Very little is known about the perceptions of NZ podiatrists towards mandatory CPD. This study presents the first known data collected about the perceptions towards CPD and the satisfaction with the CPD programme.
The survey data indicated NZ podiatrists agreed that it is important to engage in CPD and that CPD helps maintain their competence. Although respondents linked CPD to competence there is limited evidence to support the supposition that undertaking regular CPD leads to the advancement of professional competence (5, 6). This criticism stems from the belief that CPD based on attainment of a certain number of hours implies practitioners must only provide evidence of their attendance or participation in a CPD activity (6). In the context of the NZ CPD programme, evidence is not required to support the relevance of the CPD activity to the needs of the podiatrist, their level of active participation in the activity, or whether the knowledge gained through undertaking the activity is applied to practice. Therefore, the effectiveness and usefulness of the CPD activity is unknown. Consequently, CPD programmes may be a weak proxy for competency and as postulated by Lysaught et al “the primary value of CPD only be as a reminder to members that maintaining competency is a requirement of practice” (6).
In agreement with findings from CPD studies in radiographers (7), nurses (8), and pharmacists (9) lack of time, practice workload, and lack of financial resource are primary factors that influence the capacity to engage in CPD. However, the capacity for practitioners to engage in CPD is also affected by numerous interrelated elements (Fig. 5). Two major elements being geographical practice location and employment context, such as sole or group private practice. NZ podiatry workforce data indicates approximately 35% of podiatrists work outside the three main metro areas (Auckland, Wellington and Christchurch), with 80% of the profession in private practice and 60% either self-employed or a business owner (9). In the current study, qualitative data highlighted that practitioners in remote areas reported having limited access to social/peer support networks, had limited opportunities to meet face to face, and were faced with additional issues of travel time and distance to attend organised CPD meetings. Locality issues are further intensified by the employment context. Practitioners working in a sole practitioner environment may find CPD engagement difficult, due to their limited ability to engage in social interaction during daily practice. Subsequently limiting their ability to engage in essential activities such as, observational learning, imitation, peer discussion, and ‘reflective conversation (10). Conversely, podiatrists working in large organisations (universities and District Health Boards), representing two and eight percent of the NZ profession respectively (9) may not be faced with these issues due to easier access to a variety of workplace based CPD opportunities, protected time to undertake CPD, and CPD funding built into work contracts.
The PBNZ CPD programme has mandated compulsory elements of infection control, wound management and cultural safety which were also components of the original CPD framework (2004 to 2017). In the current study, data indicated dissatisfaction with hours attributed to the compulsory activities. Hours based CPD frameworks have been criticised for their counting of hours of learning, not performance, for only measuring participation, for their focus on quantity not quality, that they pay inadequate attention to helping individuals improve their own practice, and their lack of promotion of collaboration (11, 12). This criticism may be best embodied in the participant responses to the compulsory cultural safety requirement of the PBNZ CPD programme. In the context of NZ healthcare, there is growing recognition of the importance of cultural safety at both individual health practitioner and organisational levels to achieve equitable health outcomes (13). However, respondents indicated the hours towards cultural safety should be decreased (Fig. 4). On the surface this may be an alarming finding, however, it may not reflect that NZ podiatrists do not value cultural safety, it may reflect that such a concept cannot be simply and meaningfully undertaken as a CPD activity within an hours-based framework. This may suggest that the approach to cultural safety CPD should not be compressed into a time-based approach but embedded in a deeper level of CPD that promotes an understanding and relevance to practice, moving toward behavioural change.
One mechanism by which the identified barriers to CPD may be reduced and the perceived relevance of CPD increased, is through shifting the focus of learning back into the practitioners working environment, as opposed to viewing CPD as something that needs to be conducted away from the workplace. Although there will continue to be a role for conferences, external skills courses and workshops as these have an important role in providing and creating peer networks, alternative approaches must be considered. This focus shift may better align with the individual practitioners work within their ‘Scope of Practice’. Although the Scope of Practice for NZ podiatrists is tightly defined, there must be recognition that the individuals scope of practice also expands based on their role, their career progression, specialisation within their area of practice, and the wider range of tasks assumed in their practice setting, which largely evolve in response to addressing the changing needs of their patients (14, 15). Accordingly, an evolving CPD system needs to reflect the changing breadth and complexity of an individual’s professional practice and career development to enable freedom to undertake CPD viewed as relevant to the individuals learning needs. Thus, ensuring CPD does not become driven by external requirements and a subsequent task-orientated approach reduced to a tick-box exercise with the achievement of hours becoming the surrogate measure of competence.
This study is limited by the level or depth by which the CPD programme was evaluated. With reference to the Kirkpatrick model of CPD evaluation which describes four levels of evaluation: Level 1, Reaction, which is a measure of participant satisfaction; Level 2, Learning, which captures change in respondents’ attitudes, knowledge and skills; Level 3, Behaviour, which focuses on change in behaviour of the respondents; and Level 4, Results, which focuses on the final results of a CPD programme (16). The current study only evaluated the CPD programme from Level 1 perspective. Consequently, the impacts (multiple and varied short, medium, and long-term outcomes) of the CPD programme on the personal and professional practices of NZ podiatrists remains unexplored and are largely unknown. Interpretation of the data is also limited by the response rate with over two thirds of NZ registered practitioners with a practising certificate not responding to the survey. Despite these limitations this is the first data related to CPD and NZ podiatry. Future research is required to understand how CPD changes attitudes, knowledge and skills, and how CPD changes behaviours related to learning and practice. Issues that directly affect the process of learning and the relationship to CPD participation such as learning barriers, language, physical health, learning difficulties, and social and personal circumstances also require consideration. The timing of the survey must also be given consideration. The survey was delivered following COVID related lockdowns. Therefore, the timing may have influenced the survey responses.