Problems of continuing education

Little more than 10 years ago continuing education was a term only just coming into use in many countries. Now it is common parlance. Those who use it may not always have a very precise definition in mind, but most would agree, on reflection at least, that its two purposes are firstly to keep an individual abreast of advance (and change) in his own field of medicine, and secondly to keep him aware of development in others. The second purpose has so far received relatively little attention but the past decade has seen a remarkable degree of activity in regard to the first. This has affected, though not equally, all three forms of continuing education. In its first form, continuing education comes to the individual by advertisements, newspapers, journals, books, tapes, slides, television, and other similar media. There has been a great increase in the range of media and in the extent to which each is used by those pressing continuing education on the doctor. A similar increase in the use made by him of these greater opportunities for learning is less easily seen. Hopefully, it is greatest in those countries where a primary aim of undergraduate medical education is to inculcate a continuing desire to learn, along with the ability to do so. But even when that incentive is lacking, as unhappily may often be the case, there are other ways of leading the individual doctor to acquire new information or habits of practice and maybe this form of continuing education is currently the most effective of the three for many doctors. The second form is that in which the doctor himself goes to continuing education activities provided for him and others, by one of a number of different organizations. It began years ago with the activities of medical societies and other professional associations and recently there has been a very great and effective intensification of effort by specialist bodies, not only within individual countries but also between them. Specialists now have little difficulty in keeping in touch with advance in their own fields by conferring with colleagues, and the expense of travelling to conferences is increasingly borne by governments as well as by individuals. Increasingly, too, specialists have an opportunity to become aware of development in fields outside their own by attending 'general rounds', clinicalpathological conferences, and similar exercises mounted in the centres in which they work. In most countries, however, the bulk of generalists tend to work under conditions of professional isolation, and a particular feature of the past decade has been the provision of continuing education in centres where a number of individuals can come together for an intensive course or for regular recurrent meetings. Countries differ in the way in which this continuing education has been organized and in the auspices under which it is provided. In some the universities have played a major role, in others the professional organizations, and in still others government has maintained'postgraduate organizations entirely separate from those engaged in basic medical education or the delivery of health care. There is wide variation also in the methods used to try and ensure maximal attendance by those for whom the education is provided. Attendance is compulsory in some countries, irrespective of recertification. By contrast, in the United Kingdom, general practitioners are not only recompensed for attending but receive a recurring financial bonus for having done so. In between these two extremes reliance is based on the individual's desire to learn and to update himself, and perhaps on the expectation that an improved standard of practice will benefit not only his patients but himself as well. In its third form, continuing education is built into the daily work of the doctor. It applies to all who have the capacity to profit from experience, which is not everyone. It is more potent, of course, where a number of doctors work together in contact with each other. To the extent that throughout the world a process of concentration of medical personnel has been proceeding inexorably, resulting