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Abstract

Continuing professional development (CPD) involves not only educational activities to enhance medical competence in medical knowledge and skills, but also in management, team building, professionalism, interpersonal communication, technology, teaching, and accountability. This paper aims at reviewing best practices to promote effective CPD. Principles and guidelines, as already defined by some professional societies and world organizations, are emphasized as core actions to best enhance an effective lifelong learning after residency. The personal learning plan (PLP) is discussed as the core of a well-structured CPD and we describe how it should be created. Fundamental CPD principles and how they are integrated in the framework of every physician's professional life will be described. The value of systematic and comprehensive CPD documentation and assessment is emphasized. Accreditation requirements and professional relationships with commercial sponsors are discussed.

INTRODUCTION

The first reported continuing medical education (CME) course took place in 1935; however, only in the 1960s did CME start to be discussed as a coherent body of literature. This paper reviews best practices of effective continuing professional development (CPD). CPD's complexity, relevance, guidelines, and principles and managing a CPD program will be discussed. The four-step CPD cycle is discussed in the context of three professional behaviors for which doctors and CPD providers have specific roles and needs.

DEFINITION

CME's concept generally refers to expanding medical knowledge, skills, and attitudes.² CPD incorporates and exceeds this concept by acknowledging a wide range of competencies needed to practice high quality medicine, including medical, managerial, ethical, social, and personal skills [Table 1].^3,4,5 Grounded on the well-developed tradition of lifelong learning in medical profession, CPD integrates every physician's ethical responsibility and increases job satisfaction.^6,,8

A variety of CPD definitions have been given:

“A continuing process, outside formal undergraduate and postgraduate training, that allows individual doctors to maintain and improve standards of medical practice through the development of knowledge, skills, attitudes, and behavior. CPD should also support specific changes in practice.”⁹

“The wide-ranging competencies beyond clinical update, research and scientific writing, multidisciplinary context of patient care, ethical practice, communication, management and behavioral skills, team building, information technology, audit, and appropriate attitudinal change to ensure improved patient outcomes and satisfaction.”¹⁰

“A range of learning activities through which health professionals maintain and develop throughout their careers to ensure that they retain their capacity to practice safely, effectively, and legally within their evolving scope of practice.”¹¹

Each definition shares the broader perspective of CPD, that it:

• Is self-driven and individually tailored according to needs assessment

• Considers the doctor's complex working environment as a “…multidisciplinary context of patient care”.¹⁰ Four broad groups are summarized in the Basel Declaration of European Union of Medical Specialists (UEMS): The individual/society; healthcare professionals; health employers; and healthcare fund raisers¹²

• Is an ongoing learning process building on initial education to ensure competence regarding current and future work duties

• Goes beyond the traditional designation for doctor's CME after residency training, a narrower concept, usually only including medical knowledge and skill

• Expands content from clinical to holistic topics such as interpersonal communication skills, ethics, practice management, professionalism, and extends learning venues from the classical conference room to practice settings^13,14

• Embraces new educational domains set by professional societies:

  • The Royal College of Physicians and Surgeons of Canada's seven key benchmark competencies (CanMeds): Medical expert/clinical, collaborator/manager, health advocate, scholar, professional, decision maker, and communicator¹⁵

  • The Medical Council of New Zealand's domains for recertification and CPD: Medical care, communication, collaboration and management, scholarship, and professionalism¹⁶

  • The American Board of Medical Specialities evaluation domains: Bedside manner, medical knowledge, interpersonal and communication skills, professionalism, system-based practical clinical work, learning, and development efforts¹⁷

  • The United Kingdom's General Medical Council's domains: Knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust¹⁸

  • The Royal Australian New Zealand College of Ophthalmology's framework learning categories: Clinical expertise, risk management and clinical governance, and professional values¹⁹

• Is a “self-evaluation model reporting form” necessarily including an evaluation component¹⁰

• Should produce behavioral change in medical practice so that healthcare improvement is achieved and measurable¹³

• Involves legal aspects such as avoiding lawsuits and practicing under compulsory relicensure

• Promotes the physician's accountability.

RELEVANCE

Emphasis on CPD has been growing due to several factors:

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• Physicians are leading longer professional lives

• Globally increasing mobility of both patients and healthcare professionals^,

• Accelerated proliferation of new knowledge, new technology, and techniques

• Society's increased expectations of the medical profession

• Public healthcare systems concerns

• Complex healthcare working environments where doctors are constantly challenged to develop and master multidisciplinary teamwork among peers, allied healthcare personnel, employers, regulators, and healthcare systems authorities

• Increasing requirements of CPD activities’ measure of performance.

Despite the increased emphasis on CPD, a variety of barriers must be overcome:

• Physician's work overload and less time allocated to learn

• Underfunding

• Improperly defined commercial sponsorships

• Noncompliance with best practices to design, develop, implement, and evaluate CPD educational interventions

• Biased education and conflicts of interest with sponsors

• Lack of clear definition of responsible parties and their specific roles in CPD

• Effective assessment of CPD activities to gauge cost-effectiveness

• Coordination of all stakeholders

• Demonstration of the doctor's CPD to society.

PRINCIPLES

Given the increased emphasis and barriers described above, it is obvious that CPD must change to be a systematic process that is credible and transparent to the community.^,13 Though medical school and residency training have long been formally regulated, only recently has CPD garnered such attention.²⁴ Additionally, there is wide variability in the approach to CPD globally.²⁵ Despite this, the UEMS promotes free movement of European medical specialists, while trying to ensure healthcare's high quality.²⁶ Therefore in Europe, CPD programs’ harmonization among countries would enhance medical care. An effective CPD scheme should have three quality components:^24,27,

• Professional improvement that ensures personal learning related to the populations’ changing needs and developing healthcare service

• Effective learning interventions should be designed upon clear, attainable, and measurable learning outcomes and offer relevant and evidence-based content to the physician's clinical practice

• It must be accountable, transparent, amenable to regulation, and useful for assuring quality in the process of relicensure.

Furthermore, it is essential that skillful CPD management is clearly articulated based on the various CPD stakeholders’ needs.

Additionally, there must be way for the physician to monitor and report CPD activities.²⁹ Many schemes and recommendations exist as to how best to award credit to CPD programs. These schemes typically have the following key components, which can coexist to a certain extent:

• Credit based, where one credit is usually awarded for each hour of educational time spent. A minimum should be achieved over a defined time period

• Document based, where an organized flow of documents help to demonstrate and assess CPD.

As examples of good CPD practices we suggest the guidelines to administer and manage a CPD program compiled by the International Council of Ophthalmology (ICO). Additionally, the ICO has suggested that ophthalmology societies’ CPD committees should take responsibility for CPD activities. Committees should be responsible for designing, implementing, and evaluating a CPD program according to specific criteria.¹³

PARTICIPANT PERSPECTIVE

The personal learning plan

Personally designed, CPD reflects adult learning principles of autonomy, self-direction, goal orientation, and practice-based learning.²⁷ PLPs document accomplished educational events, behavior changes in practice, and how career aspirations were enhanced.

The ICO has suggested a question template¹³ to guide doctors willing to build a PLP as part of their professional development. It is a three-stage stepwise procedure:

• Development of the PLP, in which doctors are required to reflect on their learning professional needs

• Completion of activities, in which doctors choose activities to meet their professional needs, and

• Submission of a report, for which doctors must reflect and write about the effectiveness of their learning.

CPD's practice can be conceptually organized around three fundamental questions: What will I learn? How will I learn? and How well have I learned? These three questions can be thought of in terms of the CPD cycle: (1) Identify what to learn; (2) plan how to learn; (3) learn; and (4) follow-up¹⁴ [Figure 1].

The continuing professional development cycle steps (in blue) and the triggering questions to professional behaviors in practice (in orange)

What will I learn?

A learning need is a gap between current personal competencies/population health status and the desired state. 14 Well-designed educational interventions fill these gaps and remove barriers to change in behavior. Perceived needs may be identified during an appraisal; whereas, unperceived needs may demand direct knowledge testing.^,14 Learning gaps may be identified during direct patient care, in interactions with the clinical team and department, in nonclinical activities (readings, scientific conferences), in quality management and risk assessment (audits, patient satisfaction surveys), in specific needs assessment (self-assessments and revalidation), and in peer review.

Clinical audit

A clinical audit is a systematic staged cycle of review of one's own patients’ charts and surgical outcomes.³¹ Audit criteria must be best practice evidence-based and clearly presented before the audit takes place. Recommendations from clinical practice guidelines may be useful to develop criteria and standards. Criteria are explicit statements defining what the outcomes of care will measure. Standards are the threshold of expected compliance for each criterion. Data is collected and results compared to criteria and standards. Change should be implemented by formulating recommendations. Clinical audits are an important component of medical professional accountability and can serve as a method of determining gaps in knowledge.^32,33,34,35

How will I learn?

Following a gap's identification, a learning activity should be planned and undertaken–CPD cycle steps 2 and 3 [Figure 1].^,14 Sometimes an educational event is undertaken by doctors not for the sake of advancing factual learning, but for boosting their confidence on a particular topic or skill. CPD activities should be chosen according to the type of the identified need whether it be knowledge and skills updating, competency assurance, or performance demonstration in practice.¹⁴

CPD activities can assume a variety of formats characterized as practice improvement, independent professional development, or research/self education. Table 2 presents several examples of educational events according to this categorization.¹³

A portfolio is a record of what its creator has to offer in terms of range, quality of knowledge, and level of skill attainment.^36,37 An e-portfolio documents the individual's professional progression as a web-based collection of artifacts: Reflections, resources, demonstrations, accomplishments, and time periods. e-portfolios encourage exchange of ideas and feedback between owner and those entitled to interact with it, thus offering meaningful learning experiences.^38,

How well have I learned?

Assessment closes the CPD cycle and involves two components:

• Reinforcement or finding opportunities in clinical practice to apply new knowledge and skills

• Dissemination of new learning to colleagues at practice settings (e.g., rounds, clinical meetings, and unplanned moments during clinical practice).

Portfolios as portable collection of artifacts can also be valuable assessment tools amenable to appraisal discussions, peer-review, and revalidation. Within their regulator function, societies and colleges are encouraged to establish CPD guidelines and provide their members a PLP and a clinical audit template to include in their personal portfolio. This material can be available online and should ideally include the designation and description of the chosen learning activity, planned date to undertake the activity and completion date, CPD points awarded, personal reflection about learning goals fulfillment, effective learning achieved, and its impact in practice.¹³ Medical teaching organizations are increasingly adopting their own e-portfolio systems such as the free user-friendly online portfolio of the British Medical Journal.⁴⁰

PROVIDER PERSPECTIVE

Methods and tools

CME has traditionally been concerned with disseminating information, but CPD has shifted the emphasis to demonstrating change in behavior in clinical practice.^,14 Adults participate in educational events when motivated by the identification of a specific learning need and a pragmatic desire to apply knowledge and skills gained.^27, Unplanned learning that occurs in daily workplace cannot be disregarded and is usually reinforced and disseminated. CPD providers must design educational interventions to meet identified gaps considering the participants prior knowledge. Learning objectives must be designed from the learner's perspective and clearly map the content in terms of expected outcomes. Well-written learning objectives will suggest the best CPD delivery method and format concerning the educational event's goal: Knowledge updating, competency development, or performance demonstration. Consideration of the size and the type of the audience (e.g., generalists versus subspecialists) may also dictate appropriate methods.

Regardless of the selected delivery method or format, interactive practice-based learning formats are the most successful.^14,,43 Incorporating at least 25% of interactivity into a learning intervention; such as a lecture by ensuring time and opportunity for questions and discussion, shifts the educational focus from passive teaching to active learning.⁴⁴

Time and space boundless and web-based CPD events are now being widely used in medical education incorporating even remote communities. If tutor-led and interactivity opportunities are provided, passive learning situations will be avoided. Social media (social networks, wikis, blogs, virtual worlds, and simulations) is being increasingly considered by educators/organizations for its potential in medical education. The medical community is changing from having conservative and reluctant stand on this issue to embracing and leveraging these tools into formal education. Online tools improve research efficiency and social media enhances professional networking.^,46,,

Accreditation

CPD must be amenable to external evaluation to become transparent, demonstrable, and accountable.^,13,14 If consistently planned, undertaken, and recorded; CPD can be assessed. Ideally always as a self-assessment including regular discussions with peers or a formal examination. More than a process to meet accreditation requirements or to be credit awarded, assessment should be envisioned as a higher value to bring effectiveness to learning.⁴⁹ A set of international standards was defined by World Federation of Medical Education to work as a global tool for quality assurance and development of CPD.²⁴

Measuring CPD activities’ effectiveness is crucial and should start during the CPD program, but ultimately to include effects on population health status. These assessments can be used to justify cost effectiveness of educational events’ outcomes.¹⁰ CPD program's assessment should provide information on whether:

• Target audience needs were addressed

• Learning objectives were met

• Participants were engaged

• Behavior changes were achieved.

Based on business and industry widespread Kirkpatrick's evaluation model, Dixon has defined four CME levels of evaluation that should match teaching strategies and learning event outcomes:

• Perception and satisfaction

• Competencies

• Professional performance

• Healthcare outcome.⁵⁰

Two more levels were later added:

• Participation related to an educational event's attendance

• Return of investment related to cost-effectiveness.¹⁴

There are a variety of ways to perform the evaluation. Clinical audits suit patient outcomes assessment; whereas, CPD credit accumulation, learning portfolios, criterion reference methods, computer diaries, peer review, and chart audits can be used for performance evaluation. Grant describes an exhaustive list of different assessment methods according to the evaluation object. Davis contrasts a list of assessment tools to factors affecting their choice as cost, validity, reliability, acceptability, and feedback opportunity.¹⁴

Several professional societies and world organizations and colleges^{51,52,53,54,55,56,57,58,59,60} provide accreditation guidelines including:

• Online standard documentation templates and application forms, available in a transparent and practical presentation for all interested

• Accreditation criteria for providers including:

  • Goals and learning objectives clearly built on an identified learning gap

  • Content/format delivery in accordance with the goal of the educational event

  • Assessment type in accordance with the preestablished learning objectives

  • Assessment type and results shared with the participants

  • Assessment results made available for future CPD program improvement

  • Clear guidelines to avoid commercial sponsorship conflict.

The growth of e-learning CPD has led to accreditation criteria for this format. The European Accreditation Council of Continuing Medical Education (EACCME) has established criteria to ensure e-learning interventions’ accreditation.⁶¹ The same goal was pursued by the e-CPD Task Force of the Royal College.⁶² These criteria add items specific to e-learning such as:

• Confirm privacy and confidentiality of the learner

• State revision of content and expiry date

• Content must be evidence based

• Follow adult learning principles such as problem-based learning, reflective learning, and task-based learning

• Content delivery must comply with multimedia principles

• Should have engaging strategies promoting interaction and meaningful learning

• Provide feedback of learning.

Sponsor relationships

Minimizing potential conflict of interest from sponsors is imperative. To gain approval for industry sponsorship the CPD provider should make an application to the ophthalmology society's CME committee and follow criteria.^63,64 The Canadian Medical Association Policy indicates that: “Organizations providing financial support to accredited CPD events cannot have any role or influence over any aspect of the CPD planning process. Physician's organizations that receive ‘educational grants’ should provide a statement of account to each sponsoring organization for how funding was allocated or spent”.⁶⁵ The Royal College Approval of Accredited Group Activities Application Form contains items related to fiscal matters and requires a declaration of conflict of interest. A letter should be sent to the sponsor(s) indicating that funds will be received as an educational grant.⁶⁶ Speakers may verbally disclose any conflicts of interest or provide written documentation in the event's brochure.

In General, CPD providers should be made solely responsible for designing, implementing, and assessing the educational intervention. The sponsorship and its terms must be communicated to the local/national professional society/healthcare authority. Content should be unbiased, commercial sponsorship acknowledged, and speakers’ conflict of interest disclosed.

CPD sponsorship guidelines should enforce the physician's understanding that they must:

• Keep their primary obligation to their patients and duties to society

• Ensure an unbiased participation in collaborative efforts between their interaction and pharmaceutical companies (health supplies, research, and education)

• Avoid/manage situations with conflict of interest

• Promote clear physician-developed guidelines for interaction of physician-industry.

CONCLUSIONS

CME is a lifelong learning process pursued by doctors from medical school until retirement, and has traditionally been viewed in terms of knowledge updating.

CPD demands professional skills that extend beyond medical knowledge such as management, education and training, information technology, audit, communication, and team building. There is great variability in how CPD is being conducted globally. We believe that whether a legal obligation or an unregulated voluntary option, all physicians should undertake some form of CPD. Coordination and harmonization of CPD management will bring efficiency to the process and overcome barriers discussed.

Though customization is needed according to local needs, there are universal guidelines and principles to develop and maintain CPD complying to best practices. Societies and colleges should accept responsibility for both CME and CPD of doctors, establish effective CPD schemes and develop strategies to meet the needs of doctors, the populations they serve, and the organizations where they work.

Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES

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Knowledge workers are workers whose main capital is knowledge. Examples include programmers, physicians, pharmacists, architects, engineers, scientists, design thinkers, public accountants, lawyers, and academics, and any other white-collar workers, whose line of work requires one to 'think for a living'.^[1]

Definition[edit]

Knowledge work can be differentiated from other forms of work by its emphasis on 'non-routine' problem solving that requires a combination of convergent and divergent thinking.^[2] But despite the amount of research and literature on knowledge work, there is no succinct definition of the term.^[3]

Mosco and McKercher (2007) outline various viewpoints on the matter. They first point to the most narrow and defined definition of knowledge work, such as Florida's view of it as specifically, 'the direct manipulation of symbols to create an original knowledge product, or to add obvious value to an existing one', which limits the definition of knowledge work to mainly creative work. They then contrast this view of knowledge work with the notably broader view which includes the handling and distribution of information, arguing that workers who play a role in the handling and distribution of information add real value to the field, despite not necessarily contributing a creative element. Thirdly, one might consider a definition of knowledge work which includes, 'all workers involved in the chain of producing and distributing knowledge products', which allows for a very broad and inclusive categorization of knowledge workers. It should thus be acknowledged that the term 'knowledge worker' can be quite broad in its meaning, and is not always definitive in who it refers to.^[4]

Knowledge workers spend 38% of their time searching for information.^[5][dubious] They are also often displaced from their bosses, working in various departments and time zones or from remote sites such as home offices and airport lounges.^[6] As businesses increase their dependence on information technology, the number of fields in which knowledge workers must operate has expanded dramatically.^{[citation needed]}

Even though they sometimes are called 'gold collars',^[7] because of their high salaries, as well as because of their relative independence in controlling the process of their own work,^[8] current research shows that they are also more prone to burnout, and very close normative control from organizations they work for, unlike regular workers.^[9]

Managing knowledge workers can be a difficult task. Most knowledge workers prefer some level of autonomy, and do not like being overseen or managed. Those who manage knowledge workers are often knowledge workers themselves, or have been in the past. Projects must be carefully considered before assigning to a knowledge worker, as their interest and goals will affect the quality of the completed project. Knowledge workers must be treated as individuals.

Loo (^[10] 2017) using empirical findings from knowledge workers of two sectors – advertising and IT software sectors – and from three developed countries – England, Japan and Singapore – investigated a specific type of knowledge workers – the creative knowledge workers - as opposed to the generic ones as indicated above. The findings from the analysed empirical data offer a complex picture of this type of work in the knowledge economy where workers use a combination of creativity, abilities, talents, skills, and knowledge towards the eventual production of products and services.This investigation (Loo, 2017) identified a definition of creative knowledge work from four specific roles of copywriting, creative directing, software programming, and systems programme managing in advertising and IT software. The manner in which each of the creative applications is applied is dependent on the role(s) of the creative workers. This type of work includes a complex combination of skill sets or ‘creative knowledge work (ckw) capacities.’ 'Creative knowledge workers use a combination of creative applications to perform their functions/roles in the knowledge economy including anticipatory imagination, problem solving, problem seeking, and generating ideas and aesthetic sensibilities' (Loo, 2017, p. 138).

Taking aesthetic sensibility as an example, for a creative director, it is a visual imagery whether still or moving via a camera lens and for a software programmer, it is the innovative technical expertise in which the software is written.

Other sector-related creative applications include an emotional connection in the advertising sector and the power of expression and sensitivity in the IT software sector. Terms such as ‘general sponge,’ ‘social chameleon,’ and ‘in tune with the zeitgeist’ were identified which the creative knowledge workers used to identify emotionally with their potential audience in ad making. From the IT software perspective, creative knowledge workers used a ‘sensitivity’ creative application to ascertain business intelligence and as a measurement of information, the software worker might obtain from various parties (Loo, 2017).

Creative workers also require abilities and aptitudes. Passion for one's job was generic to the roles investigated in the two sectors and for copywriters, this passion was identified with fun, enjoyment, and happiness in carrying out the role alongside attributes such as honesty (regarding the product), confidence, and patience in finding the appropriate copy. As with the other roles, a creative worker in software programming requires team working and interpersonal skills in order to communicate effectively with those from other disciplinary backgrounds and training. As regards the managerial roles of creative directing and systems programme managing, the abilities to create a vision for the job in hand, to convince, strategize, execute, and plan towards the eventual completion of the given task (such as a campaign or a software) are necessary capacities (Loo, 2017).

Linking these abilities and capacities are collaborative ways of working, which the findings from this study have identified. The two modes of working ranged from individual to collaborative where a worker might be doing either or both depending on the specific activity. The abilities to traverse between these two work modes alongside the relevant creative application are part of the complexity of this style of working.

Creative workers also require an understanding of various forms of knowledge (Loo, 2017). These are related to disciplines such as those from the humanities (e.g., literature), and the creative arts such as painting and music (e.g., popular and classical varieties). Creative knowledge workers also require technical-related knowledge such as mathematics and computer sciences (e.g., software engineering) and physical sciences (e.g., physics) though there are distinctions in the two sectors. In the IT software sector, technical knowledge of software languages is especially significant for programmers as ascertained in the findings. However, the degree of technical expertise may be less for a programme manager, as only knowledge of the relevant software language is necessary to understand the issues for communicating with the team of developers and testers. The technical know-how for a creative director relates only to the understanding of the possibilities of technologies (such as graphics and typography) in order to capitalise on the technical wizardry. The technical specialists are then required to execute the creative director's vision.

The above types of disciplinary knowledge may appear in explicit formats, which can be learnt from formal programmes at teaching institutions such as higher education and professional institutions alongside other skills and abilities relating to presentation, communication, and team working. As ascertained in the findings, there was other non-disciplinary knowledge, which was not explicit but tacit in nature. Interviewees mentioned tacit experiences from their past work and life experiences, which they used to draw upon in performing their creative knowledge work. This form of knowledge was harnessed collectively as a team (of an advertising campaign or a software programme). This collaborative approach to working, especially with roles such as creative directing and software programme managing, requires tacit knowledge of the strengths and weaknesses and the needs and wants of the related team members (knowledge of psychology). This form of working may occur within the organisation, as a stand-alone group for a specific project in the organisation, or as a sub-contracted team outside the organisation. Within this role, creative knowledge workers may perform their activities individually and/or collectively as part of their contribution to the project. The findings also brought out some characteristics of collaborative working such as the varieties of stakeholders such as sub-contracted groups, and the indirect relationships between clients, workers (of an ad agency), and consumers (Loo, 2017).

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History[edit]

The term is often mistakenly said to be first coined by Peter Drucker in The Landmarks of Tomorrow (1959)^[11], which was his first use of the term 'knowledge work' but not 'knowledge worker'. Drucker first coined the term 'knowledge worker' in The Age of Discontinuity^[12] (1969). Later, in 1999, he suggested that 'the most valuable asset of a 21st-century institution, whether business or non-business, will be its knowledge workers and their productivity.'^[13]

Paul Alfred Weiss (1960)^[14] said that 'knowledge grows like organisms, with data serving as food to be assimilated rather than merely stored'. Popper (1963)^{[full citation needed]} stated there is always an increasing need for knowledge to grow and progress continually, whether tacit (Polanyi, 1976)^{[full citation needed]} or explicit.

Toffler (1990)^{[full citation needed]} observed that typical knowledge workers (especially R&D scientists and engineers) in the age of knowledge economy must have some system at their disposal to create, process and enhance their own knowledge. In some cases they would also need to manage the knowledge of their co-workers.

Nonaka (1991)^[15] described knowledge as the fuel for innovation, but was concerned that many managers failed to understand how knowledge could be leveraged. Companies are more like living organisms than machines, he argued, and most viewed knowledge as a static input to the corporate machine. Nonaka advocated a view of knowledge as renewable and changing, and that knowledge workers were the agents for that change. Knowledge-creating companies, he believed, should be focused primarily on the task of innovation.

This laid the foundation for the new practice of knowledge management, or 'KM', which evolved in the 1990s to support knowledge workers with standard tools and processes.

Savage (1995) describes a knowledge-focus as the third wave of human socio-economic development. The first wave was the Agricultural Age with wealth defined as ownership of land. In the second wave, the Industrial Age, wealth was based on ownership of Capital, i.e. factories. In the Knowledge Age, wealth is based upon the ownership of knowledge and the ability to use that knowledge to create or improve goods and services. Product improvements include cost, durability, suitability, timeliness of delivery, and security. Using data,^{[citation needed]} in the Knowledge Age, 2% of the working population will work on the land, 10% will work in Industry and the rest will be knowledge workers.^[16]

Knowledge work in the 21st century[edit]

Davenport (2005) says that the rise of knowledge work has actually been foreseen for years.^[1]:4 He points to the fact that Fritz Machlup did a lot of the early work on both knowledge as well as knowledge work roles and as early as 1958 stated that the sector was growing much faster than the rest of the economy with knowledge workers making up almost a third of the workforce in the United States.^[1]:4 'According to the Organization for Economic Co-operation and Development (1981), by the beginning of the 1970s around 40 percent of the working population in the USA and Canada were classified to the information sector, whereas in most other OECD countries the figures were still considerably lower.'^[3]:118

Tapscott (2006) sees a strong, on-going linkage between knowledge workers and innovation, but the pace and manner of interaction have become more advanced. He describes social media tools on the internet that now drive more powerful forms of collaboration. Knowledge workers engage in ‘’peer-to-peer’’ knowledge sharing across organizational and company boundaries, forming networks of expertise. Some of these are open to the public. While he echoes concern over copyright and intellectual property law being challenged in the marketplace, he feels strongly that businesses must engage in collaboration to survive. He sees on-going alliance of public (government) and private (commercial) teams to solve problems, referencing the open sourceLinux operating system along with the Human Genome Project as examples where knowledge is being freely exchanged, with commercial value being realized.

Palmer (2014) ^[17] researched knowledge worker productivity and work patterns. Part of this research has involved the analysis of how an average knowledge worker spends their day. He notes that effective and efficient knowledge work relies on the smooth navigation of unstructured processes and the elaboration of custom and one-off procedures. 'As we move to the 21st century business model, the focus must be on equipping knowledge workers with tools and infrastructure that enable communication and information sharing, such as networking, e-mail, content management and increasingly, social media.' Palmer points to the emergence of Adaptive Case Management (also known as Dynamic or Advanced case management) representing the paradigm shift triggered by the appearance from adapting business practices to the design of IT systems, to building systems that reflect how work is actually performed.

Due to the rapid global expansion of information-based transactions and interactions being conducted via the Internet, there has been an ever-increasing demand for a workforce that is capable of performing these activities. Knowledge Workers are now estimated to outnumber all other workers in North America by at least a four to one margin.^[18]:4

While knowledge worker roles overlap heavily with professions that require college degrees, the comprehensive nature of knowledge work in today's connected workplace requires virtually all workers to obtain these skills at some level. To that end, the public education and community college systems have become increasingly focused on lifelong learning to ensure students receive skills necessary to be productive knowledge workers in the 21st century.

Many of the knowledge workers currently entering the workforce are from the generation X demographic. These new knowledge workers value lifelong learning over lifelong employment.^[19] 'They seek employability over employment [and] value career over self-reliance' (Elsdon and Iyer, 1999)^{[full citation needed]}. Where baby boomers are proficient in specified knowledge regarding a specific firm, generation X knowledge workers acquire knowledge from many firms and take that knowledge with them from company to company (2002).^[19]

Roles[edit]

Knowledge workers bring benefits to organizations in a variety of ways. These include:

• analyzing data to establish relationships
• assessing input in order to evaluate complex or conflicting priorities
• identifying and understanding trends
• making connections
• understanding cause and effect
• ability to brainstorm, thinking broadly (divergent thinking)
• ability to drill down, creating more focus (convergent thinking)
• producing a new capability
• creating or modifying a strategy

These knowledge worker contributions are in contrast with activities that they would typically not be asked to perform, including:

• routine tasks
• simple prioritization of work

There is a set of transitional tasks which include roles that are seemingly routine, but that require deeper technology, product, or customer knowledge to fulfill the function. These include:

• providing technical or customer support
• handling unique customer issues
• addressing open-ended inquiries

Generally, if the knowledge can be retained, knowledge worker contributions will serve to expand the knowledge assets of a company. While it can be difficult to measure, this increases the overall value of its intellectual capital. In cases where the knowledge assets have commercial or monetary value, companies may create patents around their assets, at which point the material becomes restricted intellectual property. In these knowledge-intensive situations, knowledge workers play a direct, vital role in increasing the financial value of a company. They can do this by finding solutions on how they can find new ways to make profits. This can also be related with market and research. Davenport (2005) says that even if knowledge workers are not a majority of all workers, they do have the most influence on their economies.^[1] He adds that companies with a high volume of knowledge workers are the most successful and fastest growing in leading economies including the United States.

Reinhardt et al.'s (2011) review of current literature shows that the roles of knowledge workers across the workforce are incredibly diverse. In two empirical studies they have 'proposed a new way of classifying the roles of knowledge workers and the knowledge actions they perform during their daily work.'^[2]:150 The typology of knowledge worker roles suggested by them are 'controller, helper, learner, linker, networker, organizer, retriever, sharer, solver, and tracker':^[2]:160

Additional context and frameworks[edit]

Drucker (1966) defines six factors for knowledge worker productivity:^[21]

1. Knowledge worker productivity demands that we ask the question: 'What is the task?'
2. It demands that we impose the responsibility for their productivity on the individual knowledge workers themselves. Knowledge workers have to manage themselves.
3. Continuing innovation has to be part of the work, the task and the responsibility of knowledge workers.
4. Knowledge work requires continuous learning on the part of the knowledge worker, but equally continuous teaching on the part of the knowledge worker.
5. Productivity of the knowledge worker is not — at least not primarily — a matter of the quantity of output. Quality is at least as important.
6. Finally, knowledge worker productivity requires that the knowledge worker is both seen and treated as an 'asset' rather than a 'cost.' It requires that knowledge workers want to work for the organization in preference to all other opportunities.

The theory of Human Interaction Management asserts that there are 5 principles characterizing effective knowledge work:

1. Build effective teams
2. Communicate in a structured way
3. Create, share and maintain knowledge
4. Align your time with strategic goals
5. Negotiate next steps as you work

Another, more recent breakdown of knowledge work (author unknown) shows activity that ranges from tasks performed by individual knowledge workers to global social networks. This framework spans every class of knowledge work that is being or is likely to be undertaken. There are seven levels or scales of knowledge work, with references for each are cited.

1. Knowledge work (e.g., writing, analyzing, advising) is performed by subject-matter specialists in all areas of an organization. Although knowledge work began with the origins of writing and counting, it was first identified as a category of work by Drucker (1973).^[22]
2. Knowledge functions (e.g., capturing, organizing, and providing access to knowledge) are performed by technical staff, to support knowledge processes projects. Knowledge functions date from c. 450 BC, with the Library of Alexandria,^[dubious] but their modern roots can be linked to the emergence of information management in the 1970s.^[23]
3. Knowledge processes (preserving, sharing, integration) are performed by professional groups, as part of a knowledge management program. Knowledge processes have evolved in concert with general-purpose technologies, such as the printing press, mail delivery, the telegraph, telephone networks, and the Internet.^[24]
4. Knowledge management programs link the generation of knowledge (e.g., from science, synthesis, or learning) with its use (e.g., policy analysis, reporting, program management) as well as facilitating organizational learning and adaptation in a knowledge organization. Knowledge management emerged as a discipline in the 1990s (Leonard, 1995)^{[full citation needed]}.
5. Knowledge organizations transfer outputs (content, products, services, and solutions), in the form of knowledge services, to enable external use. The concept of knowledge organizations emerged in the 1990s.^[20]
6. Knowledge services support other organizational services, yield sector outcomes, and result in benefits for citizens in the context of knowledge markets. Knowledge services emerged as a subject in the 2000s.^[25]
7. Social media networks enable knowledge organizations to co-produce knowledge outputs by leveraging their internal capacity with massive social networks. Social networking emerged in the 2000s ^[26]

The hierarchy ranges from the effort of individual specialists, through technical activity, professional projects, and management programs, to organizational strategy, knowledge markets, and global-scale networking.

This framework is useful for positioning the myriad types of knowledge work relative to each other and within the context of organizations, markets, and the global knowledge economy. It also provides a useful context for planning, developing, and implementing knowledge management projects.

Loo (2017) investigates how a particular group - creative knowledge workers – carries out their jobs and learns within it. Using empirical data from advertising and software development in England, Japan and Singapore, it develops a new conceptual framework to analyse the complexities of creative knowledge work. The framework draws from four disciplines of business and management, economics, sociology and psychology (Loo, 2017, p. 59). Focusing uniquely on the human element of working in the knowledge economy, Loo explores the real world of how people work in this emerging phenomenon and examines the relationships between knowledge and creative dimensions to provide new frameworks for learning and working. This research identified three levels of creative knowledge applications. They relate to intra-sectoral approaches, inter-sectoral approaches (where jobs require different styles of work depending on the sectors), and changes in culture/practices in the sectors. With the intra-sectoral work, they refer to the roles and functions of specific jobs in each of the two sectors of advertising (e.g. copywriting and creative directing) and software development (e.g. software developing and software programme managing). With the inter-sectoral work, it may include software programme managers having different functions when working in different organisations – e.g. a computer software company and a multinational financial organisation. With the last type of creative working, it may include aspects such as the culture of ‘good practice’ in technical problem-solving and the ‘power of expression’ in software programming. All the three types of micro-level of creative knowledge work offer a highly contextualized understanding of how these workers operate in the knowledge economy. This approach is different from that taken by Zuboff (1988), Drucker (1993), Nonaka and Takeuchi (1995) and Reich (2001) who sought to provide a more generic understanding (Loo, 2017).

Finally, complex creative knowledge work needs a supportive environment. One such environment relates to the supporting technical base. Based on the findings, information, communications and electronic technologies (ICET) are viewed as an organisational tool, a source of ideas (such as the Internet), and a way of modelling a concept. It may also be applied to inter-sectoral activities such as software for cross-disciplinary applications. This organisational tool enables creative knowledge workers to devote their energies to multi-faceted activities such as analysis of huge data sets and the enabling of new jobs such as webpage designing. ICET enables workers to spend more time on advanced activities, which leads to the intensification of creative applications. Lastly, it was noted from the findings that a supportive environment focused on training, work environment, and education (Loo, 2017 Loo, S. (2017) Creative Working in the Knowledge Economy. Abingdon: Routledge).

See also[edit]

References[edit]

1. ^ ^abcdDavenport, Thomas H. (2005). Thinking For A Living: How to Get Better Performance and Results From Knowledge Workers. Boston: Harvard Business School Press. ISBN1-59139-423-6.
2. ^ ^abcReinhardt, W.; Schmidt, B.; Sloep, P.; Drachsler, H. (2011). 'Knowledge Worker Roles and Actions – Results of Two Empirical Studies'. Knowledge and Process Management. 18 (3): 150–174. doi:10.1002/kpm.378. hdl:1820/3523.
3. ^ ^abPyöriä, P. (2005). 'The Concept of Knowledge Work Revisited'. Journal of Knowledge Management. 9 (3): 116–127. doi:10.1108/13673270510602818.
4. ^Mosco, V.; McKercher, C. (2007). 'Introduction: Theorizing Knowledge Labor and the Information Society'. Knowledge Workers in the Information Society. Lanham: Lexington Books. pp. vii–xxiv. ISBN978-0-7391-1781-1.
5. ^Crabtree, R.A., Fox, M.S., Baid, N. (1997). 'Case Studies in Coordination Activities and Problems in Collaborative Design'(PDF). Research in Engineering Design. 9 (2): 70–84. doi:10.1007/bf01596483.CS1 maint: Multiple names: authors list (link)
6. ^Mcdermott, Michael (2005). 'Knowledge Workers: You can gauge their effectiveness'. Leadership Excellence. 22 (10): 15–17. ISSN8756-2308.
7. ^Kelley, Robert E. (1986). The Gold-collar Worker: Harnessing the Brainpower of the New Workforce. Reading: Addison-Wesley. ISBN0-201-11739-8.
8. ^Cortada, James W. (1998). Rise of the Knowledge Worker. Boston: Butterworth-Heinemann. ISBN0-7506-7058-4.
9. ^Jemielniak, Dariusz (2012). The New Knowledge Workers. Cheltenham: Edward Elgar. ISBN978-1-8484-4753-0.
10. ^Loo, S. (2017). Creative Working in the Knowledge Economy. Abingdon: RoutledgeISBN9781315453095
11. ^Drucker, P. F. (1959). The Landmarks of Tomorrow New York: Harper and Row, p.93.
12. ^Drucker, P. F. (1969). The Age of Discontinuity: Guidelines to Our Changing Society. William Heinemann Ltd., London, U.K. pp. 248, 250.
13. ^Drucker. P.F. (1999). Management Challenges for the 21st Century. Harper Collins.
14. ^Weiss, Paul A. (1960). 'Knowledge a growth process'. Science. 130 (3415): 1716–1719. doi:10.1126/science.131.3415.1716.
15. ^Nonaka, I. (1991). 'The Knowledge-Creating Company'. Harvard Business Review. 69 (6): 96.
16. ^Savage, Charles (1995). Fifth Generation Management: Co-creating through Virtual Enterprising, Dynamic Teaming and Knowledge Networking. Boston: Butterworth-Heinemann. ISBN0-7506-9701-6.
17. ^Palmer, Nathaniel (2014). Empowering Knowledge Workers.Future Strategies Inc. ISBN978-0-984976478.'Where is ACM Today?'
18. ^Haag, S.; Cummings, M.; McCubbrey, D.; Pinsonneault, A.; Donovan, R. (2006). Management Information Systems for the Information Age (3rd Canadian ed.). Canada: McGraw Hill Ryerson. ISBN0-07-095569-7.
19. ^ ^abBogdanowicz, Maureen S.; Bailey, Elaine K. (2002). 'The Value of Knowledge and the Values of the New Knowledge Worker: Generation X in the New Economy'. Journal of European Industrial Training. 26 (2–4): 125–129. doi:10.1108/03090590210422003.
20. ^ ^abcdefDavenport, Thomas H.; Prusak, Laurence (1998). Working Knowledge: How Organizations Manage What They Know. Boston: Harvard Business School Press. ISBN0-87584-655-6.
21. ^Drucker, Peter F. (1999). Management Challenges of the 21st Century. New York: Harper Business. ISBN0-88730-998-4.
22. ^Drucker, Peter F. (1973). Management: Tasks, Responsibilities, Practices. New York: Harper & Row. ISBN0-06-011092-9.
23. ^Mcgee, James; Prusak, Lawrence (1993). Managing Information Strategically: Increase Your Company's Competitiveness and Efficiency by Using Information as a Strategic Tool. New York: John Wiley & Sons. ISBN0-471-57544-5.
24. ^Mumford, Lewis (1961). The City in History: Its Origins, its Transformations, and its Prospects. New York: Harcourt, Brace & World.
25. ^Simard, Albert; Broome, John; Drury, Malcolm; Haddon, Brian; O’Neil, Bob; Pasho, Dave (2007). Understanding Knowledge Services at Natural Resources Canada. Ottawa: Natural Resources Canada, Knowledge Services Task Group. ISBN978-0-662-44528-9.
26. ^Tapscott, Don; Williams, Anthony D. (2006). Wikinomics: How Mass Collaboration Changes Everything. New York: Penguin. ISBN1-59184-138-0.

Further reading[edit]

• Bil, Ton; Peters, Jean (2001). De breineconomie (Hardback ed.). Amsterdam: FinancialTimes Prentice Hall. ISBN90-430-0419-7.
• Barbrook, Richard (2006). The Class of the New (Paperback ed.). London: OpenMute. ISBN0-9550664-7-6.
• Ikujiro Nonaka (1998). 'The Knowledge-Creating Company'. Harvard Business Review on Knowledge Management. Boston: Harvard Business School Press. pp. 21–46. ISBN0-87584-881-8.
• Leonard, Dorothy (1993). Wellsprings of Knowledge. Boston: Harvard Business School Press. ISBN0-87584-612-2.
• Liu, Alan (2004). The Laws of Cool: Knowledge Work and the Culture of Information. Chicago: University of Chicago Press. ISBN0-226-48698-2.
• O'Brien, James; Marakas, George (2010). Management Information Systems (10th ed.). New York: McGraw-Hill. p. 32. ISBN978-0-07-337681-3.
• Sheridan, William (2008). How to Think Like a Knowledge Worker. New York: United Nations Public Administration Network. ISBN978-0-9810814-0-3.
• Thorp, John (1998). Information Paradox. Toronto: McGraw-Hill Ryerson. ISBN0-07-560103-6.

External links[edit]

• How to think like a knowledge worker (UNPAN)