are not capable of being standardized, there is no strong accrediting body that oversees CEU's, and CEU earning does not assure changes in competence of performance.

• The dynamic and rapidly changing health care field demands lifelong learning.
• To maintain competence among health care practitioners.
• To avoid professional obsolescence. Factors which contribute to professional obsolescence are as follows: (1) decreasing inclination with age to do professional reading, to attend educational programs, and to maintain professional membership; (2) failure to perceive the past, present, and future changes in knowledge affecting practice; (3) absence of or desire for a broader education through self-directed or formally organized learning experiences; (4) lack of personal initiative to continue learning in any format; and (5) desire to maintain the status quo.
• Maintenance of competency is the responsibility of athe individual.  A true professional realizes that continuous learning is essential to a lifetime of service to the public. Continuing education implies a system of life-long learning, personal self-development, and actualization of needs. Continuing education is created out of a demand realized by the individual as a desire to upgrade one's skill and competence.
• Continuing education is many things to many people. It is a route to professional advancement, a means to an increase in salary, or fulfilment of the desire to perform as effectively as possible. It can also be a burdensome requirement to some.

The issue of mandatory versus voluntary continuing education is controversial. Many believe that being a professional implies commitment to lifelong learning to pursue practice-enhancing skills, therefore continuing education need not be mandated. Due to advances in knowledge and technology and the public demand for accountability and consumer protection, the number of states mandating continuing education for health care professionals has significantly increased in the last 10 years.

Those opposed to mandatory continuing education argue it violates adult learning principles which include voluntary participation, informal education, self-direction, and attention to individual learning needs. Professionals are suppose to be autonomous, self-managed, and responsible for mastery of knowledge. Mandatory continuing education is punitive to those who voluntarily participate. Evidence that continuing education results in improved practice or competency is lacking. Programs are not consistently and uniformly available.  Many lack quality and relevance to practitioner needs and encourage providers of continuing education programs to focus on profit. Requiring participation may hinder learning by reducing motivation and individual responsibility. Some argue professionals should be accountable for effective performance, not participation.

The proponents of mandatory continuing education believe to expect individuals to voluntarily participate in continuing education is unrealistic. Mandates are necessary to protect the public from incompetent practitioners. Some evidence exists that well-designed programs can influence effective practice. Although imperfect, continuing education programs are better than examinations or practice reviews.

• Every profession has lazy or uncaring people who do not keep up with their field.  Mandatory CE will force them to stay current.
• Are these 'lazy' people the majority or minority of practitioners?
• Mandatory CE disrupts a person's learning style.
• Most CE is given in a lecture format. Is this compatible with everyone's learning style?
• Independent study and experiential learning are not usually acceptable forms of CE.
• Forcing participation can be time consuming and/or unrealistic especially when CE programs are inaccessible, expensive, and require travel to distant locations.
• With increased knowledge, professionals will be more competent and caring.
• Research does not substantiate this claim.
• Attendance does not insure learning has occurred.
• Knowing facts does not perfect skills.
• Competency does not increase compassion or improve attitudes.
• Affective (attitudinal) domain is rarely addressed in CE.
• Someone else knows better than a professional what should be learned and how it should be learned.
• This questions the concept of professionalism since being a professional means keeping current and maintaining competency.
• True professionals realize continuous learning is essential to a lifetime of service to the public.
• Forced participation frustrates competent professionals since they feel the public does not trust their competency or their ability to maintain that competency.
• Public believes mandatory CE will screen out incompetent practitioners.

• Development of CE programs must include participation by all types of interest groups involved in the profession.
• Health care institutions
• Professional associations
• Educational institutions
• Accrediting agencies
• Commercial organizations
• Government agencies
• CE should be accessible and attainable.
• CE should be relevant to individual learning needs, applicable to practice and designed for different learning styles.
• CE should represent a multidisciplinary approach where appropriate.
• Emphasis should be placed on assessment of competence in relationship to job performance standards which can be used as a basis for determining continuing education needs.
• CE should be cost effective and affordable.
• Financing of CE should involve participation by professional organizations, employers, employees, and educational institutions.
• CE programs should be geared to include as many health care professions as possible (interdisciplinary approach).
• CE should be less oriented toward authority and recognize individual initiative.
• Greater recognition of innovative, non-traditional methods of CE.
• Consider validating CE in the work setting when individuals interact and learn on a one-to-one basis.
• Encourage lifelong learning to students in health profession programs so they will embrace this concept early in their professional career.
• CE should be viewed as an extension of professional education.
• CE should link competence to the ideals of public service and accountability.
• Stress value judgments and ethical considerations in practice.
• Develope competence and expertise in conjunction with understanding of the human purposes of professional service.
• Promote cooperation, interdependence, and collaboration as ways to improve competence.

A competent professional has the attributes (knowledge, skills, abilities, attitudes) necessary for performing a job to appropriate standards. These aptitudes include interpersonal skills, motivation, professional judgment, values, beliefs, and attitudes.

Professional competence can be determined through expert opinion and empirical methods.  Expert opinion uses expert judgment in defining requisite skills and knowledge. The Delphi Technique is a procedure which utilizes expert opinions to determine competencies of a profession.  Empirical methods include the critical incident technique and task analysis.

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References:

Houle, Cyril O. (1980). Continuing Learning in the Professsions. Jossey-Bass.

McGuire, C.H., FOley, R.P., Gorr, A., Richards, R.W., & Associates. (1983). Handbook of Health Professions Education. Jossey-Bass.

Kerka, S. (1994). Mandatory Continuing Education. ERIC Digest No. 151.

Glacken, J. (1981). Continuing Education: Mandatory or Voluntary? Unpublished paper from Rutgers University Graduate School of Education.