Continuing education (CE) is necessary to remain up-to-date with current practice issues. In most states, CEs are mandatory and require a specific number of credit hours be attained before license renewal (Ellis, n.d.). Licensed professionals run on a renewal clock. It is a cycle that begins ticking the day we obtain a professional credential. From that point on, there is a date by which we must accumulate a specified number of credits or else risk loss of licensure. However, comprehensive examinations of the current CE system have exposed weaknesses and vulnerabilities and raised questions about the relationship between CEs and the professional competency of health professionals (Dobson & Hess, 2010).

During the interim between renewal, we are tasked with gathering a sufficient number of CE credits. At times, we must obtain credits in a particular subject area. For instance, effective in the 2018 renewal cycle, the Board of Registration in Nursing in Massachusetts must comply with a law that requires domestic and sexual violence training for health care providers as a condition of licensure (Board of Registration in Nursing, 2017). Although some states require specific course topics, others leave it to the licensed professional to direct his or her own learning (Ellis, n.d.). License renewal details are usually defined by one's practice act and the regulatory board from which the license emanates. This entity is often known as a Board of Registration or Board of Professional Licensure. In addition to licensure, many individuals achieve an additional professional credential to validate their background, education, and knowledge of case management. This is another clock ticking a beat to which many of us march in cadence. Again, individuals must gather a specific number of CE credits to renew their certification.

There is an entire industry built around providing continuing professional education. In addition to this, CEs are offered by professional organizations and certification organizations (e.g., online courses, webinars, in-person conferences). With all this opportunity, we should have already seen an improvement in practice competence, quality measures, and efficiency associated with case management intervention.

One is hard-pressed to argue that there is a lack of CE opportunity. But neither opportunity nor completion equates to practice improvement. With that in mind, perhaps we should look at whether the number CEs obtained is an appropriate barometer of one's knowledge or instead should there be a more robust evaluation of theoretical learning impact on one's practice fluency, competence, improved quality outcomes, or efficiency?

I propose that we consider our collective and individual CE efforts from the perspective of measurable impact on practice improvement. As we shift toward this stance, there are questions that demand discussion, including the following:

* Is there a measurable impact on case management competence, quality outcomes, or efficiency that is directly relatable to continuing professional education?

* How do CE providers best justify their existence if not through meaningful and measurable contributions to individual practice improvement?

* Is there a disconnect between individual and employer priorities where CE is concerned?

* Should we translate the current methodology of stated individual behavioral objectives in CE into improved competence at work?

What is holding us back from moving from an additive CE approach to one that ties knowledge gained and measurable practice improvement together?

An argument may be made that one's primary licensure drives the CE bus so that case managers need only fulfill that requirement. While that may be true for some, those having attained the certified case manager credential from the Commission for Case Manager Certification face an additional set of CE requirements if renewal is desired.

By and large, employers are disconnected from the CE process. Although some bring educational programs in-house to their respective staffs, whether there is a subsequent measurement of impact is unknown. On the same theme, when an employer pays for his or her employee to attend an educational event, the measurement of the event's impact is also unknown.

Companies devoted to CE delivery could move from a behavioral objectives approach to one of practice improvement outcomes. This would be difficult to create, given the cross-continuum nature of case management practice. However, if these courses were paid for by an employer, creating a practice improvement impact metric would be easier to identify and measure.

Presently, case management professionals are primarily responsible for obtaining CEs, usually on topics that are appropriate to their practice specialty and/or areas of interest. If case management is to be recognized as a profession, we must begin holding ourselves accountable (both individually and collectively) to the pursuit of knowledge for the purpose of practice improvement and systematically measuring CE impact on practice in order to demonstrate the benefit we represent to the health care continuum. As we stand at a crossroads, we must embark on a path that represents a synthesis of CE learning into measurable practice improvement because pursuit of knowledge is a professional mandate to be enthusiastically embraced, not simply pursued as a chore.

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