The birth of ‘MidPLUS’: Australia's new national continuing professional development program for midwives

Article Outline

• Summary
• Introduction
• Background
• Purpose of the review
• Method
  • Selection of CPD programs for review
• Results
• Designing a CPD program
  • The changing educational focus of professional development
  • Linking learning to learning needs
  • Linking learning to practice
  • Linking learning to the needs of healthcare consumers
  • CPD program frameworks
  • Point systems
  • Preferred types of activities
  • Preferred topics
  • Recording CPD activity
  • Quality in CPD
• CPD program administration
  • Program delivery
  • Length and type of CPD program cycle
  • Reporting processes
  • Monitoring and auditing processes
  • Incentives for participation
  • Cross crediting of activities
• Professional issues
  • Inter-professional CPD
  • Professional values
• Discussion and conclusion
• Conflict of interest
• Acknowledgements
• References
• Copyright

Summary 

The national continuing professional development (CPD) program of the Australian College of Midwives, MidPLUS, was officially launched in September 2007. In our role as program developers we were dedicated to the belief that this national CPD program would be an important step for Australian midwives, and contribute to demonstrating a commitment to providing safe and effective care for Australian women and families. This paper outlines key issues involved in providing CPD programs for professional groups and highlights how this information was used in the decision making behind the design of MidPLUS. The key operational elements of CPD programs included program design, program administration and related professional issues. Important features and functions of the MidPLUS program are highlighted and justification is given for our overall design. This information may assist midwives who are considering using the MidPLUS program and are asking the question: CPD—what does it mean for me?

Keywords: CPD, Midwifery, Professional development, MidPLUS

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Introduction 

The official launch of Australia's first national continuing professional development (CPD) program for midwives, called ‘MidPLUS’,¹ was a significant event for the Australian midwifery profession. ‘MidPLUS’ provides a national approach to keeping midwives current, competent and capable in providing high quality care for Australian women and families. This national CPD program of the Australian College of Midwives was designed to ensure that the evidence of an individual's professional development is collected and recorded using a valid, consistent and systematic process. This paper provides an overview of the key ingredients of CPD programs from Australia, New Zealand and the United Kingdom. The paper explains how we included key elements of ‘best-practice’ CPD, as well as the views of Australian midwives, to inform our design and function of MidPLUS.

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Background 

National registration of Australian nurses and midwives is soon to be a reality. This significant change is likely to include a requirement that all Australian midwives and nurses provide evidence of ongoing professional development as part of the annual re-registration process. While participation in continuing professional development (CPD) has not been conclusively shown to improve patient outcomes in the context of healthcare, CPD programs are recognised internationally as a necessary framework of support for an individual's professional growth and development.

In recognition that CPD is an important step for the Australian midwifery profession, in 2006 the Australian College of Midwives received funding from the Commonwealth Department of Health and Ageing, to conduct a year long project to develop a CPD program for use by all Australian midwives. We were appointed as project officer and project leader, respectively, with the clear undertaking that the tangible outcome of the project would be a program to support all Australian midwives in maintaining and updating their midwifery knowledge and practice. The underlying goal of the CPD program was to enhance the provision of safe, high quality midwifery care, which was something that we both considered to be an essential driver for a new Australian midwifery CPD program.

In the first stage of the project, we conducted a review of international literature on CPD and of existing CPD programs from other professions within Australia and overseas. Programs included nursing, medicine and allied health professions. Our review specifically identified current issues associated with the provision of CPD programs. Information from the review was used to develop a draft CPD framework and program, which we presented to groups of midwives from a variety of practice settings during a series of consultation workshops around Australia. Feedback on the proposed program structure was sought to ensure that the direction we were taking was appropriate to all Australian midwives. In particular midwives commented on mechanisms that might support participation in CPD and lead to widespread use within the profession. This information was used to further develop the program and devise our implementation plan.

This paper will outline key issues in CPD programs and highlight our decision making behind the development of MidPLUS. The paper will identify important features and functions of the MidPLUS program and note the justification for our design. This information may assist midwives who are considering using the MidPLUS program and may be asking the question: CPD—what does it mean for me?

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Purpose of the review 

For the purpose of this paper, a CPD program is defined as a structured system that describes the amount and type of CPD activities that each participant in the program should undertake, over a specified period of time. A total of ten CPD programs were selected from Australian nursing, medicine and allied health, and international midwifery and nursing professional organisations. The purpose of the review was to gain an understanding of the underlying principles of contemporary CPD program development. The review compared features of the CPD programs and considered whether the feature would support participants to undertake sufficient, relevant CPD activities. Each program feature or function was considered in light of feedback and consultation with Australian midwives in order to ensure that the program would meet the needs of midwives within an Australian context.

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Method 

Selection of CPD programs for review 

CPD programs were selected for this review based on their suitability for comparison and either availability for public review or permission being provided by the professional organisation. After compiling a list of nursing, medical and allied health professional organisations within Australia, an Internet search was conducted to determine whether a CPD program was being provided. Organisational web sites with public access areas were then searched to view handbooks and user guides that explained the key elements of the CPD program. If information was not freely available on the web-site, we contacted the professional organisation either by telephone or e-mail and asked for detailed information about their CPD programs.

The list of CPD programs included in our review appears with an alphabetical reference used in text (Table 1). No programs from the USA were chosen, partly due to the use by many programs of the recertification examination as the basis for re-registration. As the purpose and elements of these programs have little similarity to CPD programs, it was decided that they would not be able to provide a useful comparison for the purposes of this review.

Table 1. CPD programs reviewed

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Results 

The key operational elements of CPD programs examined during the review process were: program design, program administration and related professional issues. The operational features and the various individual components are summarised in Table 2, Table 3. A description is provided about the way in which the MidPLUS program has incorporated each element. This enables midwives to see the way in which the MidPLUS program fits within the context of other CPD programs

Table 2. Comparison of administration of CPD programs

Table 3. Comparison of elements of CPD programs

Name of program	Length of program	Categories of activity specified	Weighting of categories/activities	Minimum activity/credit requirements
a. LEAP Pilot Project	Nil specified pilot program	Yes—3 main categories, based on domains of practice: clinical expertise, risk management, prof. values & responsibilities	Yes—3 levels of CPD activities, based on capacity to increase knowledge, facilitate and/or evaluate change in practice	No minimum specified—pilot program only
b. RCNA—3LP	1 year	No	No	30 points p.a.—1 point=1h
c. AASW—CPE	1 year	Yes—4, accountability, skill development; gaining new knowledge; contributing to development of profession; social work knowledge & practice	Yes—must accrue minimum 10 points in first 3 categories.	75 points in 1 year. 1h of CPD=1 point. Courses accredited & points allocated by AASW
d. NZMC—Recert. Program	3 years	Yes—3, based on compulsory & elective educational activities	Yes—compulsory, elective and other	Every 3 years—2 day skills workshop, ½ day breastfeeding workshop, adult & neonatal CPR, 40 points elective CE, 60 points CPD activities—points allocated by NZMC.
e. RACGP—QA & CPD Program	3 years	Yes—2, based on educational effectiveness: (1) activities producing behavioural change and (2) other CPD activities	No, but should undertake activities in domains of general practice	130 points over 3 years, with a minimum of two category 1 activities—points allocated by College
f. RANZCOG—CPD Program	3 years	Yes—4 categories based on practice and education activities	Yes—practice review (PR) and clinical risk management (CRM) category only	150 Points over 3 years—25 points min. or all points in PR & CRM category. Maximum 75 points in other CPD categories
g. APA—CPD	3 years	No	40% of points in practical or clinical physiotherapy	100 points (APA accredited=2 points/hour, other=1 pt)
h. AIR—CPD Program	3 years	Yes, activities that have been approved by the Institute or other CPD activities	No	36h over 3 years, 1 credit per hour for AIR approved CPD, university or TAFE program, 0.5 credits per hour for other CPD activities
i. OAA—CPD	2 years	Yes—based on type of educational activity	No, but only clinically related and accredited CPD activities will accrue points	80 points over 2 years (40 points average per year), courses accredited by OAA
j. NMC—PREP	3 years	No	No	35h over 3 years

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Designing a CPD program 

The changing educational focus of professional development 

Most Australian and many international continuing education programs are moving away from the traditional values of continuing education, in which the focus has been on teaching and attendance. Contemporary programs embrace the concept of CPD, where the focus is on improving the performance in practice of the individual practitioner through meeting their identified learning needs.², ³ The basis of this model is that ongoing education is most effective when each individual is able to:

Of the programs that have recently adopted the CPD approach or have altered their programs to incorporate the principles of the CPD approach, all have identified the reasons for their change, based on the understanding that CPD is most effective when the focus of the program is on individual learning needs^{a, e, f, g, j}. It is significant that as organisations move further towards the concept of CPD, the focus of their programs change from specifying the types of activities that must be undertaken to facilitating CPD by providing guidance in planning for individualised engagement in CPD.

MidPLUS Program: The CPD model of ongoing education was chosen as the foundation for the program. This was not only due to the increasing uptake of this model by Australian and international professional organisations, but also due to the increasing body of knowledge that supports this approach. Midwives around Australia were supportive of the flexibility that this approach could bring to them, especially in rural and remote areas. MidPLUS accepts a broad range of activities (both formal and self-directed) that can be included as CPD and provides support for individual planning to meet learning needs.

Linking learning to learning needs 

Most CPD programs required participants to demonstrate that the CPD activities they undertook corresponded to the participant's identified learning needs, with programs providing varying amounts of guidance in how to identify and meet these needs. Several programs used a reflective learning cycle to help participants describe their individual practice, identify learning needs from practice, set learning goals, identify and undertake appropriate CPD activities and then reflect upon the impact of the activities on their practice or role^{e, f, g}. This is also a common approach in the literature and once again, highlights the move by many professional organisations towards the facilitation of learning approach with CPD.²

MidPLUS Program: A CPD learning cycle approach was developed as part of the program to be consistent with the contemporary approach to CPD worldwide. The MIDPLUS learning cycle acknowledges the importance of planning and reflecting on individual CPD activities. The link between identified learning needs and actual learning is valued as part of the MidPLUS process and tools are provided to support users to record these activities either on-line, or in hard copy as part of a portfolio.

Linking learning to practice 

None of the programs we reviewed required participants to evaluate their participation in CPD and/or its effect on their practice in more than a token manner, either before or after their participation in CPD activities. This is despite all programs indicating that the purpose of CPD was to help improve practice. At least half of the programs reviewed advised participants to undertake reflection on their practice but it was not clear from the materials provided if any program provided guidance in doing this.

Pre CPD reflection on practice may be effective in helping ascertain learning needs, while post CPD reflection may be effective in helping the professional judge the value of the activity and its applicability to their practice.⁵ Post CPD reflection is also a useful tool for performance review and can act to embed CPD into practice.

MidPLUS Program: An active reflective approach to CPD with direct links to the Australian Nursing and Midwifery Council (ANMC) National Competency Standards for the Midwife⁶ was identified by midwives as an important feature of a midwifery CPD program. Therefore support tools are included in the program to assist all midwives to engage in a planned learning and reflection process and participants are required to identify the ANMC competency domain that relates to the activities recorded.

Linking learning to the needs of healthcare consumers 

All programs reviewed stated that CPD activities should improve service provision for consumers. Two programs^{a, e} provided guidance for participants in how to identify the needs of consumers, whilst others^{d, f} required specific consumer feedback on service provided as part of their review process. In general, consumer feedback is limited to satisfaction with care provided and is usually retrospective. To improve linkages between individual CPD activities and the ongoing needs of consumers, the needs of the consumer should be considered before CPD takes place.

MidPLUS Program: Midwives are encouraged to evaluate their context of practice and think about the healthcare needs of women when planning CPD activities. In addition, a peer review process, such as Midwifery Practice Review⁷, is integrated within the overarching CPD framework and involves consumer feedback within the process of review. This is a voluntary component of the program.

CPD program frameworks 

Most CPD programs^{a, c, e, f, g, h, i} used a framework to drive the program or provided categories that divide the CPD program into manageable parts. The reasoning behind the choice of framework or categorisation was not always explicit. In the programs reviewed, there were three main types of frameworks that were used. The first is the process type framework which leads participants through the learning process. Categories in this type of framework include review of practice, maintenance of a portfolio, the undertaking of CPD activities and reflection on the value of the CPD activities.

The second type of framework is based on the participant's professional role. The role based framework leads participants through a review of their professional roles, skills, knowledge and attitudes in order to determine individual CPD needs. This type of framework was utilised by the LEAP pilot project which used medical professionalism as a theoretical framework from which to categorise the CPD program, thus covering all practice domains and professional responsibilities.

A further type of framework is based on types of educational activity. These are generally divided into formal (accredited, endorsed) versus informal (work based or self directed) types of education. One of the major drawbacks of the educational classification is that it prevents professionals choosing CPD activities that suit their learning style which contradicts the principles of adult learning. Several CPD programs had a mix of categories of educational activities and professional roles.

The use of professional roles or domains may be best suited to guiding professionals through a review of their individual job role and responsibilities for the purposes of a CPD program. Frameworks based on educational format are not only at odds with theories of CPD that promote individual choice of CPD activity to suit learning styles, but also gives precedence to education type over learning needs. Process type frameworks may however be useful, particularly for professionals who are unfamiliar with using CPD frameworks.

MidPLUS Program: A combined approach to the CPD framework was chosen for MidPLUS, to cater for the needs of a broad range of midwives. Consultation with midwives found that there was unanimous support for linking CPD activities to ANMC competencies and midwives expressed a need for supportive features to help them plan and reflect on CPD activities. As a result MidPLUS uses a learning process framework, guidance about activities that lead to effective learning and direct links to professional competency standards to aid in the review of the professional role and identification of related learning needs.

Point systems 

All programs reviewed made use of a points system to direct participants in the amount of CPD and types of CPD activities that must be undertaken. Points ranged from 15 to 75 per year. While most programs^{b, c, e, f, g} set a point value at one point per hour of CPD activity, several of these^{c, g, h} allocated either extra points for CPD activities that were endorsed or accredited by the organisation or half points for activities that were not. In some instances^{d, h, i}, there were no criteria for the allocation of points and the link to educational value described, which made the process of weighting the CPD activities unclear.

The points system is widely used for CPD programs.² The one point per hour method of point allocation appeared to be an effective way in which to allocate points and was felt to be easily applied by any participant. If differing points were to be allocated to different activities, a valid and reliable set of criteria to assist in determining the value of each CPD activity was needed. This system was more cumbersome than the points per hour system.

MidPLUS Program: The 1 point per hour system was selected as midwives felt that it would be easy to understand and document. 30 points per year was set because it is a common minimum level and therefore a good starting point for a new program.

Preferred types of activities 

While two programs^{b, j} did not require that participants undertake specified activities, all other programs required that participants accrue a greater amount of points in either specific framework categories or specific CPD activities. In some CPD programs, there was little indication why a category or an activity was favoured above others. Two programs^{e, f} that required greater accrual of points in specific categories favoured clinical practice and risk management categories, with accrual of points in other categories having lesser value. Other programs required greater accrual of points in practice related or formal education categories.

A recent innovation in CPD programs is to require a greater accrual of points in CPD activities that lead to behavioural change and thus have been shown to be effective in improving practice.³ CPD activities that are effective and those that have been shown to be not as effective are grouped in different categories, with participants required to accrue more points from the educationally effective category. The adoption of this innovation was noted in several of the CPD programs reviewed^{a, e, f}. In one program^f, the requirements of the program went further, to restrict participants from accruing many points in the less educationally effective categories, such as attendance at conferences and meetings.

In the LEAP Pilot Project^a educational activities were graded into a hierarchy according to their ability to lead to behavioural change in the following way:

Level One Activities are considered to be those activities that provide the participant solely with information to improve their practice. The level of demand on the participant is considered to be relatively low. Generally, these learning activities focus on increasing knowledge and skills and include the more traditional, passive activities such as lectures, conferences and journal reading^a.

Level Two Activities are those that impose a higher demand on the participant. Generally, it is expected that involvement in these activities will ensure that the participant can demonstrate the maintenance of best practice standards and/or that they have implemented a particular activity or facilitated changes in practice and health outcomes. Level Two activities include things such as preparation for and taking part in a practice review or clinical audit, critical incident monitoring, or trying a new approach or technique^a.

Level Three Activities are those that have the highest demand on the participant. Generally, these will involve change and evaluation activities where the practitioner evaluates the impact of an activity or intervention, perhaps resulting from involvement in a Level Two activity, makes adjustment in order to address the problem or issue, and measures the effect. Level Three activities include things such as trying out a new approach/technique and evaluating the outcomes; peer reviews and audits—implementation of recommendations and evaluation of the improvements made; and completion of a quality cycle where an action plan has been developed, implemented and evaluated^a.

MidPLUS Program: In recognition of the theory that active CPD activities are more likely to result in effective learning than passive CPD activities, participants are encouraged to participate in more ‘active’ and less ‘passive’ CPD activities. Therefore, of the minimum 30 points required, at least 20 of those points should be gained using ‘active’ CPD rather than ‘passive’ CPD. For example, midwives are encouraged to participate in active CPD such as peer review processes or active participation in quality assurance activities within their individual practice context. However, participants can still gain points for attending passive activities such as listening to a conference presentation. A table of examples is provided in the MidPLUS handbook to assist, however the self-directed approach leaves the decision to midwives themselves as to which activities have been active or passive and which have resulted in learning for them.

Preferred topics 

Only one program^d required participants to undertake CPD in specific practice topics during the program cycle and use approved specific providers for the delivery of CPD activities. The use of required topics tends to fall into a ‘one size fits all’ approach which may not meet the individual learning needs of midwives. The use of approved providers only may increase the cost of CPD activities, and once again may restrict the choice of activities that can be undertaken.

MidPLUS Program: A broad approach to CPD activities was chosen to provide midwives with an opportunity to select CPD that meets individual learning needs and styles. The potential for allocation of bonus points for important issues or topics is included within the program's framework to signal the importance of special relevant midwifery topics.

Recording CPD activity 

There is a consensus in the literature that the professional portfolio is the best tool for planning and recording CPD activity.⁵, ⁸, ⁹ All programs reviewed used some form of portfolio or log book to record CPD activity, with the majority of programs giving the responsibility of recording CPD activities and calculating points claimed to the program participant. One of the main challenges for a successful CPD program portfolio is to document that learning has had any effect and this can best be achieved by recording the actual learning process, evaluation and educational plan, and any outcome, for example the effect on practice.⁵

MidPLUS Program: Australian midwives felt that options for both paper-based and on-line services would be necessary to cater for the needs of all Australian midwives The professional portfolio with tools and proformas was developed to enable midwives to be systematic in planning and documenting their individual professional development. On-line documentation options are built into the program to enable electronic storage of information as well as submission of a summary for the purpose of annual confirmation of CPD points.

Quality in CPD 

There is clearly a need for health professionals to undertake high quality CPD activities. Organisations face the dilemma of whether to promote the self selection of CPD activities, in line with adult learning principles and quality in CPD¹⁰, or to gain an assurance that CPD activities meet organisational quality criteria by undertaking an appraisal of each learning activity. Organisations respond to this situation in different ways. Some CPD programs allowed participants to undertake any self-selected CPD activities; others only recognised CPD that has been endorsed by the organisation, while some organisations encouraged a mix of the two. A number of programs undertook accreditation of courses and learning activities^{c, d, e, g, h, i}, with each organisation setting criteria on what it considered an acceptable CPD activity, including course development, delivery and content and required proof of an individual's attendance at these activities for legitimate inclusion in the CPD program.

MidPLUS Program: Given the nature of the MidPLUS program, with its focus on individual learning, participants are encouraged to self select the type of CPD activities they take part in. To promote quality in the provision of formal CPD activities, the College offers an endorsement process to providers of CPD activities. The CPD activities endorsement process was adapted from the Optometrists Association of Australia accreditation process.

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CPD program administration 

Program delivery 

All medical and allied health CPD and one of the nursing programs reviewed were developed and administered by the professional organisation. In contrast, two of the three nursing and midwifery CPD programs reviewed were administered by the regulatory authority. When administered by the regulatory body, sanctions for non-participation could be applied.

MidPLUS Program: As the peak national professional body for Australian midwives and the developer of MidPLUS, the Australian College of Midwives (ACM) will administer the program. Participation in MidPLUS is voluntary and no sanction will be applied by the professional organisation for non-participation. Midwives would have the opportunity to present evidence of participation in MidPLUS if participation in a CPD program is required by the relevant regulatory authority for re-registration purposes. For example if a new national regulatory authority were to require evidence of participation in a minimum of 30h of CPD, participants in MidPLUS would be able to use their certificate of participation for this purpose.

Length and type of CPD program cycle 

All organisations except the LEAP pilot project^a conducted their CPD programs over a specific period of time, called an administrative cycle. This assisted the organisation to monitor ongoing participation in their program. Cycles ranged from one year^{b, c} to five years^{d, e, f, g, h}, with one program cycle being over three yearsⁱ. Cycles either ran from the start of the calendar year, or from a specified date within each year, sometimes the anniversary of the individual joining the program.

With the exception of the LEAP pilot, all programs required participants to undertake a set amount of CPD activity in each year and each cycle. For example, 30 points of CPD activities in one year, and 90 points of CPD activities over the three year cycle, with a requirement to report CPD activity yearly. Programs did not penalise participants who entered after the start date, and allowed each participant to calculate CPD requirements pro rata.

Where a set cycle existed, all program participants finished their current cycle on the same date, which aided in monitoring of participation rates. This had the disadvantage of increasing the amount of administrative support needed at these times. Some programs made allowance for participants having a career break, such as maternity leave, and allowed participants to decrease their required points pro rata for the amount of time out of the program^{c, e, f, h, j}.

MidPLUS Program: The 12 month cycle was selected for MidPLUS for its simplicity. There were advantages noted by midwives in linking with annual regulatory requirements. In addition, participants may be encouraged to undertake annual CPD planning and review alongside their annual MidPLUS cycle.

There was no obvious ideal length of time for a program cycle, however, sufficient time was needed to allow the organisation to effectively monitor and support participation in the CPD program. It was considered important to ensure the cycle is sufficiently long to allow program participants to effectively plan and undertake their CPD. In the first instance, the MidPLUS cycle is a 12 month period, allowing for evaluation of the implementation process.

Reporting processes 

All programs reviewed utilised a ‘self-reporting’ process for CPD activities. Participants were required to submit proof of their involvement to their CPD program administrator (generally the professional organisation), in the form of a summary of the type and amount of CPD activities they had participated in. The self regulation approach is widely used by professional organisations internationally.²

MidPLUS Program: A self-reporting approach was adopted so that as professionals, midwives will be responsible for managing their own CPD records. This was considered to be an advantage in reducing the overall administrative burden for the College.

Monitoring and auditing processes 

Participation in all programs was monitored in some way. Monitoring generally consisted of a review of all participants’ completion summaries, with further intensive auditing of CPD activities for a selected group of participants for quality assurance purposes. One program^h conducted monitoring during the CPD cycle to identify participants who were at risk of failing to complete their program requirements. Monitoring was considered to be helpful in the early identification of barriers to participation and in taking steps to improve the CPD program or encouraging participation.¹¹ The possibility that a participant might be audited was also considered an inducement to engage in CPD activities on an ongoing basis, rather than when faced with audit or when a CPD cycle is about to expire.

All programs used an audit process as a quality assurance exercise. Almost all audits included a document review with selected material from the professional portfolio being submitted for review. Participants were informed in each CPD program guide that they may be required to submit part of their portfolio upon request. All mandatory programs selected a percentage of participants for review each year. The percentage ranged from 3 to 10%, with most programs selecting 5% of participants for audit each year. Several programs stated that participants selected for an audit would not be eligible for audit again for a specified time period.

MidPLUS Program: A random audit of 5% was adopted with the caveat that those audited in a given cycle would not be eligible for audit in the following cycle. This was considered to be administratively and professionally acceptable to midwives whilst providing an incentive for participants to keep their records up to date.

Incentives for participation 

All mandatory programs provided some form of incentive for participation in the CPD program. Completion of the CPD program was required for ongoing registration, indemnity coverage or both in many programs^{j, b, e, f, h}. Sanctions for participants who did not complete their CPD cycle ranged from removal from the professional register, an inability to use the relevant college appellation to the removal of indemnification. Unless participation is mandatory for re-registration, however, no type of sanction can be used.¹² Instead incentives for participation can be built into the program.

MidPLUS Program: Incentives that were considered by midwives included certificates of completion, use of an appellation and other benefits provided to participants of the CPD program. A certificate of completion was most acceptable to Australian midwives because it could be used by the participant to support requirements for re-registration. MidPLUS participants receive an annual certificate of completion.

Cross crediting of activities 

Two programs^{a, e} indicated that CPD activities relevant to a professional role could be cross credited from the CPD program of another organisation. Cross crediting has the potential to reduce the time and financial constraints placed on professionals by the need to undertake CPD for different programs.³

MidPLUS Program: Cross crediting is considered to be of benefit to Australian midwives, as long as activities can be demonstrated as relevant to the midwife's professional role or learning needs. It must relate directly to competency standards, such as the Australian Nursing and Midwifery Council's Competency Standards for the Midwife.⁶ An example of cross crediting might be CPD activities undertaken for recertification as a lactation consultant. Any cross credited CPD activities would still need to be relevant to the learning needs and professional role of the program participant and fit the criteria for inclusion in the MidPLUS CPD program.

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Professional issues 

Inter-professional CPD 

Two programs^{e, f} acknowledged the value of inter-professional CPD by permitting the accrual of points from inter-professional CPD activities, including those provided by other professions, for example, a fetal monitoring workshop for medical practitioners provided by a midwife. Inter-professional CPD with members of the same healthcare team has the potential to improve communications between professional groups and therefore patient care, and is a good use of time and financial resources for the different professional organisations.¹³

MidPLUS Program: The broad approach to CPD encourages the inclusion of time spent in inter-professional CPD as valid CPD activities. Examples may include team-based learning activities such as simulation-based learning within the healthcare environment or multi-disciplinary case review learning activities.

Professional values 

The values of each profession and the desired relationship with patients or clients were reflected in each CPD program.

MidPLUS Program: The values of the profession and the unique relationship midwives have with childbearing women and their families is acknowledged in the program. This relationship is enhanced by linking learning to women's needs, using feedback from women to determine if their needs are being met and encouraging CPD activities that enhance the development of the midwife/woman relationship.

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Discussion and conclusion 

Participation in CPD is a professional expectation for all professions around the world. The need for midwives to produce evidence of participation in CPD activities already exists in many parts of Australia and is expected to increase further in the future. This paper has provided a summary of the common features of CPD programs from various professional groups to provide a foundation to a discussion of the features of the new MidPLUS program for Australian midwives.

Most CPD programs we reviewed had undergone a program evaluation in recent years, with all of these programs adopting the adult learning principles of CPD as the basis for the program. The focus of these programs had changed from directing engagement in continuing education, to the facilitation of learning. Most CPD programs also promoted linkages between the individual's identified learning needs and practice, the needs of health care consumers and CPD activities undertaken. The importance of the link between the role of individual midwives and the CPD activities they engage in is a key feature supported by the MidPLUS framework and learning cycle approach.

Provision of women-centred care should be explicitly linked to the identification of individual learning needs and learning with a program, regardless of the context in which a midwife is employed. Quality and safety in healthcare is an important issue for all Australian midwives and the development of a CPD program using principles of CPD best practice is not only timely but long overdue.

As an integral part of the program development we planned an evaluation process for the first 12 months of the implementation phase to help identify whether the CPD needs of midwives are being adequately met by the program. An evaluation will also assess the degree to which the tools support the user in systematic documentation of individual CPD planning and participation. The next step will be to examine whether CPD is able to assist midwives in providing high quality care and whether the safety of women and families can be enhanced through participation in this type of CPD program. When midwives ask the question…CPD, what does it mean for me? …the answers is that MidPLUS can help midwives to plan and participant in CPD activities that are relevant to their learning needs and their midwifery practice or role. It also demonstrates to our community, as well as to other professions, that midwives are truly professional and take responsibility for their own learning and development with the aim of providing safe and effective care.

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Conflict of interest 

The authors verify that, within their knowledge, the publication of this paper will not constitute any conflict of interest.

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Acknowledgements 

The authors wish to acknowledge the Commonwealth Department of Health and Ageing for funding this project. We would also like to thank:

Members of the Project Management Team:

Members of the Project Reference Group:

Thanks to all midwives who attended the workshops and provided feedback that enabled the program to be designed to meet the needs of midwives.

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References 

1. Australian College of Midwives, MidPLUS: The Australian College of Midwives Continuing Professional Development Program http://www.midwives.org.au/Default.aspx?tabid=310.
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