Impact of continuing professional development (CPD) on patient outcomes: a systematic scoping review

Abstract

Background

Continuing Professional Development (CPD) is vital for maintaining healthcare professionals’ competence in providing quality patient care. However, evidence linking CPD directly to patient outcomes remains limited and methodologically diverse, hindering generalizable conclusions. This scoping review synthesises available evidence on the impact of CPD participation on patient outcomes, identifies patterns in intervention design and outcome measures, and explores key implementation and contextual factors that influence CPD effectiveness.

Methods

In September 2024 PubMed, Embase, CINAHL, and ERIC were searched for studies that assessed the impact of CPD interventions on patient health outcomes in healthcare settings. Two reviewers independently screened the articles for eligibility and charted the data. Findings were synthesized using a mixed-methods approach combining quantitative summary and qualitative content analysis.

Results

Of 1562 records screened, 17 studies met the inclusion criteria. Most of the articles (n = 16) originated from high-income countries. Multi-component CPD interventions, particularly those with sustained support and practical skills development, demonstrated greater effectiveness than standalone educational activities. Positive patient outcomes were reported in 14 studies, including reduced hypoglycemic events, and shorter ICU stays. The most impactful interventions were those implemented with organizational support, clear protocols, and ongoing reinforcement. Nevertheless, the evidence base was constrained by variations in outcome measures (e.g., mortality rates, complication rates, functional scores), and short follow-up durations.

Conclusions

Despite CPD’s prominence in healthcare systems, only a few studies directly evaluate it to improved patient outcomes. This review highlights that CPD programs incorporating practical skill development, protocol-based implementation, organizational support, and ongoing reinforcement can enhance patient care. Future research should adopt rigorous methodologies, consistent outcome measures, and long-term follow-up to better evaluate CPD’s effectiveness. Additionally, CPD providers should prioritize integrated approaches between theoretical knowledge, applied practice, and continuous support mechanisms to maximize clinical impact.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-025-07883-4.

Background

Continuing Professional Development (CPD) for healthcare professionals (HCP) is an essential element for healthcare systems to operate efficiently and safely. As health landscapes rapidly evolve with new knowledge and technologies, CPD helps to ensure that practitioners remain updated with the latest advancements, adopt evidence-based practices, and address the evolving challenges of patient care and safety [1–4]. Growing demands on healthcare services and increased scrutiny of limited resources means that the need to implement successful CPD strategies has never been greater [5–8].

Although CPD initiatives have been widely implemented in healthcare for many years, there remains a significant gap in our understanding of their tangible and measurable impact in the context of their ultimate goals: improving patient health outcomes [9–12]. In fact, most previous research has focused solely on intermediate outcomes like knowledge acquisition or skill development without a clear link to patients’ gains [13–15].

Several established evaluation frameworks exist, including Moore’s modified CPD outcome framework [13], Kirkpatrick’s Four-Level Model [16], and Stufflebeam’s CIPP Model [17]. Moore’s modified CPD outcome framework provides a valuable structure for evaluating CPD effectiveness across multiple levels, from participation and satisfaction (levels 1–2) through knowledge and competence acquisition (levels 3–4) to performance change, patient health improvement, and population health impact (levels 5–7) [13, 18]. However, most CPD evaluations focus primarily on the lower levels of this framework, with relatively few studies examining the higher-level outcomes related to patient and population health [19, 20].

The diversity of CPD activities presents significant challenges for standardized evaluation. CPD initiatives vary considerably in their aims, length, delivery modes, target audiences, and implementation contexts, making standardized assessment difficult [21, 22]. This heterogeneity, combined with the complexity of healthcare systems, creates substantial methodological challenges for researchers attempting to establish direct causal links between CPD interventions and patient outcomes. Additional barriers include resource and time limitations, the presence of numerous confounding factors in clinical environments, and the difficulty of isolating the specific effects of educational interventions within complex healthcare delivery systems [23–25].

In the literature, several other critical knowledge gaps persist. For instance, the factors influencing the successful implementation of CPD initiatives and their translation into improved patient outcomes remain inadequately understood [26–28]. There is also a lack of standardized guidelines to develop tailored and effective CPD programs [26, 29, 30] and insufficient evidence of the cost-effectiveness of different approaches [31]. These challenges collectively contribute to the limited evidence base linking CPD directly to patient health improvements despite the substantial resources invested in professional development activities globally.

This scoping review aims to collate, summarize, and categorize the existing literature on the impact of CPD interventions on patient health outcomes. By synthesizing the current evidence, this review identifies patterns, trends, and areas requiring further investigation on the impact of CPD on patient outcomes. It also maps contextual determinants, design characteristics, and implementation factors that influence the translation of CPD learning into improved patient outcomes. Through this comprehensive synthesis, the review provides insights that can inform the development of more effective CPD strategies, ultimately contributing to the advancement of evidence-based CPD practices that demonstrably improve patient outcomes. Understanding whether CPD delivers measurable improvements in patient outcomes is essential not only for advancing educational practice but also for informing policy decisions, guiding funding allocations, and ensuring that investments in professional development represent good value for money, particularly in resource-constrained health systems where efficient allocation is paramount.

Methods

Protocol and registration

This scoping review was conducted following the guidelines of the Joanna Briggs Institute (JBI) [32] and the PRISMA-ScR framework [33]. The protocol was preregistered on the Open Science Framework (OSF) under DOI 10.17605/OSF.IO/62UAZ to ensure transparency and methodological rigor [34].

Eligibility criteria

The eligibility criteria were established following the Population, Concept, and Context (PCC) framework [35]. The population of interest comprised healthcare professionals, including physicians, nurses, pharmacists, dentists, allied health professionals such as physiotherapists, occupational therapists, dietitians, and other relevant practitioners. Studies focusing on students, postgraduate trainees, or non-healthcare professionals were excluded.

The concept of interest was CPD, defined as educational activities, programs, or interventions that aim to enhance professional knowledge and skills. Studies assessing CPD interventions in any format, including formal courses, workshops, online training, or workplace-based learning, were eligible for inclusion. Non-CPD interventions, such as initial professional education, general education programs unrelated to CPD, and personal development activities outside the scope of professional practice, were excluded.

The review’s context included studies in healthcare settings (hospital, primary care, community health, specialized clinics, etc.), and reporting measurable patient health outcomes, such as morbidity and mortality rates, treatment results, clinical recovery, and care quality indicators. Studies that did not report patient health outcomes, those that focused solely on intermediate outcomes like knowledge acquisition or skill development without a clear link to healthcare impact, patient self-reported outcomes, or those that only reported economic outcomes without relevant health data were excluded.

Eligible study designs included only empirical research. Non-empirical literature, such as editorials, commentaries, opinion pieces, letters to the editor, and reviews, were excluded. Case reports were also not considered.

Only studies published in English were included. The review focused on peer-reviewed journal articles presenting original research findings. Grey literature, including theses, dissertations, policy briefs, government reports, and other non-peer-reviewed sources, was excluded. The search was conducted from database inception to the date of the final search, 20th September 2024.

The rationale for these exclusion criteria was to ensure the review focused specifically on empirical evidence linking CPD interventions to measurable patient health outcomes. Student and trainee populations were excluded as they are still in initial professional education rather than continuing development. Non-empirical literature was excluded to maintain focus on original research with measurable outcomes. The exclusion of studies reporting only intermediate outcomes (e.g., knowledge acquisition) without patient health data was essential to address our primary research question about CPD’s direct impact on patient care. Grey literature was excluded to ensure peer-reviewed quality standards, and the English language restriction was applied due to resource constraints for translation.

Information sources and selection process

An extensive search strategy was developed to identify relevant literature from several databases, including PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Education Resources Information Center (ERIC). The complete search strategy for all databases can be found in supplementary file 1. The latest database search was conducted on 20th September 2024.

Following the search, all identified citations were uploaded into EndNote 20 and then Rayyan AI^® (https://www.rayyan.ai), and duplicates were removed in two stages (Endnote then Rayyan AI). Titles and abstracts of identified articles were screened against the inclusion and exclusion criteria. The full text of the remaining articles was then retrieved and screened. Two independent reviewers conducted the screening at all stages. Discrepancies were resolved through discussion and consensus between the two reviewers, with a third reviewer consulted as arbiter when consensus could not be reached.

Data charting process and data items

An extraction sheet was designed to tabulate data from the included articles using a Microsoft Excel^® spreadsheet, which included study characteristics, CPD intervention details, outcomes assessed, key findings, and other metrics. In addition to outcome measures, data were also extracted on contextual and implementation factors influencing CPD effectiveness, such as organizational support, delivery methods, and reported barriers and facilitators. Two investigators piloted a data extraction sheet on three sample articles, and one investigator performed the complete data extraction following the successful piloting.

Data synthesis and analysis

The data were synthesized using a descriptive approach to collate, summarize, and categorize the literature findings through both quantitative methods (numerical counts of studies) and qualitative methods (inductive content analysis). The content analysis focused on items that included descriptive data to create categories. These items encompassed approaches for assessing the reporting methods, tool development, and limitations of the articles. The analysis involved assigning labels to the extracted text data and grouping similar labels into subcategories, ultimately generating themes to summarize the data. Two investigators independently conducted the content analysis, with findings compared and discussed to ensure consistency. Any discrepancies in categorization or theme development were resolved through discussion and consensus, with a third reviewer consulted when agreement could not be reached.

Results

The results of this scoping review are presented in four main areas: [1] an overview of the included studies [2], the impact of CPD on patient outcomes [3], the design characteristics of effective CPD interventions, and [4] factors that influence CPD effectiveness. Each area synthesizes findings across the 17 included studies to identify patterns and relationships between CPD approaches and patient outcomes.

Overview of studies

The PRISMA flow diagram is presented in Fig. 1. From an initial 1562 records identified across four databases (after removing duplicates), 17 studies met the inclusion criteria. The included studies spanned a 36-year period (1988–2024) and reported on various patient outcomes resulting from CPD interventions for healthcare professionals.

Fig. 1.

PRISMA flow diagram of study articles selection process

The included studies showed a distinct geographic concentration in high-income countries, with the United States contributing the largest proportion (n = 7) [36–42], followed by Australia (n = 3) [43–45] and Canada (n = 2) [46, 47]. Only one study originated from a low-income country (Eritrea) [48]. This geographic imbalance highlights systemic disparities in access to research funding, infrastructure, and capacity to implement and evaluate multi-component CPD interventions. These contextual limitations hinder the generalizability of current evidence and underscore the need for greater inclusion of diverse healthcare systems in future research.

Methodologically, the studies employed various designs, including six pre-post quasi-experimental designs [36, 37, 44, 45, 48, 49] and four randomized controlled trials [38, 41, 43, 50]. Study settings were diverse, spanning acute care hospitals (n = 4), primary care facilities (n = 4), community settings (n = 3), and specialized clinics (n = 6), allowing for comparison of CPD effectiveness across different healthcare contexts.

Additionally, only three studies [36, 40, 45] utilized a theoretical framework to guide their CPD intervention design and evaluation: Plan-Do-Study-Act (PDSA) principles [36], Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) [45], and The Institute for Healthcare Improvement’s Model for Improvement [40]. This suggests a need for more theory-informed approaches to CPD research.

The CPD interventions examined in the included studies were substantially heterogeneous in approach, delivery method, and duration. Table 1 summarizes the characteristics of these interventions. Traditional educational workshops formed the foundation of most interventions but varied considerably in format, ranging from brief two-day sessions [45, 51] to comprehensive programs extending over several months [37, 38]. Table 1 provides a detailed comparison of these intervention characteristics across studies.

Table 1.

Characteristics of the CPD programs

Study	CPD Type	Duration and Frequency	Data collection Tool(s)	Time of Data Collection (n)
McMahon, McKenna (39)	Mixed (individual consultations + group-based continuing education session)	Individual meetings (45–60 min) followed by one evening group session	Length-of-stay data; quality of care, physician performance metrics, Hospital administrative data, Patient records	16 months pre-intervention, 16 months post-intervention (2)
Oleske and Hauck (41)	Mixed (didactic sessions + nurse specialist consultations + outreach activities)	30 h over two and half years	Patient records review, Home health agency charts, Physiologic complication monitoring, Cancer patient referral rates	Pre-training, post-training (2)
Gill and Ursic (47)	Mixed (face-to-face teaching + distance learning + practical demonstrations)	Day-long workshop with no specified follow-up	SAQ; hospital logbooks; time-to-first ambulation records; length-of-stay data	Pre-training, 6 months post-training (2)
Clarke, Abbenbroek (44)	Mixed (didactic sessions + experiential exercises + practice scenarios)	One-day workshop followed by ongoing clinical support for nine weeks	Patient health records, Hospital logbooks, Complication monitoring forms	Pre-training, two months post-training (2)
Cleland, Fritz (38)	Mixed (didactic content + case studies + hands-on practice + group discussion)	Two-day initial course plus two 1.5-hour follow-up meetings at 4 and 7 weeks post-course	NDI; pain rating scale, Visit number tracking	Pre-training, post-training over 16 months (multiple)
Braido, Comaschi (50)	Mixed (didactic sessions + case studies + Q&A sessions)	Five residential events plus four short distance-learning refresher courses over one year	Knowledge assessment questionnaires, Patient records review, Healthcare resource usage data	Pre-training, post-training (2)
Boyle, O’Neil (36)	Mixed (workshops + interactive follow-up)	Three live educational workshops (each lasting 120 min) delivered over one year	Patient chart review; clinical indicators database	Baseline, 3 months post-training (2)
Deutscher, Werneke (52)	Mixed (lectures + demonstrations + case studies + hands-on practice)	Four 28-hour courses delivered over multiple years with recommended 1-year intervals between training stages (Total 112 h).	FOTO’s lumbar-specific computerized adaptive test, Clinical records	Multiple time points over 6 years (multiple)
Brennan, Fritz (37)	Interactive (CE course + interactive improvement project)	Two-day course delivered as a single intervention then therapists met approximately once per month	Neck Disability Index (NDI); pain rating scale	Pre-training, immediately post-training (2)
Marzolf, Zekarias (48)	Interactive (lectures + case studies + hands-on simulation + question-answer sessions)	Two times per week for 5 weeks, resulting in a total of 10 lectures, each lasting 2 h	Safety Attitudes Questionnaire, Hospital logbooks, Maternal/neonatal outcome measures	Pre-training, post-training, 3-month follow-up (3)
Chipchase, Cavaleri (43)	Mixed (lectures + hands-on practical sessions)	Two-day workshop followed by one five-hour follow-up session one month later	Safety Attitudes Questionnaire (SAQ); physiotherapy outcome measures (NDI)	Before training, 4 weeks post-training (2)
Perry, Golley (45)	Mixed (PowerPoint presentations + hands-on demonstrations + role-playing activities)	Two-day workshop with ongoing implementation support over three years (10 sessions)	Child BMI z-scores; dietary questionnaires; body image scales	Pre-training, post-training over 3 years (2)
Baillargeon, St-Cyr-Tribble (46)	Mixed (preceptorship + electronic networking)	Two-day initial preceptorship followed by monthly webinars over an unspecified period	Safety Attitudes Questionnaire, De-identified medical records, Patient health indicators (BMI, waist circumference)	Pre-training, 1-month post, 1-year follow-up (3)
Miner (40)	Mixed (online e-learning [60%] + simulation-based training [40%])	Ten weeks. The e-learning modules for maternity emergencies were designed to be completed in an average of 2.25 h for prioritized activities, compared to an expected 4 h for the entire course.	Patient outcome measures, Electronic health records, Maternal hemorrhage rates; transfusion rates; ICU admission data	Baseline (6 months), 12-month performance period (multiple)
Apikoglu, Selcuk (49)	Mixed (face-to-face training + interactive refresher courses)	Three-day initial course followed by continuous implementation over one year	Clinical database records, Prescription database, Patient outcome measures	Pre-training, post-training (2)
Jordal, Skudutyte-Rysstad (51)	Mixed (lectures + hands-on training with reciprocating file system)	Two-day course with no specified follow-up	Radiograph analysis, Root canal treatment quality measures; electronic health records; practitioner surveys	Pre-course, post-course, 1-year follow-up (3)
Alfano, Riddle (42)	Mixed (PowerPoint presentations + hands-on demonstrations with mannequin + electronic charting practice)	Three days of education sessions covering both day and night shifts with follow-up assessment	Patient chart review, staff questionnaires, Clinical outcome measures (VAP rates; ventilator days; ICU length of stay)	Baseline (3 months), 3 months post-intervention (2)

The included studies targeted diverse healthcare professional groups, allowing for comparison of CPD effectiveness across disciplines. Physical therapists were the focus of four studies [37, 38, 43, 52], while nurses were represented in five studies [40, 42, 44, 47, 48]. Physicians [39, 46, 50] and pharmacists [49] were also represented, though to a lesser extent. This distribution reflects the multidisciplinary nature of healthcare delivery but suggests a need for more research on interprofessional CPD approaches.

The educational content varied according to clinical focus but consistently emphasized evidence-based practice principles and clinical skill development. The interventions addressed a range of conditions including ventilator-associated pneumonia [42], postpartum hemorrhage [40], obesity management [45, 46], and cancer care [41].

Analysis across the 36-year time span (1988–2024) revealed a notable evolution in CPD approaches and evaluation methods. Earlier studies [39, 41] focused primarily on direct clinical outcomes such as mortality and morbidity rates. In contrast, more recent investigations [40, 42] have incorporated broader measures, including resource utilization, system-level impacts, and implementation factors, in addition to the reported patients’ outcomes. Moreover, contemporary studies (post-2015) increasingly implement integrated approaches that combine traditional education with technology-enhanced learning [40], standardized protocols [42], and systematic evaluation frameworks [45].

Table 2 presents a comprehensive overview of the included studies, summarizing their key characteristics.

Table 2.

Characteristics of studies included

Study	Country (Year)	Study Design	Target Participant(s)	Primary Research Question(s)	Reported Patients’ Outcomes	Study Limitations
McMahon, McKenna (39)	United States (1988)	Mixed methods	Physicians across multiple specialties (internal medicine, hematology-oncology, nephrology).	CPD impact on hospital length of stay for Prison inmates with various medical conditions requiring tertiary care.	Reduced length of stay without compromising care quality.	Limited generalizability due to unique population; potential confounding factors not controlled for
Oleske and Hauck (41)	United States (1988)	Randomized controlled trial	Nurses (Home health agency nurses and Oncology nurses)	CPD for oncology home care.	12.6% cancer mortality reduction; increased home care referrals.	Small sample size; limited follow-up period; potential selection bias in patient referral patterns
Gill and Ursic (47)	Canada (1994)	Quasi-experimental design	Registered Nurses (orthopedic unit)	CPD for elderly hip fracture care.	Reduced ambulation time and length of stay.	Relatively small sample size; limited control for confounding variables
Clarke, Abbenbroek (44)	Australia (1996)	Pre-post test	Nurses (working in high-dependency areas)	CPD for high-dependency (HD) patients who had undergone non-cardiac surgery.	8% reduction in complications; slight improvement in survival to discharge.	Potential documentation inconsistencies; lack of randomization
Cleland, Fritz (38)	United States (2009)	Randomized controlled trial	Physical therapists (9 control and 10 intervention)	Ongoing CPD for neck pain management.	Disability reduction with fewer visits; no significant pain improvement.	Small sample size of therapists; potential for contamination between groups; limited patient outcome measures
Braido, Comaschi (50)	Italy (2012)	Randomized controlled trial	General Practitioners.	CPD for asthma management.	Improved spirometry use; reduced hospitalizations for acute respiratory failure.	Limited follow-up period; potential Hawthorne effect; self-reported outcome measures
Boyle, O’Neil (36)	United States (2013)	Pre-post test	Physicians, Administrators, Nurses, Certified nursing assistants, Nutrition staff	CPD impact on diabetes care.	Hypoglycemia reduced from 31–11%; limited HbA1c improvement.	Lack of control group; relatively short follow-up period; confounding factors not controlled
Deutscher, Werneke (52)	Israel (2014)	Prospective, observational cohort	Physical therapists	Mckenzie education for LBP Low back pain (LBP) patients.	Improved functional status scores; fewer therapy visits.	Observational design limiting causal inference; potential self-selection bias; variable training levels among therapists
Brennan, Fritz (37)	United States (2015)	Pre-post test	Physical therapists	CPD effect on neck pain management.	Continuing education alone showed no significant impact; ongoing support improved outcomes.	Non-random assignment to quality improvement project; potential selection bias; limited standardization of treatment delivery
Marzolf, Zekarias (48)	Eritrea (2015)	Pre-post test	Midwives, Associate nurses, Obstetrics and Gynecology specialists, and other hospital-based staff who were directly or indirectly involved in maternity care.	CPD effect on maternal/neonatal outcomes.	Reduced blood transfusion rates; no significant change in maternal/neonatal death rates.	Limited sample size; short follow-up period; difficulty in isolating effects of intervention from other concurrent changes in care practices
Chipchase, Cavaleri (43)	Australia (2016)	single-blind, randomized controlled trial	Physiotherapists	CPD workshop with follow-up vs. workshop alone for neck pain	No significant difference between groups; both showed some improvement.	Small sample size; limited follow-up period; potential contamination between intervention groups
Perry, Golley (45)	Australia (2017)	Pre-post test	dietitians and health professionals	CPD for community obesity intervention.	Reduced BMI z-score and improved dietary behaviors.	Organizational and political barriers affected implementation; high dropout rate; incomplete outcome data collection
Baillargeon, St-Cyr-Tribble (46)	Canada (2020)	Prospective interventional study	Nurses and physicians	Impact of CPD on obesity management.	15.2% of patients lost ≥ 5% weight; significant waist circumference reduction.	Non-randomized design; potential selection bias; limited generalizability
Miner (40)	United States (2020)	Retrospective performance improvement project	Obstetricians, maternal-fetal medicine specialists, certified nurse-midwives, family practice physicians, and registered nurses.	Blended CPD for postpartum hemorrhage (PPH) for pregnant women experiencing childbirth.	Reduced median transfusion rates and maternal ICU admissions.	Retrospective design; potential confounding from concurrent quality improvement initiatives; lack of randomization
Apikoglu, Selcuk (49)	Turkey (2022)	Pre-post test	Pharmacists (community pharmacists)	Effect of CPD on chronic conditions (asthma, COPD, diabetes, hypertension).	Improvements in asthma peak flow, inhalation techniques, HbA1c levels; no significant change in hypertension outcomes.	Limited follow-up period; high dropout rate; potential selection bias in pharmacist participation
Jordal, Skudutyte-Rysstad (51)	Norway (2022)	Observational intervention study	Dentists	CPD effect on root canal quality.	No significant improvement; decrease in adequate root fillings.	Limited sample size; potential confounding from other factors affecting practice quality
Alfano, Riddle (42)	United States (2024)	Pre-post test (Quasi-experimental design)	Nurses (Registered Nurses who were employed in the NTSB ICU)	CPD to reduce ventilator-associated pneumonia (VAP).	Reduced ventilator days and ICU stay; improved oxygen requirements.	Lack of control group; potential documentation inconsistencies; newly developed survey tool without validation

Quality of evidence and methodological considerations

While formal quality appraisal using tools like GRADE is not standard in scoping reviews, we examined key methodological features that could influence the validity and interpretation of each study’s findings regarding CPD’s impact on patient outcomes. Studies with robust methodological design included four randomized controlled trials [38, 41, 43, 50] provided the strongest evidence base. However, each had limitations that tempered their conclusions. For instance, Cleland, Fritz [38] had a small therapist sample (n = 10 intervention, n = 9 control) which limits generalizability, though the randomization and blinding of outcome assessors strengthened the finding that ongoing education improved disability outcomes. In addition, the study by Chipchase, Cavaleri [43] suffered from potential contamination between groups as therapists worked in the same facilities, which may explain why both groups showed improvement with no significant between-group differences.

Studies with moderate methodological rigor included pre-post quasi-experimental designs [36, 37, 42, 44, 48, 49], which allowed for practical evaluation in real-world settings but lacked control groups. The study by Boyle, O’Neil [36] used PDSA methodology which strengthened internal validity, and their 18% reduction in hypoglycemic events was likely attributable to the intervention given the structured implementation. In Alfano, Riddle [42] study, significant reductions in VAP rates and ICU stays were shown, but it was acknowledged that concurrent quality initiatives could have contributed to these improvements. Marzolf, Zekarias [48] found no change in mortality despite improved work environment scores, suggesting the educational intervention alone was insufficient without sustained organizational support.

On the other hand, several studies had design features that substantially limit causal inference. For instance, the observational design in the study by Deutscher, Werneke [52] cannot establish whether McKenzie training caused better outcomes or whether more motivated therapists both sought training and achieved better results. Jordal, Skudutyte-Rysstad [51] found decreased quality of root fillings post-training, but the one-year gap between training and measurement, combined with no control group, makes it impossible to determine if this reflected the training’s ineffectiveness or other system changes. Finally, the study by Perry, Golley [45] experienced high attrition and organizational barriers that compromised their ability to fully implement the intervention, making the modest BMI improvements difficult to attribute solely to the CPD program.

Impact on patient outcomes

A wide range of clinical outcomes were reported depending upon the focus of the CPD activity. The reported outcomes generally showed improvement across most studies, though the extent varied based on intervention characteristics and implementation factors. Table 2 shows the research question for each study with its reported impact.

Clinical outcomes

Analysis of mortality-related outcomes revealed variable effectiveness across interventions. Oleske et al. [41] reported significant decreases in cancer patient mortality when combining oncology nurse specialist support with continuing education. Marzolf et al. [48] found no significant changes in maternal mortality following resident-led education. Disease-specific indicators showed more consistent improvements. Boyle et al. [36] demonstrated an 18% reduction in hypoglycemic events, while Alfano et al. [42] reported significant reductions in ventilator days (17.45 to 13.42 days, P = 0.085) and ICU length of stay (24.77 to 17.62 days, P = 0.035). These findings suggest that CPD interventions may have more consistent effects on specific clinical processes than on mortality outcomes, which are influenced by multiple factors beyond provider education.

In physical therapy interventions, three studies examining neck pain management revealed that continuing education alone did not significantly improve patient outcomes. However, significant functional improvements were observed when CPD interventions were combined with ongoing support and clinical improvement projects [37, 38, 43]. Specifically, Cleland et al. [38] reported more significant improvements in disability scores and fewer required visits among patients treated by therapists receiving ongoing education. Notable gaps in the evidence include minimal investigation of CPD in mental health settings and limited evaluation of chronic disease management programs.

Non-clinical outcomes

In addition to reporting clinical outcomes, some studies reported non-clinical outcomes (n = 11). For instance, resource utilization demonstrated notable improvements across several studies. As an example, Miner et al. [40] reported a 77% decrease in maternal ICU admissions following their e-learning intervention. Deutscher et al. [52] found that physical therapists with McKenzie training required fewer patient visits while achieving similar outcomes compared to untrained therapists. In community pharmacy, Apikoglu et al. [49] reported improved pharmaceutical care services and more efficient resource utilization.

The majority of the studies also reported improvements in clinical processes (n = 15). Clarke et al. [44] reported a 30% improvement in implementing appropriate nursing interventions and an 8% reduction in patient complications. Perry et al. [45] observed improvements in BMI scores and lifestyle behaviors, though they noted implementation challenges.

CPD delivery method and study design

The included studies employed various CPD delivery methods, with differences in format, duration, and approach. While face-to-face delivery was the most common (n = 14), three studies utilized blended approaches combining in-person and online components [40, 46, 47]. The duration of the CPD activities ranged from one-time workshops [47, 51] to extended programs spanning several months [38, 45, 46, 52].

Various tools were used to capture patient outcomes, including standardized clinical assessment instruments [37, 38, 43, 52] and medical record audits [36, 39–42, 44, 47, 49, 50]. Evaluation approaches varied considerably across studies. Outcome measurement timing ranged from immediate post-intervention [37] to long-term follow-up of 12 months or more [38, 39, 46, 51, 52]. Seven studies employed multiple data collection points post-training to assess the sustainability of outcomes, while ten studies relied on one-time post-intervention measurements.

Randomized controlled trials [38, 43, 50] provided the most robust evidence, though their generalizability was often limited by setting or professional group. Acute care settings [40, 42] generally demonstrated more immediate and measurable impacts compared to community-based interventions [45, 49]. Studies involving highly specialized professionals [37, 38, 43, 52] showed more consistent improvements in specific clinical skills, while those targeting broader practice changes [39, 50] demonstrated more variable results.

Factors influencing CPD effectiveness

Implementation characteristics

Overall, multi-component interventions resulted in superior outcomes compared to single-approach strategies. For instance, Miner et al. [40] integration of e-learning with clinical protocols and simulation training showed a successful approach. This resulted in significant reductions in hemorrhage rates (3%) and ICU admissions (35%).

This pattern of multi-component CPD superiority was consistent across multiple studies. Baillargeon et al. [46] demonstrated that combining clinical preceptorship with electronic networking tools led to significant improvements in obesity management outcomes, with 15.2% of patients achieving ≥ 5% weight loss. Similarly, Cleland et al. [38] showed that physical therapists receiving ongoing education following initial training achieved greater disability reduction with fewer patient visits compared to those receiving initial training only. Studies incorporating practical skill development alongside theoretical knowledge [37, 38, 43, 52] consistently showed more substantial and sustainable improvements in patient outcomes than those focused solely on knowledge transfer.

The duration and intensity of interventions were also critical determinants of success; short-term interventions, such as the two-day program in Jordal et al.‘s [51] study, showed limited impact on clinical outcomes. On the other hand, sustained interventions (i.e., longer than 4 weeks) with regular reinforcement showed more substantial improvements [38, 43].

Organizational context

Organizational support and infrastructure significantly influenced CPD’s success. This was highlighted in several studies, such as the one by Perry et al. [45], which highlighted that the translation of their evidence-based program into community practice faced substantial organizational and political barriers. Similarly, Marzolf et al. [48] noted that while their resident-led program improved work environment scores, the lack of sustained organizational support limited its impact on clinical outcomes. Studies conducted in well-resourced settings with strong institutional support [40, 42] demonstrated more consistent positive outcomes compared to those implemented in resource-constrained environments [45, 48].

Professional group characteristics and implementation factors

Physical therapy studies [37, 38, 43, 52] consistently showed that practical skill development combined with theoretical knowledge was essential for improving patient outcomes. Deutscher et al. [52] demonstrated that while any level of specialized training improved outcomes compared to no training, the relationship between training level and patient outcomes was not linear. In nursing-focused studies [40, 42, 44, 47], interventions that combined clinical skill development with protocol standardization showed the most promising results.

Implementation barriers

Common implementation barriers included time constraints [45], resource limitations [48], staff turnover [41], and organizational resistance to change [39]. Facilitating factors for successful implementation included strong leadership support [40], explicit integration with existing clinical protocols [42], and established feedback mechanisms [50]. Studies that incorporated these elements generally yielded a better impact on patients outcomes. As an example, Braido et al. [50] found that systematic monitoring and feedback were essential to maintain the improvement in clinical practices and patient outcomes in their study.

In summary, the most successful interventions shared common characteristics: clear clinical protocols [42], integrated approaches combining multiple educational strategies [40], and ongoing support mechanisms [38, 46].

Discussion

Summary of key findings

This scoping review identified 17 studies demonstrating that while CPD interventions can improve patient outcomes, the evidence base remains limited and methodologically diverse. Three key patterns emerged: multi-component interventions outperformed single-approach strategies, organizational support was critical for success, and sustained interventions with ongoing reinforcement showed superior outcomes compared to brief educational activities.

Multi-component CPD interventions, those that integrate theory, hands-on training, and ongoing reinforcement, consistently outperformed single-event sessions. This finding is consistent with previous syntheses showing that interactive, spaced, and context-specific education yields better clinical results than didactic sessions alone [21, 53, 54].

The consistency of this pattern across diverse healthcare contexts suggests underlying mechanisms that transcend specific clinical domains or professional groups. In high-acuity settings like intensive care units [40, 42], multi-component approaches appeared to address the complex, team-based nature of care delivery. In primary care and community settings [45, 46], these approaches helped bridge the gap between controlled educational environments and the messy realities of real-world practice. In specialized therapeutic contexts [38, 52], they supported the integration of technical skills with clinical reasoning.

The methodological quality of included studies significantly influenced the strength of conclusions about CPD effectiveness. Studies with more rigorous designs (RCTs with adequate sample sizes and control for confounding) generally showed more modest effects than pre-post studies, suggesting potential overestimation of CPD impact in less controlled evaluations. The most reliable evidence for positive patient outcomes came from studies that combined robust methodology with multi-component interventions and organizational support [38, 40]. Conversely, studies with significant methodological limitations often reported either no effect or could not definitively attribute observed changes to the CPD intervention.

Interpretation of findings

Our findings can be interpreted through three complementary theoretical frameworks that help explain why so few CPD programs demonstrate measurable patient outcomes despite substantial resource investments.

First, through Bloom’s taxonomy of learning [54–56], our findings suggest that most CPD activities successfully address lower-level cognitive processes (remembering and understanding) but struggle to facilitate the higher-level processes (application, analysis, and synthesis) essential for practice transformation and measurable patient benefits. Second, applying Kirkpatrick’s four-level evaluation model [16, 57], we found that studies demonstrating positive patient outcomes [38, 40, 42] consistently addressed all four levels; reaction, learning, behavior change, and results, while most CPD research remains focused on the first two levels. Third, the knowledge-to-action framework developed by Graham et al. [58] provides insight into our findings. This framework emphasizes the dynamic, iterative processes required to adapt knowledge to local contexts and address barriers to implementation elements present in the most successful interventions identified but absent in those showing limited impact.

The results of this review reinforce a fundamental paradigm: CPD interventions can improve patient outcomes only when certain conditions are met. Notably, the studies that reported the most positive outcomes were those employing multi-component, interactive approaches. This pattern must be understood within the broader healthcare context where these interventions were implemented.

Building on the first key pattern, the second major finding concerns implementation context. The critical role of contextual and organizational factors revealed in this review suggests that CPD effectiveness may be fundamentally misunderstood when conceptualized as primarily an educational intervention. Rather than viewing CPD as a discrete learning event, these findings suggest it might be more accurately understood as an organizational change intervention that happens to use education as its mechanism. This reconceptualization explains why even excellently designed educational content fails without supportive organizational infrastructure—the intervention is incomplete without the contextual elements that enable knowledge application.

This finding echoes results from implementation science and realist reviews, which indicate that practitioner development is most effective in supportive workplace environments with a culture that values continuous learning​. Martin et al. (2018), for instance, found that practitioner-driven CPD yields positive outcomes only when backed by facilitative organizational conditions and an effective workplace learning culture​ [59]. Likewise, in their synthesis of 39 systematic reviews, Cervero and Gaines argue that efforts to improve patient outcomes through education must “take account of the wider social, political, and organizational factors” that influence whether clinicians can actually change their behavior​ [21].

This review supports these assertions. In practice, this means that even a perfectly crafted CPD curriculum may fail to produce meaningful change if, for example, participants lack time to implement what they learned, or if institutional policies do not enable new practices. The gap observed between knowledge gains and patient outcomes can often be traced to such real-world barriers, a phenomenon consistent with the well-known “knowledge-to-practice” gap in healthcare​ [54].

The case of Miner et al. [40] postpartum hemorrhage intervention illustrates how reconceptualizing CPD as an organizational change initiative can dramatically improve outcomes. Their approach, which reduced massive transfusions by 35% and ICU admissions by 77% succeeded not because of superior educational content alone, but because it created a comprehensive learning ecosystem. By integrating e-learning with simulation drills, mentorship, and clinical protocols, they effectively bridged the knowing-doing gap that plagues traditional CPD. This example demonstrates that the most effective CPD does not simply transfer knowledge but transforms practice environments to make the application of that knowledge the path of least resistance for clinicians.

By contrast, in studies where CPD was delivered in relative isolation from the clinical context (for example, a single workshop without follow-up or an online course offered without managerial support), improvements in provider knowledge did not always translate into significant patient benefit. Such outcomes reinforce the idea that overcoming implementation barriers is often the missing link between CPD participation and improved patient care​ [54, 60]. In summary, the findings emphasize that effective CPD is not merely a matter of what is taught, but also how it is implemented in practice with CPD being most impactful when delivered as an ongoing, supported process rather than a one-time educational event.

The third key pattern relates to methodological approaches. Several limitations were identified across the included studies that warrant consideration when interpreting results, particularly regarding how outcomes were measured and evaluated. Methodological constraints were common, with many studies having relatively small sample sizes [38, 42, 43, 51] that limited statistical power. Follow-up periods were often short [40, 42, 48], preventing assessment of long-term sustainability of outcomes. Many studies lacked randomization [36, 44, 46] or proper control groups [39, 41], introducing potential selection bias. High attrition rates were reported in some studies [45], while others faced implementation challenges due to organizational and political barriers [45, 51]. Data collection methods varied considerably, with several studies relying on physician-reported measures [36, 46, 52] rather than objective assessments. Documentation inconsistencies [42, 44] and potential contamination between intervention and control groups [38, 43] further complicated interpretation. Economic evaluations were notably scarce, particularly in resource-limited settings [48]. Additionally, several studies [37, 49, 52] acknowledged that their findings might not be generalizable beyond their specific contexts due to unique patient populations, healthcare settings, or regional characteristics. These limitations highlight the need for more methodologically rigorous research with longer follow-up periods, adequate sample sizes, and standardized outcome measures to strengthen the evidence base for CPD effectiveness.

Finally, a notable gap identified in this review was the limited exploration of CPD providers’ perspectives regarding factors that influence the application of CPD-acquired knowledge into clinical practice. Specifically, the insights of CPD program developers and educators—who are directly involved in tailoring CPD to organizational and clinical contexts—were markedly absent. Addressing this knowledge gap could substantially improve the understanding of how CPD initiatives can more effectively translate into tangible patient-care outcomes.

Implications for policy, practice, and research

This review underscores several important implications. For policy, CPD should be treated as a strategic investment in quality improvement rather than a regulatory checkbox. Sustained, multi-component CPD initiatives supported by institutional infrastructure are more likely to translate into improved patient outcomes. For clinical practice, designing CPD programs with hands-on skill development, ongoing reinforcement, and integration into workplace protocols is essential. From a research perspective, future studies should adopt more rigorous designs, include long-term follow-up, and explore contextual variables to better understand how CPD interventions translate into measurable patient benefits. Additionally, consensus on standardized outcome measures is needed to enable cross-study comparisons and guide evidence-informed CPD implementation globally.

Strengths and limitations of the study

This review has several strengths that enhance its contribution to understanding CPD’s impact on patient outcomes. To our knowledge, it is among the first to systematically map the evidence linking CPD initiatives to patient-level outcomes across multiple health disciplines and settings. Our methodological approach featured three key strengths. First, we employed a rigorous, comprehensive search strategy covering multiple databases and following established scoping review frameworks. This approach increases confidence that we captured the relevant literature across diverse healthcare contexts. Second, our inclusive selection criteria allowed us to synthesize common patterns despite the diversity of interventions, providing insights that transcend specific professional groups or clinical domains. Third, our analysis framework, organized around intervention characteristics, implementation factors, and outcome measures, enabled systematic comparison across heterogeneous studies. These features distinguish our work from prior reviews that focused on narrower aspects of CPD.

We also recognize important limitations that affect the interpretation and application of our findings. These limitations fall into three interconnected categories. First, the evidence base we identified has significant geographical and contextual constraints. The majority of included studies (82.4%) were conducted in high-income Western countries, particularly the US, Canada, and other Anglophone healthcare systems. This geographic concentration limits the generalizability of our findings to other contexts where healthcare systems differ in resources, culture, and CPD infrastructure. What works in a well-resourced hospital in North America may not directly translate to low- and middle-income countries.

Second, methodological heterogeneity across studies created analytical challenges. The CPD activities ranged from brief workshops to multi-year programs, and outcomes assessed varied from clinicians’ self-reported changes to objective patient health indicators. This variability precluded conducting a meta-analysis and required us to draw more qualitative inferences about effectiveness factors. This limitation is compounded by the potential influence of unmeasured confounders in individual studies, such as concurrent quality improvement initiatives. Third, our methodological approach as a scoping review introduced specific limitations. We did not exclude studies based on methodological quality, and we did not perform a formal risk of bias assessment. While this inclusive approach was appropriate for mapping the landscape of evidence, it means that the quality of included studies varies considerably.

Therefore, the relationship between CPD interventions and outcomes must be interpreted according to study design strength—with randomized controlled trials [38, 41] supporting stronger causal inferences, and well-designed observational studies [40, 52] establishing important correlational relationships that, while not definitively causal, provide valuable insights into real-world effectiveness. Findings should therefore be interpreted with caution regarding causality. Finally, most studies in our sample evaluated outcomes only in the short to medium term (often immediately post-intervention up to about 12 months). Few data were available on whether improvements in practice or patient outcomes were sustained beyond one year. This is a significant limitation, as the true goal of CPD is long-term enhancement of care quality. The dearth of longitudinal follow-up means we cannot be certain that the observed benefits persisted, or that late-emerging effects were captured.

These methodological limitations reflect the broader challenges in CPD research and evaluation. The heterogeneity in study designs, interventions, and outcome measures suggests a field still searching for standardized approaches to measuring educational impact.

Finally, while we did not conduct formal quality appraisal using standardized tools, our analysis of methodological features revealed substantial variation in study quality that influenced the interpretability of results. Future systematic reviews in this area should consider formal quality assessment to better weight the evidence from different study designs.

Conclusions

This scoping review shows that while well-designed CPD interventions can improve healthcare processes and patient outcomes, their success depends heavily on implementation factors. Education alone rarely changes practice; it must be supported by practical application, ongoing mentorship, and organizational alignment. Multi-component, sustained CPD programs that integrate theory with hands-on learning and are embedded within a supportive system yield the best outcomes.

To maximize CPD’s impact, it should be treated as a strategic investment in quality care rather than an isolated or regulatory exercise. This calls for coordinated planning, resource commitment, and cultural support for continuous learning. Addressing real-world barriers and designing CPD as a dynamic process rather than a one-time event will help close the gap between learning and patient care.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

Authors’ contributions•Conceptualization: SA, AhS, AbS, ZN•Methodology: SA, AhS, AbS, ZN•Formal analysis: SA, AhS, AbS, ZN•Data curation: SA•Writing - original draft: SA, AhS, AbS, ZN•Writing - review & editing: SA, AhS, AbS, ZN•Supervision: AhS, AbS, ZNAll authors reviewed the manuscript.

Funding

Not applicable.

Data availability

All data supporting the findings of this study are provided in the results section of the article. Additionally, a supplementary file (Supplementary File 1) containing the complete search strategy is available and referenced within the manuscript.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.