Continuing Education: A Call to Exploration and Action

Continuing education is a common requirement for the maintenance of a professional license. Given the requirement to earn continuing education, is enough known about how those who take continuing education, those who require it as part of licensure, and those who offer it value such education and its effectiveness? This article discusses potential issues with continuing education and presents an agenda for ensuring continuing education supports the expectations of the public, licensees, regulators, and educators.  

Continuing education (CE) can be somewhat like multivitamins—one is likely doing no harm, but the good that might be done is difficult to measure and assess. How much CE is necessary to maintain the licensee’s practice? What is the best type of CE—in person or online? What is the impact from CE? I ask these questions as someone who is regularly engaged in a range of issues about CE, from determining what is and is not appropriate CE to working with providers to gain program approval from the Board.  

Ohio’s Experience and the Key Issues 

During my time serving as the executive director of the Ohio Counselor, Social Worker, & Marriage and Family Therapist Board (CSWMFT), the Board has been engaged in ongoing discussions about CE that help to inform this article. The discussions have centered on both the process for approval and the content and relevance to practice. The process of review and approval can be refined and improved with feedback. Content poses some difficult challenges owing to the evolving nature of the professions licensed by the CSWMFT. One must be careful not to overgeneralize and simplify; nonetheless, research on the impact of CE on professional performance and ethical violations is limited, but available, with a significant focus on medically related fields such as nursing and medicine. A review of this research shows minor impacts on professional practice resulting from CE. Why might this be the case? Perhaps there is not enough time dedicated to topics, or there are issues with quality and content, or maybe there is a lack of motivation from the attendees to apply the information to their practice. Nonetheless, CE is required in most forms of credentialing and licensure. There are two key reasons why CE remains part of professional licensure, though these may not always be acknowledged: 

1. theories and values regarding the importance and impact of ongoing learning and development on professional performance and public protection 
2. use as a regulatory control by licensure boards

Ostensibly, CE is required to ensure licensed professionals both maintain and improve the knowledge and skills necessary to fulfill the professional requirements of their occupation. By requiring professionals to continue to develop skills and knowledge, the legislators and/or regulators imposing such requirements do so with the understanding that both the public and the professional will benefit. CE is not the same as personal growth. The focus of CE is—or should be—on professional development. The skills and knowledge acquired should enhance the ability of the professional to practice their profession starting from a broad perspective and focusing on the professional requirements of the occupation. Requiring CE, and subsequently tracking it, forms part of a larger public protection strategy. Not fulfilling CE requirements—be it in responding to audits or not completing course—can be indicative of underperformance, lack of motivation, or even possibly lack of respect for the profession and those it serves. In other words, CE, while possibly enhancing the knowledge and skills of professionals, acts as a type of sifting mechanism, identifying those professionals less than able to operate within the constraints established for that profession. The more robust the requirements, the more likely non-compliant professionals will be identified. The appropriate regulatory body can then take disciplinary action.  

Some professions have implemented a continued competency program, a course of study developed by the licensee that is designed to meet the specific licensee’s learning needs. This approach requires more work and thought on the part of the licensee but can result in the licensee creating a program that meets their needs. One drawback is a greater investment on the part of the regulatory board, as it can require more intensive monitoring. Additionally, the cost of such a program can be higher for a licensee than other types of CE programs. 

Requiring CE to maintain a professional license does imply that professionals will not find means to enhance their professional knowledge independently. Further, by setting up a requirement based on the number of hours (the general standard), regulators are setting what can be considered by some an upper limit, not a minimum amount, of CE necessary to retain a license or registration. Most would agree that a professional should never allow any such requirement to limit their growth and development. Ultimately, the professional is responsible for how valuable CE is to their own professional development. No matter the rules or requirements, the professional must make choices that help them work more effectively as a licensed professional.  

One significant challenge that may undermine the value of CE is determining what is “continuing education” that is related to employment or job duties versus what is not evidence-based or may not have application in the settings where a licensed professional works. There is a balance to be struck between what may be marketable and what should count as CE. This is particularly the case when CE must be approved by a licensing board that may take seriously its duty to ensure quality CE.   

Related to identifying CE is a concern about measuring outcomes. Quality education is more than backsides in seats, or in front of screens, for a set period. It involves figuring out pre and post use of skills and knowledge. Although participant surveys are often conducted, these seem to be of limited value in determining learning outcomes, but they are important from a customer service perspective.  

An Agenda for Enhancing CE 

As someone who is a continuous learner, and as a licensure board administrator responsible for the standards regulating five dynamic professions, I want evidence that CE is being used to its full value, as it is likely to remain a requirement for licensees for some time to come. For me, this means that CE imparts new knowledge and skills to those taking it. Including the key stakeholders in regulating and offering CE, a modest high-level agenda is proposed below. 

Licensure Boards 

1. Set and enforce reasonable standards for licensees and providers and be a good partner in evaluating CE, if the Board does so as part of its role in regulating. This may mean understanding the demands placed on providers (low cost and relevant training) and licensees (low cost and accessible training). 
2. Find ways to reduce bureaucracy around CE while increasing access to programs. Could this mean more limited reviews or allowing more latitude to licensees to select CE? 
3. Stay knowledgeable about trends and industry needs. This may require developing relationships with associations and getting out and meeting with licensees, as well as reading professional journals and magazines. It can also involve doing some research. 
4. Encourage research by making data available and working with researchers to evaluate CE and the results of requiring it. 

Providers and Associations 

1. Create and deliver relevant, high-quality CE programs that are responsive to the needs of licensees and follow licensing board CE requirements. 
2. Communicate industry needs and share observations about trends in CE to those who regulate and approve CE. Recognize that providers are often more agile than licensing boards when it comes to adjusting to changes in professional practice.  
3. Acknowledge the role the licensing board has in approving programs and providers by establishing positive working relationships. It can be particularly helpful to understand the role of the Board (e.g., once a process for approving a program is in place, there will be some standards that must be followed).   

 Licensees 

1. Take seriously the responsibility to earn CE credits and apply what is learned. Through the importance licensees place on CE, those who provide CE will respond with appropriate and effective training. 
2. Work closely with the regulatory board to set up and understand all CE requirements. This can mean gaining familiarity with the rules and standards, as well as commenting during rule writing opportunities.  
3. Demand CE programs that provide information and skills relevant to your practice. 

 Educators and Researchers 

1. Study the effectiveness of CE across a broad range of professions, as well as mental health professions, to ensure unique aspects of practice are part of understanding CE.  
2. Conduct research that explores the link between professional performance and CE. Research focused on self-reports can be helpful but does not close the gaps in research about the effectiveness of CE, as it does not measure outcomes independent of the bias of the responding licensee. Too often, we assume that CE is imparting useful information that is improving the level of practice of those professionals who take it.  
3. Encourage students to value lifelong learning. This is challenging to impart, but necessary, as it will boost the value and impact of required CE.   
4. Participate in the CE marketplace by offering CE programs based on the research being conducted. 

CE is likely to remain a requirement for holding a professional license. As a licensing professional, it is my duty to ensure the public is protected. One means of doing so is to ensure sufficient skills and abilities are possessed by those professionals regulated by licensing boards. Those of us who practice the professions or support the professions through education or regulation should be asking questions and taking steps to ensure CE is an effective part of professional licensure and not simply a valueless step that must be completed as part of remaining licensed.      

Brian Carnahan is Executive Director of the State of Ohio Counselor, Social Worker, & Marriage and Family Therapist Board. He is a Member at Large on the Executive Committee of the Counseling Compact Commission. Formerly a compliance manager in the affordable housing industry, he regularly publishes articles on a variety of topics, including licensure, regulatory affairs, affordable housing, and adoption. Carnahan can be reached via email at brian.carnahan@cswb.ohio.gov.