Legal, Ethical, and Professional Issues in Psychoanalysis and Psychotherapy
The issue of mandatory continuing education (MCE) for professionals is controversial because at its heart are questions about the nature of professions and of adult education. Being a professional implies commitment to continuing one's education and the ability to pursue practice-enhancing learning. So there would seem to be no need for mandates. However, due to advances in knowledge and technology, as well as public demands for accountability and consumer protection, the number of states requiring continuing education for many professions has significantly increased in the last 10 years (Queeney and English 1994). This Digest reviews arguments on both sides of the debate and relates MCE to the national standards and competency movements. It describes how continuing professional education (CPE) program developers can provide effective learning for professionals in a mandated environment.
1. It violates adult learning principles, such as voluntary participation, the informal nature of adult education, and adult self-direction. It promotes uniformity by disregarding individual learning needs and styles.
2. By definition, professionals are supposed to be autonomous, self-managed, and responsible for mastery of knowledge; MCE is punitive to those who participate voluntarily.
3. Evidence that it results in improved practice is lacking. All that is mandated is attendance, which will not necessarily change attitudes, motivation, determination to practice responsibly, or ability to learn.
4. Programs are not consistently and uniformly available. Many lack quality and relevance to practitioner needs. MCE may encourage providers to focus on profit.
5. Requiring participation may hinder learning by reducing motivation and individual responsibility.
6. Professionals should be accountable for effective performance, not participation.
Proponents support MCE for the following reasons (Brockett and LeGrand 1992; Little 1993; Nelson 1988; Queeney and English 1994; Queeney, Smutz, and Shuman 1990):
1. Expecting voluntary participation is unrealistic. Those who need it most may be least likely to participate.
2. There is some evidence that well-designed programs can influence effective practice.
3. MCE can provide equal access to a range of opportunities.
4. Mandates are necessary to protect the public from incompetent or out-of-date practitioners.
5. Although imperfect, it is better than such alternatives as examination or practice review.
6. By choosing a profession, professionals submit to its norms. A license to practice implies consent to be governed by the rules of the profession.
Although some studies have found negative attitudes among those required to participate, Queeney, Smutz, and Shuman (1990) suggest that MCE participants may judge their participation more thoughtfully and critically because it is required; they expect high quality and applicability and become more astute consumers of learning opportunities.
Some feel that the mandatory debate is a dead issue (Brockett and LeGrand 1992; Nelson 1988; Queeney and English 1994). Rather than arguing about whether professional continuing education should be mandatory, the focus should be on improving the content and delivery of CPE. However, the "content of CPE courses is often based on precedent or what the providers think is worthwhile, rather than any systematic analysis of what constitutes competent current practice of the profession" (Hager and Gonczi 1991, p. 24). Some consider competency-based standards the solution.
Competency-based standards for professionals are nearly as controversial as MCE, because a mechanical approach that tries to break down professional performance into discrete tasks or skills ignores such higher-level aspects as critical reflection and professional judgment. Hager and Gonczi (1991) propose an integrated approach that identifies the KSAs displayed in the context of realistic professional tasks. The resulting standards would enable professionals to assess their own levels of competence and choose continuing education accordingly.
Another flaw in the competence approach is the assumption that performance is individual. Cervero et al. (1990) identify other influences upon performance: the relationship of the professional with peers, subordinates, superiors, and clients; the multiple cultures to which individual practitioners belong; and the relationship of the professional to society (the cultural context of practice). Thus, although continuing education (mandatory or not) may be a factor in improving competence, it is difficult to separate the effects of participation from those of other influences on practice (Queeney and English 1994).
Effective CPE should be accessible, affordable, and of high standards. It is difficult to balance quality considerations with the need to keep costs reasonable, serve large numbers, and address continual updating needs in many specializations. Collaboration among providers is recommended. CPE should be relevant to individual learning needs, applicable to practice, and designed for different learning styles. Professionals in organizational settings should receive support for transferring learning to practice, and interstate mobility of MCE credentials should be established.
CPE should be rooted in and viewed as an extension of professional education. Competence evolves over time, and effective learning is a long-term, cumulative, integrated process (Cervero et al. 1990; Queeney and English 1994). CPE should be viewed as part of the lifelong learning continuum, and development of a mindset toward continuing education should begin prior to practice. This requires a systematic approach to developing a strategic lifelong learning agenda that is holistic (taking into account the multiple cultural influences on practice). Currently rare, educational counseling services for professionals are needed.
CPE should link practitioner competence to the ideals of public service and accountability by (1) stressing the value judgments and ethical considerations in practice, (2) developing competence and expertise in conjunction with understanding of the human purposes of professional service, and (3) promoting cooperation, interdependence, and collaboration as additional ways to improve competence (Cervero et al. 1990).
Nelson (1988) warns that MCE should not be oversold as a solution. Associations for professions in which continuing education is mandatory should promote the values of CPE to their members while acknowledging to the public the limitations and difficulties of certifying competence and of documenting MCE's effects on practice.
A most important factor in overcoming objections to mandated education is consideration of the professional as an adult learner. Program design and delivery should emphasize consultation and cooperation, not coercion (Nelson 1988). Professionals can be given broad latitude in the selection and design of their individual learning programs (Brockett and LeGrand 1992), especially if standards against which to compare them have been established. Cervero et al. (1990) give the following description of professionals as learners: "professionals construct an understanding of current situations of practice using a repertoire of practical knowledge acquired primarily through experience in prior 'real life' situations" (p. 178). CPE must foster both practical knowledge or know-how as well as critical reflection.
Although in some professions MCE has become the norm, its mandatory nature should not be the focus. "One answer to the mandatory continuing education conundrum may be not the mandatory or voluntary nature of continuing education, but the transformation of professionals into motivated seekers of education" (Queeney and English 1994, p. 4).
Cervero, R. M. et al. VISIONS FOR THE FUTURE OF CONTINUING PROFESSIONAL EDUCATION. Athens: Georgia Center for Continuing Education, University of Georgia, 1990.
Davison, T. "Competency-Based Training & Competency-Based Assessment." Paper presented at the Queensland (Australia) Training Officer Society Conference, May 1994.
Hager, P., and Gonczi, A. "Competency-Based Standards: A Boon for Continuing Professional Education?" STUDIES IN CONTINUING EDUCATION 13, no. 1 (1991): 24-40. (EJ 440 649)
Little, C. D. "Mandatory Continuing Education." JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 13, no. 2 (1993): 159-167. (EJ 466 410)
Morrison, A. A. "Resisting Compulsory Continuing Professional Education." AUSTRALIAN JOURNAL OF ADULT AND COMMUNITY EDUCATION 32, no. 3 (November 1992): 146-150. (EJ 458 745)
Nelson, J. W. "Design and Delivery of Programs under Mandatory Continuing Professional Education." STUDIES IN CONTINUING EDUCATION 10, no. 2 (1988): 81-103. (EJ 384 843)
Queeney, D. S., and English, J. K. MANDATORY CONTINUING EDUCATION: A STATUS REPORT. Columbus: ERIC Clearinghouse on Adult, Career, and Vocational Education, Center on Education and Training for Employment, The Ohio State University, 1994.
Queeney, D. S.; Smutz, W. D.; and Shuman, S. B. "Mandatory Continuing Professional Education." CONTINUING HIGHER EDUCATION REVIEW 54, no. 1 (Winter 1990): 11-25. (EJ 408 065)
This "digest" (ERIC Digest No. 151) was developed with funding from the Office of Educational Research and Improvement, U.S. Department of Education, http://adulted.about.com/cs/mandatoryconted. It may be reprinted freely.
Ethical, and Professional Issues in Psychoanalysis
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