Cost effectiveness of continuing professional development in health care: a critical review of the evidence
BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7338.652 (Published 16 March 2002) Cite this as: BMJ 2002;324:652
- C A Brown, research fellow (C.A.Brown@bham.ac.uk)a,
- C R Belfield, assistant director for researchb,
- S J Field, regional postgraduate deanc
- a Centre for Research in Medical and Dental Education, School of Education, University of Birmingham, Birmingham B15 2TT
- b National Center for the Study of Privatization in Education, Teachers College, Columbia University, New York, USA
- c West Midlands Deanery, Birmingham
- Correspondence to: C A Brown
- Accepted 13 August 2001
Continuing professional development (CPD) for healthcare professionals is an important strategic instrument for improving health. The Department of Health identifies CPD as a way of maintaining standards of care; improving the health of the nation; and recruiting, motivating, and retaining high quality staff.1 To this end, direct NHS spending on continuing professional development in 1999-2000 was about £1bn ($1.6bn). 2 3 If we regard CPD as any method to improve health professionals' skills the total resources devoted to it are probably much greater, particularly with the recent increased participation in response to the need for recertification and revalidation.4 To ensure the maximum gain from participation in CPD, these resources must be used efficiently.
To assess the efficiency of participating in CPD, economic criteria are needed. Resources for health care are scarce, and money spent on CPD could otherwise be used for direct patient care. These opportunity costs are explicitly considered in the economic methods of cost benefit analysis and cost effectiveness analysis. The literature contains various reviews of cost effectiveness analysis in both health care 5 6 and education.7 Such articles explain why cost effectiveness analysis (or another method of economic evaluation) is essential and how such evaluation should be undertaken, and they clearly define the set of economic terms (such as cost benefit analysis, cost effectiveness analysis, rate of return, and opportunity cost) that need to be incorporated into this type of research. Casebeer et al highlighted the need for economic evaluation of CPD activities,8 but they emphasised the use of cost benefit analysis, which requires monetary values to be assigned to measures of effectiveness. Cost benefit analysis is generally used to ascertain whether an intervention should be undertaken. Cost effectiveness analysis is used to decide which interventions (out of a number of alternatives) should …