What are the barriers to and facilitators of undertaking continuing professional education amongst private non-specialist primary care physicians in Hong Kong?

Abstract

Private non-specialist primary care physicians (PCPs) play an active role in early detection and management of diseases and public health education by improving their medical knowledge and skills through undertaking continuing professional education (CPE). The context of CPE has changed due to increasing patients’ expectations on PCPs, emphasis on self-directed practice-based life-long learning and implementation of reformed undergraduate medical curriculum. The traditional didactic teacher-based classroom learning is no longer sufficient to meet the PCPs’ learning needs. However, the purposes of as well as barriers to and facilitators of undertaking CPE amongst them in the new context are not well understood. The aim of this project was to explore how private non-specialist PCPs undertook CPE. The outcomes of this exploration will provide health care policy makers, continuing medical education (CME) organisers and medical educators with information to design and implement health care policy and medical education programmes that are better targeted to and encourage participation by private non-specialist PCPs. A qualitative approach was adopted to explore the subject. Three sequential interview studies in different interview designs, including a 12-month longitudinal prospective individual interview, a cross-sectional in-depth individual interview, and a cross-sectional focus group interview, were conducted to complement each other and fill the knowledge gap. Participants’ motivators to undertake CPE were a desire for excellence in primary care and maintaining their psychological health. They participated in both CME- and non-CME-accredited CPE activities with the purposes of maintaining and improving their care standards, gaining confidence in managing patients, strengthening long-term doctor–patient relationships, professional networking, and meeting personal and social needs. Through the long-term doctor–patient relationships, they provided patients with high-standard care and managed diseases early. Time allocation to fulfil the duties of different roles was the major challenge of participating in CPE. Many participants extended consultation hours to provide patients with convenient and continuous care and cover the high operation costs of their practices at the expense of time spent in other activities. The other barriers included solo practice, being a salaried employee, unavailability of locum doctors to cover work during learning time, inconvenient timings and venues of CME lectures, corporate sponsorship of CME lectures, unacceptable tuition and registration fees, discrepancy in the practicality expectations of CPE on clinical practice, lethargy, and negative attitudes towards digital technology-assisted learning amongst older participants. Participants’ attitudes towards patient care and meeting patients’ expectations determined the effort put towards CPE. Group practice, accessible high-speed Internet connection facilities, CME lectures utilising interactive group learning activities, credible lecture speakers, improved practice outcomes, job satisfaction and security, pride in learning, and enriched social life were facilitators of the decision to undertake CPE. Suggestions for encouraging PCPs to undertake CPE include arranging CME lectures that are convenient to their working schedules, enhancing interactive learning activities of CME lectures with handouts available, meeting professional networking needs, narrowing the gap between theory and practicality, reducing influences from corporates, organising communities of practice, setting up online discussion forums, and seeking additional learning resources from private specialists and academic and public bodies.