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• Research article
• Open access
• Published: 14 April 2021

Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature

• Mandlenkosi Mlambo 1 , 2 ,
• Charlotte Silén 2 &
• Cormac McGrath 2 , 3  

BMC Nursing volume  20 , Article number:  62 ( 2021 ) Cite this article

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Continuing professional development (CPD) is central to nurses’ lifelong learning and constitutes a vital aspect for keeping nurses’ knowledge and skills up-to-date. While we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. A metasynthesis of how nurses experience and view continuing professional development may provide a basis for planning future continuing professional development interventions more effectively and take advantage of examples from different contexts. The aim of this paper is to conduct such a metasynthesis, investigating the qualitative research on nurses’ experiences of continuing professional development.

A metasynthesis of the qualitative literature was conducted. A total of 25 articles fulfilled the inclusion criteria and were reviewed.

We determined five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. This metasynthesis highlights that nurses value continuing professional development and believe that it is fundamental to professionalism and lifelong learning. Moreover CPD is identified as important in improving patient care standards.

Conclusions

Based on the metasynthesis, we argue that access to continuing professional development could be made more attainable, realistic and relevant. Expediently, organizations should adequately fund and make continuing professional development accessible. In turn, nurses should continue to actively engage in continuing professional development to maintain high standards of nursing care through competent practice. This paper highlights the perceived benefits and challenges of continuing professional development that nurses face and offers advice and understanding in relation to continuing professional development. We believe that this metasynthesis contributes with insights and suggestions that would be valuable for nurses and policy makers and others who are involved in nurse education and continuing professional development.

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Introduction

Health care professionals need to update their skills regularly and continuing education, or continued professional development (CPD) enables the renewal and updating of skills in health care settings. While we know about the need for CPD, less is known about how nurses experience and perceive CPD, and currently, there is no comprehensive global picture of how nurses view and experience CPD. A metasynthesis of the qualitative literature on nurses’ experiences of CPD may provide a basis for planning future CPD interventions more effectively and take advantage of examples from different contexts. This paper is organised in the following way; first we present the notion of CPD, we then use the United Kingdom, (UK) as a setting to offer an overview of the different mechanisms that exist in one specific health care setting, which may impact engagement with CPD. We acknowledge that similar mechanisms may exist in other health care settings and countries too, and identify the UK context, merely as a way to frame the paper. Subsequently, we conduct a metasynthesis of the qualitative literature addressing the topic of how CPD is experienced by nurses.

Continued professional development

This section aims to unpack the notion of CPD, which exists in different forms and is driven, in part, by top-down requirements, but also, bottom-up, from the needs of practitioners. Continuing professional development (CPD) programmes are central to nurses’ lifelong learning and are a vital aspect for keeping nurses’ knowledge and skills up-to-date. The requirement for nurses to participate in CPD differs between European countries and elsewhere in the world and can be mandatory or voluntary [ 1 , 2 ]. For example, CPD is mandatory in the U. K, Belgium, Spain, Australia and in some states in the United States of America, [ 2 , 3 , 4 ]. In these countries, nurses engage in CPD because it is a mandatory condition by nurse regulators for remaining registered to practice. However, in Sweden, Netherlands and Ireland nurses participate in CPD of their own volition [ 1 , 3 , 4 , 5 ]. Table  1 provides an overview of some of the European countries which provide mandatory and non-mandatory CPD.

In jurisdictions where CPD is mandatory, nurses engage in continuing education by participating in professional development that is relevant to their areas of practice. Mandatory CPD, refers to “… the process of ongoing education and development of healthcare professionals, from initial qualifying education and for the duration of professional life, in order to maintain competence to practice and increase professional proficiency and expertise” ([ 6 ], p.1). CPD can sometimes refer to a learning framework and activities of professional development which contribute to the continual professional effectiveness and competence [ 7 ]. Broadly, CPD is related to continuing education, and continual learning, both formal and informal, which results in the acquisition of knowledge and skills transfer by the practising nurse with the aim of maintaining licensure and competent practice [ 8 ]. Learners can utilise a mixed style approach to learning depending on the circumstances and context of the learning environment [ 9 , 10 , 11 ]. To succeed in providing comprehensive care for their patients, nurses need to utilise the best evidence available to them [ 12 , 13 , 14 ]. This requires different modes of learning and ways of knowledge acquisition and construction. To achieve this, nurses can engage in different approaches of acquiring knowledge through CPD, through formal learning, courses or workshops as well as workplace informal learning, through self-reflection, appraising literature for best evidence through journal clubs and giving feedback to each other [ 5 , 7 , 15 ]. Informal learning is often volitional and is largely initiated and controlled by individual nurses with the intention to develop their knowledge and skills [ 16 , 17 , 18 ]. Due to its unstructured and, at times, unintentional manner, such learning is often acquired during interactions with colleagues and patients [ 19 ]. One of the advantages of on-site learning, both formal and informal is that learners can utilise expertise which are already available on the ward [ 5 , 15 ]. On-site learning occurs often at the discretion and the willingness of managers to facilitate by providing time and space for learning to occur within the clinical areas. Even so, the fact remains that informal on-site learning is not an event but a continuous process, which draws from daily professional experiences. Lack of CPD trained nurses and ward needs, coupled with poor staffing levels, are cited as main barriers to informal workplace learning [ 5 , 15 ]. Evidence from CPD literature indicates that many nurses prefer informal work-based methods of learning, noting that most meaningful learning occurs through interactions with their colleagues [ 20 ]. From a study by Clarke [ 21 ], it was noted that nurses found informal learning methods such as supervision, attending team meetings/briefings, mentoring and observations to be important. Ultimately, whichever delivery method is used for CPD, continuous professional development extends the practitioner’s professional ability beyond pre-registration training, qualification and induction, thereby potentially enhancing the practitioner’s practice.

Continued professional development: the UK example

This next section aims to illustrate the different mechanisms that arise in one specific health care setting when implementing CPD on a national scale. We recognise that other mechanisms will exist in other contexts, and in places where CPD is not a formal requirement.

Today, nurses in the U.K. are required to engage in continuous learning in order to maintain competence as a means of keeping their licensure with their professional body, the Nursing & Midwifery Council (NMC) [ 22 ]. Since the 1980s, UK nurses and other allied health care professionals such as physiotherapists and occupational therapists have been required to engage in continuous professional development [ 23 ]. A justification for CPD has been the need to maintain professional registration to practice. For registered nurses in the UK, the requirement to engage in CPD came to the fore of continuing education in 1995. It was introduced by the then licensing body, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting (UKCC) as post registration education and practice (PREP) [ 24 ]. Further to that, the Agenda for Change Reforms in 2003 introduced a system for linking pay and career progression to competency called the National Health Service Knowledge and Skills Framework [ 25 ]. The framework is linked to the individual nurse’s ability to demonstrate that they possess the necessary knowledge and skills to get promoted and be remunerated accordingly [ 25 ]. In the UK, further reforms to CPD were introduced in 2012 through the introduction of the Health Education England (HEE) in England [ 27 ]. Its mandate was to equip the NHS (National Health Service) workforce, including nurses with appropriate knowledge and skills to deliver high standard care to patients. The HEE’s role was to support workforce development by providing funding largely for nurses’ CPD. In 2016, PREP was replaced with revalidation, which still requires nurses to attend 35 h of CPD every 3 years [ 24 , 26 ]. Revalidation is the process through with nurses and midwives continue as registrants with the Nursing and Midwifery Council (NMC) [ 25 ]. However, comprehensive HEE budget cuts have had a negative effect on nurse CPD initiatives [ 27 ]. CPD funding in UK was cut from 205 million pounds in 2015–16 to 83 million in 2017–18 [ 28 , 29 ]. Consequently, nurses have struggled to fulfil revalidation requirements due to some authorities freezing access and refusing to give nurses time to attend CPD activities [ 27 ].

This previous section offers an insight into different push-pull mechanisms, in the UK alone. Statutory requirements are underpinned by the need for nurses to maintain and develop the knowledge and skills to meet the expected competence standards of practice in response to expanding nursing roles and global trends. Our experience suggests that local governing bodies may enforce similar measures in contexts where CPD measure are not formalised. Nurses may find themselves caught between a patchwork of statutory requirements and a need to develop their skills and knowledge. Consequently, while we know about the need for nurses’ continuing professional development, less is known about how nurses experience and perceive continuing professional development. Therefore we propose that a metasynthesis of the qualitative literature could be a part of forming such a comprehensive view and use the following three questions to examine the literature What is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge?, What are the conditions necessary for CPD?, and, What are the challenges faced by nurses when engaging in CPD?

In this study, a metasynthesis was used to investigate the qualitative literature [ 30 , 31 ]. Metasynthesis is a form of systematic review method used to review qualitative studies in order to develop theory, to explore and understand phenomena or generate new knowledge, thereby creating meaning from that knowledge [ 32 , 33 , 34 , 35 , 36 ]. In this review, we present a metasynthesis based on the interpretation of qualitative results from topically related qualitative reports. In doing so we strive towards theoretical development, which according to Zimmer refers to the synthesis of findings into a product that is ‘thickly descriptive, and comprehensive’ and thus more complete than any of the constituent studies alone ( [ 30 ] p.313).

The results from metasynthesis studies may be used to underpin and inform healthcare policy, nursing practice and patient care. Furthermore, such information can be utilised by health care professionals involved in nursing education to inform planning and designing of training and educational programs. A number of steps are taken when conducting a metasynthesis [ 36 ] and involve;

a) bringing together a multidisciplinary team, in our case the team of three people includes two skilled medical education professional researchers with extensive experience in qualitative studies, including systematic reviews, moreover these two authors have more than 40 years of comprehensive experience of CPD in health care settings, two of the team are registered nurses and afford the team key insights into the context of nursing CPD, the team is spread across three institutions in two countries, finally, the team consisted of a search engine expert,

b) defining inclusive but manageable research questions, see the questions above;

c) conducting the systematic search, in our case this was conducted by the search engine expert, see Table  2 for the search criteria,

d) quality assessment of the studies, this was done using the CASP (Critical Appraisal Skills Programme) criteria, weighting three levels (not met, partially met, totally met) where assessment was done by all three authors see Table  4 , e) extracting data from the studies, see Table  3 ,

e) data analysis, which is explained in more detail below, and.

f) expressing the details of the synthesis which is done in the findings sections below.

Search strategy

A comprehensive systematic search of literature was subsequently conducted on Medline (OVID), PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science (Clarivate) and ERIC (ProQuest). The literature search was conducted by a librarian. The literature search was conducted in December 2019 and was limited to articles published in English from 2010 to 2019. Inclusion and exclusion criteria for the literature search were established and are presented below in Table 2 . The inclusion criteria comprise of articles from empirical studies (using qualitative methods), discussing nurse continuing learning and education, professional development, lifelong learning, CPD, motivation and barriers.

Data analysis

A total of 1675 records were identified, and following de-duplication, 1395 articles remained. All 1395 articles were screened. Articles had to address nurses’ CPD and continuing education, using qualitative oriented methods. After the first screening 72 articles remained. These articles were divided into three batches and were divided among the researchers. Each author read one batch to further identify if the articles were to be included. For each batch, a second author read the articles, meaning all articles were read by at least two authors. Any remaining ambiguities were discussed and resolved among the team. Figure  1 is a summary of the literature search and screening and Table 3 presents an overview of each study with its citation, location, cohort size and data collection method. 25 articles were identified for the final metasynthesis. All authors read the final 25 articles. Quality assessment using CASP criteria as outlined by Lachal et al., [ 36 ] is reported in Table 4 . In the quality assessment we assess the following components; Was there a clear statement of the aims of the research?, Is a qualitative methodology appropriate?, Was the research design appropriate to address the aims of the research?, Was the recruitment strategy appropriate to the aims of the research?, Were the data collected in a way that addressed the research issue?, Has the relationship between researcher and participants been adequately considered and reported?, Have ethical issues been taken into consideration?, Is there a clear statement of findings? We also introduce the question of whether the texts are available in Open Access form or not. We introduce this question, as we believe the outcomes on research on nurses’ perceptions and experiences of CPD is potentially important for their practice, and access via Open Access channels could act as a quality dimension. However, without access to the data and the process of interpretation we choose not to assess; How valuable is the research?, Was the data analysis sufficiently rigorous?

Overview of the steps in the literature screening

For the final analysis enabling the synthesis of the studies in this metasynthesis the articles were read carefully, findings related to the research questions; What is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge?, what are the conditions necessary for CPD? And what are the challenges faced by nurses when engaging in CPD?, were identified. In the next step of the analysis, study findings were examined using constant comparative analysis. The findings and conceptual categories were coded, compared, and sorted, focusing on conditions, strategies, and consequences. Finally, the synthesis, the interpretation of the findings, were described as themes, and these were revised several times until a coherent whole was formed [ 30 , 36 , 37 , 38 ] Before the final description of the synthesized themes, all the three authors discussed the content of the themes until consensus concerning credibility was reached.

From the metasynthesis we present five overarching themes, Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. Each theme is further explained below with references to the relevant literature.

Organisational culture shapes the conditions

Organisational culture played an important role towards the professional development of staff. Organisational commitment and support to personal and professional development of its staff was seen as an indication that staff were valued [ 5 , 15 ] Moreover, CPD initiatives contributed to attracting and retaining staff [ 39 ]. Additionally, a culture that was flexible and adaptable to change was perceived by some participants to be favourable towards CPD [ 40 , 41 , 42 ]. Flexibility extends to matters such as CPD availability, and also location, but related also to creating opportunities in the work schedule for the nurses to participate [ 43 ]. Other organisational factors such as funding for CPD programs, staff access of CPD learning, role of management in staff CPD, manageable nursing workloads, the design & delivery of CPD activities, communication and collaboration between CPD providers and management are specifically organisational factors seen as crucial to effective staff development [ 44 , 45 ]. Developing a strategy for CPD was also acknowledged as a key element of organisational culture as a way of enabling participation [ 46 ]. In a similar fashion, it was argued that the organisation needs to be focussed on incremental, but constant development of practices, and here CPD was seen to play a key role [ 47 ]. This sentiment was expressed elsewhere too, but from a re-skilling, or keeping up-to-date perspective, where the organisation is seen to have great importance [ 48 , 49 ]. The value of partnerships and shared understanding between managers and nurses as key enabling factors was identified in several studies [ 46 , 50 ]. In a related fashion, Jantzen argues that organisations should actively avoid fragmentation of CPD initiatives [ 51 ]. As more CPD training is digitised IT/ICT (information communication technology) skills were seen as key to successful CPD implementation [ 46 , 52 ]. It was acknowledged that the transformation to online learning does not only affect nurses, it involves change for the whole department [ 52 ].

Supportive environment as a prerequisite

An environment that supports learning was seen as a necessary prerequisite for CPD. Conditions had to include, flexible off-duty patterns to allow time for staff to study, availability of workplace learning, workloads were not excessive and CPD was fully funded or a shared responsibility between employer and staff [ 46 , 52 ]. Other indicators of a supportive environment included staff access to different CPD activities relevant to their career goals, while at the same time meeting organisational goals and where staff felt free to study openly and not secretively [ 15 , 41 ]. Moreover, the development of local and contextual CPD was seen as something that supported and made participation possible [ 43 , 53 , 54 ]. Participants indicated that nurses required financial support and practical support in the form of adequate time to participate in CPD activities and suitable staff cover when colleagues were away attending CPD activities [ 47 ]. Jantzen et al. [ 51 ] suggest there are three catalysts in a supportive environment; mentors, workplace camaraderie and a highly functional workplace team. Moral support or encouragement was identified in more than one study, where it was articulated that learners want to know there is an appreciation for the time and dedication needed to engage in CPD [ 44 , 46 , 50 ]. The value of learning from other health professionals other than nurses, in the day-to-day work was highlighted for professional development [ 54 ]. Similarly, the sense of a supportive environment with a strong team spirit is communicated elsewhere [ 39 ]. Explicit support is noted in several studies; support for novice nurses [ 39 ] but also the importance of explicit managerial support [ 55 ]. Conversely, in one study, respondents noted that there was less support for experienced or late career nurses [ 56 ].

Attitudes and motivation reflect nurse’s professional values

The value and importance of CPD was discussed in many of the studies. In some, CPD was perceived to be key in defining nurse professionalism [ 6 , 15 , 40 , 47 , 49 ]. Engaging in CPD was also viewed by new nurse graduates as an important element of their individual professionalisation in nursing [ 6 , 15 , 40 ]. In addition, CPD was perceived to be important for enhancing and up or re-skilling, keeping knowledge and skills up-to-date, considering that nursing practice has become more evidence based [ 6 , 43 , 46 , 51 , 54 , 56 ]. Furthermore, nurses stated that CPD was important for maintaining licensure, and felt that the responsibility for enrolling and participating in CPD activities was with the individual nurse, not with the employing organisations [ 53 ]. On the other hand, participants felt more motivated to learn if they could easily access CPD programs, if they felt supported and if there were a variety of CPD activities on offer. Here, bedside and informal learning was emphasized as important [ 57 ]. Similarly, contextualising learning and placing it in close proximity to practice was seen to enhance motivation and engagement [ 42 ]. CPD was also viewed as a way to start networking with other peers [ 44 ]. In one study, a competency framework was introduced, here participants felt that such a framework could help them reflect on their own practice and, as it provides a systematic approach to assessing a patient, look at their own strengths and weaknesses [ 58 ]. Such competency frameworks help to harness scarce training more effectively and encourage individuals to take more responsibility for their own development [ 58 ].

Participants’ attitudes towards CPD funding were mixed, with some stating that funding for CPD was the employer’s responsibility, while others felt that the individual practitioner was responsible or that the burden ought to be shared between the organisation and the nurse [ 5 , 15 , 40 ].

Nurses’ perceptions of barriers

Poor staffing levels, heavy workloads, lack of funding, lack of study time and anti-intellectualism were some of the perceived barriers to CPD brought out by this review. Participants in the studies reviewed felt that a lack of organisational support, especially from their managers, was an indication that the organisation did not take professional development of its staff seriously [ 46 ]. Some respondents reasoned that an anti-academic culture and lack of relevant CPD programs was further indication of this [ 5 , 15 , 40 ]. Seeing a connection to patient care was identified as a strong driver and nurses identified that CPD initiatives would be filtered out unless there was such a clear connection to patient care [ 43 , 51 ].

Additionally, some studies indicated that as role models, managers had to show interest in their own CPD, in order to motivate other nurses. In other words, the manager’s knowledge of CPD activities was reflected by their attitude towards work-based study, acceptance of staff who studied openly, the way the manager prioritised funding support and managed staff shift schedules to allow study release time [ 5 , 39 , 54 , 56 ]. Fatigue was identified as a major barrier. For example in Jho et al. [ 53 ], in a context of mandated CPD, respondents felt tired due to the heavy nursing workload in conjunction with CPD. Lack of strategy, and financial initiatives in terms of money, or time off to study was also acknowledged as a barrier [ 5 , 39 , 54 , 56 ]. Lack of transparent career trajectories were also acknowledged as an area of concern [ 44 ].

Other barriers, or de-motivating factors were identified; difficulties in attending CPD and keeping a life-work balance [ 48 ]. Barriers included: formal CPD courses away from the clinical areas were perceived to lack in authenticity [ 47 , 49 ] and a mis-match in expectations and outputs, where nurses viewed themselves as agents of change, but where the organisation was unable to offer means to capitalise on this perception and desire to bring about change [ 50 , 59 ]. As much as competency frameworks were viewed positively in offering a sense of direction, a divergent view was that they were limiting or created set boundaries that participants experienced as limited, for example, if used as prescriptive, hindering nurses to define their own learning needs [ 58 ]. Lack of IT competence was also perceived as a barrier [ 52 ] with more CPD being conducted online.

Perceived impact on practice as a core value

The impact of CPD on nursing practice was perceived as important and valuable in different ways. The impact could be both direct and indirect depending on the organisational culture [ 41 , 45 ]. This mixed perception could be due to the complex nature of health care organisations which can make knowledge sharing difficult [ 45 ] and that some CPD learning was done secretly, results of which were difficult to evaluate [ 41 ]. In the case where a competency framework was studied, participants felt that using the competency framework helped them organise their work and their thought processes [ 58 ]. A common sentiment was that CPD would benefit health care organisation through the provision and enhancement of practitioners’ knowledge and skills [ 46 ]. Sentiments articulating expectations of an impact of CPD could also be seen elsewhere too [ 52 , 55 , 56 , 60 ]. Moreover, CPD is expected to rely on better communication between managers and nurses as a way of informing each other about needs and means of fulfilling those needs [ 48 ]. Direct impact was realised through improved interprofessional collaboration and the idea that new methods could be directly translated into practice [ 47 ]. Others however, raised concerns that CPD programmes or courses may not translate into new practices [ 50 ]. This sentiment was echoed elsewhere too, where a need to situate CPD in close proximity of patients was seen as important for CPD to impact practice [ 49 ] While indirect impact happened through dissemination of knowledge and skills from CPD learning to other nurses at ward level, arguments were put forward that there will be no difference to practice unless organisational processes support and evaluate its effect on practice [ 46 ]. Participants reported that their professional confidence was enhanced, they felt they could challenge medical decisions and the status quo [ 41 ]. Furthermore, participants felt that CPD enhanced their professional knowledge and skills for better patient care through improved care standards, how they communicated and collaborated with other professionals. Participants also believed that learning increased their chances for career progression and reduced work-related anxiety because of enhanced knowledge [ 40 , 41 ].

The aim of this paper is to conduct a metasynthesis investigating the qualitative research on nurses’ experiences of continued professional development. As a result, this metasynthesis revealed a number of overarching themes, which synthesize the findings of previous qualitative oriented research during the period 2010–2019. 2010 was chosen to include the last 10 years of CPD research. The themes are; Organisational culture shapes the conditions, Supportive environment as a prerequisite, Attitudes and motivation reflect nurse’s professional values, Nurses’ perceptions of barriers and Perceived impact on practice as a core value. The themes put focus on important issues that were recurrently put forward by the nurses in the studies reviewed. However, the themes are not isolated from each other, rather, the content of the themes is interrelated. Some of the themes mainly mirror an overarching perspective at the organisational level of health care, while other themes describe the nurses’ experiences and needs on a personal level. The following discussion explores the above themes in relation to the three questions posed earlier; what is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge? What are the conditions necessary for CPD? What are the challenges faced by nurses when engaging in CPD? While we acknowledge that the questions and themes overlap, we have endeavoured to frame the discussion around the three research questions individually.

What is the reported value of CPD for nurses’ lifelong learning and its impact on nursing knowledge?

Nurses reported that CPD raises professional standards through competencies gained, thereby increasing professional performance with positive benefits for patients, organisations and individual nurses [ 40 ]. These outcomes were seen most prominently in the themes Attitudes and motivation reflect nurse’s professional values, and Perceived impact on practice as a core value. Closely aligned to CPD are the nurses’ clinical effectiveness and competence. Maintaining both requires nurses to keep their practice up-to-date highlighting the importance of CPD for nurses. The knowledge and skills gained by nurses through CPD advances the professional status of nursing, which was an idea that was prevalent in some of the studies in this review [ 15 , 40 , 47 , 50 ], but is also illustrated elsewhere in the literature [ 8 , 21 ]. Nurses acknowledged that expectations of professional accountability meant that standards of practice ought to be kept high in order to pass public scrutiny [ 15 , 40 ]. Furthermore, skills acquired through CPD, such as the ability to conduct systematic peer-reviews [ 45 ] and appraise literature for best evidence, provide nurses with essential professional competencies, embeds values such as caring behaviours, influences beliefs and attitudes which in turn shape nurses’ professional conduct [ 61 ]. As such CPD is seen as a tool for nurses to update their skills, and in doing so deliver safe and high-quality health care. As revealed in this review, nurses were willing to fully fund or part-fund their CPD as long as CPD programs were captivating, easily accessible, there was fair allocation of study time and their efforts towards CPD were recognised. The latter implies that nurses want time and space to transfer their CPD learning into practice and for their CPD to be recorded [ 5 , 45 ]. The belief is that, consequently, patient care will improve with positive impact from organisational change [ 15 , 45 ]. However, it is clear that the organisation is key in making CPD work for nurses. The issues brought up in the theme organisational culture shapes the conditions is thus very important in stimulating nurses to engage in CPD. The nurses’ attitudes and motivation to engage in CPD also depends on a supportive environment and engagement may in turn influence the organisational culture.

What are the conditions necessary for CPD?

A disconnect could be seen in relation to the conditions for CPD, where access to CPD training came to the fore as problematic in some of the studies. Nurses had to travel long distances to attend courses [ 15 , 62 , 63 ]. To avoid these challenges, nurses settle for CPD as long as it fulfils mandatory requirements for registration [ 53 ]. If intentions of CPD are to provide a basis for the continual updating of skills, then authentic learning as an expected outcome is seen as a prerequisite for nurses to engage in CPD, whether it occurs at the bedside, at a training facility or through an IT mediated interaction. This calls for accessible CPD, improved design and delivery methods for all nurses [ 52 ]. Nurses’ experiences described in the themes Organisational culture shapes the conditions, Supportive environment as a prerequisite, show that structural and moral support are both important. Structural support in the form of availability, time to engage in CPD, as well as clear expected outcomes [ 46 , 49 ], but also moral support in the form of an understanding management and environment, and also peers and leaders who themselves also prioritise CPD [ 58 ]. Organisational support and commitment towards CPD should mean allocation of study time, support of nurses who study privately, by creating space for knowledge and skills integration and managing poor cultural practices that hinder open study. Funding is seen as a key factor across many of the studies, both in terms of enabling nurses to participate, but also as a way of acknowledging nurses who engage in CPD. Further studies may need to look more closely at how nurses perceive different aspects of funding. For nurses’ lifelong learning to endure, CPD programs need to be more accessible and kept interesting by making them more relevant to nurses’ practice contexts. Here the importance of the organisation for creating a CPD conducive environment is emphasized [ 46 , 51 , 52 ]. As role models, managers need to lead by example and engage in CPD themselves, but also demonstrate explicit support. They also need to influence policy to create environments conducive to CPD. If funding situations do not improve, work-based CPD learning could be one of the alternative ways of CPD delivery for nurses. To promote CPD engagement and cost reduction, eLearning approaches could be utilised for education and training. However, poor IT skills among nurses, but also within organisations continues to be a potential weakness [ 52 ]. A challenge remains here in enabling nurses to get recognition from informal on-site learning [ 16 , 17 , 18 ], where elements of meta-cognitive reflection can be used to acknowledge nurses’ continued professional development.

What are the challenges faced by nurses when engaging in CPD?

In some of the literature reviewed, participants lamented their current conditions for CPD, and identified clear barriers and challenges in the form of concerns related to lack of funding for CPD, staffing levels, time allocation for study, lack of organisational support because of negative cultural practices, CPD design & delivery and limited choice of CPD activities. This is articulated within the themes: Organisational culture shapes the conditions, Supportive environment as a prerequisite, Nurses’ perceptions of barriers [ 2 , 11 , 34 , 41 ] . However, studies did not explore the views of nurses on recruitment and retention and its impact on accessing a variety of CPD activities. Evidence from this review indicates that modernising healthcare and simultaneously cutting CPD funding for nurses could lead to a limited number of nurses attaining the skills and competences needed for the modernisation process. In view of the understaffing that is reported elsewhere [ 5 , 15 ], we identify a cause for concern. These perceived barriers may undermine nurses’ professional development [ 23 , 59 ]. Moreover, the findings presented here revealed that nurses face a number of challenges in relation to their CPD participation. The challenges include limited CPD activities to choose from, poor CPD delivery methods, negative organisational culture practices such as anti-intellectualism and lack of support. As a result, nurses were less motivated to participate in CPD training [ 57 ].

It is clear from the review, that IT concerns are becoming more and more prominent, given that more CPD programmes are being offered through digital platforms [ 47 ]. This is a concern for both the individual nurses, but also their organisations. On concerns regarding CPD delivery methods, nurses indicated that they preferred different styles. With these concerns comes the view that learners learn in different ways depending on the context and subject of study [ 61 , 62 ]. This supports the notion that individuals have different learning preferences [ 61 ], where some adult learners learn better in a structured and teacher guided context, while others prefer self-direction.

Limitations

The search was conducted by an experienced search engine expert. Even so, we may still have been unsuccessful in finding all the relevant articles. The study was focussed on qualitative studies, which means that studies using predominantly quantitative or mixed methods were not included, but could hold important insights. In the introduction to the study we used the UK as an example for how CPD might be regulated. However, we have conducted a comprehensive search of the literature and our analysis was not conducted with a UK-centric perspective. While each study needs to be understood in terms of local rules and regulations, the similarities in the findings are striking.

The metasynthesis indicates that differences exist between the nurses’ CPD needs and expectations and organisations’ approaches to nurses’ professional development. The review lays bare a disconnect between the rhetoric of identifying CPD as a way to enhance nurses’ skills, and the reality of CPD interventions, where nurses do not feel support within their organisations or from their immediate supervisors. The review also revealed that CPD is an important element of nursing practice and nurses’ lifelong learning. Furthermore, it suggests that nurses are motivated to take part in CPD to enhance their knowledge, improve skills and keep up- to -date with recent evidence. While evidence from this review indicates that nurses believe that CPD has a positive impact on patient care, there is lack of contemporary research to qualify this claim and there is limited evidence from this review to support this assumption. However, evidence from the review suggests and confirms, that the greatest barriers for CPD in nursing are a lack of funding and time to participate in CPD activities, which are clearly related to organisation structure. It is difficult to envisage how such conditions could be conducive for nurse CPD to flourish. Such perceived barriers undermine nurses’ efforts to keep knowledge and skills up-to-date and provide better patient care while meeting the ever-changing needs and expectations of their patients. This is further exacerbated by negative organisational cultural practices and lack of knowledge on how to facilitate, design and deliver CPD for their staff. We conclude that policy makers and relevant stakeholders need to put in place strategies to support nurse CPD in long term and in doing so tear down the barriers of CPD.

Availability of data and materials

The data in the study is comprised of previous research articles. A full list of articles is included in the Table 3 .

Abbreviations

Continued Professional Development

United Kingdom Central Council for Nursing, Midwifery and Health Visiting

Post registration education and practice

Nursing & Midwifery Council

Health Education England

National Health Service

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Acknowledgements

We would like to thank Gun Brit Knutssön, at Karolinska Institutet’s University Library, Stockholm, Sweden for the systematic search.

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Mandlenkosi Mlambo

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Mandlenkosi Mlambo, Charlotte Silén & Cormac McGrath

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Mlambo, M., Silén, C. & McGrath, C. Lifelong learning and nurses’ continuing professional development, a metasynthesis of the literature. BMC Nurs 20 , 62 (2021). https://doi.org/10.1186/s12912-021-00579-2

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Continuing Professional Development: Best Practices

Helena p. filipe.

Ultrasound Department, Ocular Surface Disease Department, Head of Contact Lens Unit of Institute of Ophthalmology Dr. Gama Pinto, Lisbon, Portugal, UE

Eduardo D. Silva

1 Ophthalmology Pediatric Department, Head of Genetic Department, Coimbra University Hospitals, IBILI, Professor of the Medicine Faculty of Coimbra University, Coimbra, Portugal, UE

Andries A. Stulting

2 Department of Ophthalmology, Emeritus Professor of University of the Free State, Kimberley Hospital Complex, Kimberley, South Africa

Karl C. Golnik

3 Department of Ophthalmology, Neurology and Neurosurgery at University of Cincinnati, Cincinati Eye Institute, Cincinnati, Ohio, United States of America

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. 1 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.

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 , 7 , 8

CME and CPD contrasts

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 raisers 12
• 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
• 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 communicator 15
• The Medical Council of New Zealand's domains for recertification and CPD: Medical care, communication, collaboration and management, scholarship, and professionalism 16
• 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 efforts 17
• The United Kingdom's General Medical Council's domains: Knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust 18
• The Royal Australian New Zealand College of Ophthalmology's framework learning categories: Clinical expertise, risk management and clinical governance, and professional values 19
• Is a “self-evaluation model reporting form” necessarily including an evaluation component 10
• Should produce behavioral change in medical practice so that healthcare improvement is achieved and measurable 13
• Involves legal aspects such as avoiding lawsuits and practicing under compulsory relicensure 1
• Promotes the physician's accountability. 20

Emphasis on CPD has been growing due to several factors:

• Physicians are leading longer professional lives
• Globally increasing mobility of both patients and healthcare professionals 21 , 22
• 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. 23

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. 1 , 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. 21 An effective CPD scheme should have three quality components: 24 , 27 , 28

• 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. 1

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 30
• Document based, where an organized flow of documents help to demonstrate and assess CPD. 1

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 template 13 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-up 14 [ 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. 1 , 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. 1

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 ]. 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. 1 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

CPD activities

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 , 39

How well have I learned?

Assessment closes the CPD cycle and involves two components: 1

• 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. 39 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. 1 , 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 , 41 Unplanned learning that occurs in daily workplace cannot be disregarded and is usually reinforced and disseminated. 1 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 , 42 , 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. 45 , 46 , 47 , 48

Accreditation

CPD must be amenable to external evaluation to become transparent, demonstrable, and accountable. 1 , 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. 1 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
• 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.

Source of Support: Nil

Conflict of Interest: None declared.

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The effectiveness of face-to-face versus online delivery of continuing professional development for science teachers: a systematic review.

1. Introduction

1.1. definition of terms, 1.1.1. face-to-face delivery of cpd, 1.1.2. online delivery of cpd, 2. research questions.

• RQ1. How does the effectiveness of face-to-face CPD compare to that of online CPD for science educators?
• RQ2. What factors could potentially impact the efficacy of diverse forms of CPD programs?
• RQ3. What are the advantages of different CPD delivery modes?

3. Methodology

3.1. inclusion and exclusion criteria, 3.2. data source, 3.3. search strategy, 3.4. data extraction, 3.5. quality assessment, 4.1. comparative effectiveness of face-to-face and online cpd, 4.2. factors influencing different cpd delivery modes, 4.2.1. factors affecting face-to-face cpd effectiveness, 4.2.2. factors affecting the effectiveness of online cpd, 4.3. advantages of different cpd delivery modes, 5. discussion, 6. conclusions, 7. implications, author contributions, institutional review board statement, informed consent statement, data availability statement, acknowledgments, conflicts of interest.

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Li, Z.; Hassan, N.C.; Jalil, H.A. The Effectiveness of Face-to-Face versus Online Delivery of Continuing Professional Development for Science Teachers: A Systematic Review. Educ. Sci. 2023 , 13 , 1251. https://doi.org/10.3390/educsci13121251

Li Z, Hassan NC, Jalil HA. The Effectiveness of Face-to-Face versus Online Delivery of Continuing Professional Development for Science Teachers: A Systematic Review. Education Sciences . 2023; 13(12):1251. https://doi.org/10.3390/educsci13121251

Li, Zhi, Norlizah Che Hassan, and Habibah Ab. Jalil. 2023. "The Effectiveness of Face-to-Face versus Online Delivery of Continuing Professional Development for Science Teachers: A Systematic Review" Education Sciences 13, no. 12: 1251. https://doi.org/10.3390/educsci13121251

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Effectiveness of continuing education programmes in nursing: literature review

Affiliation.

• 1 Joint Cape Breton University/St. Francis Xavier University Nursing Program, Cape Breton University, Sydney, Nova Scotia, Canada. [email protected]
• PMID: 16866840
• DOI: 10.1111/j.1365-2648.2006.03940.x

Aim: The aim of this paper is to review the literature on what facilitates or inhibits continuing education in nursing and to identify ways to make continuing education more effective.

Background: [corrected] Healthcare professionals have always been encouraged to update their knowledge and maintain clinical competence. The rapid changes currently taking place within healthcare systems have increased the pressure from direct care providers, professional bodies and the general public for nurses to engage in continuing education programmes. Despite a growing body of empirical research on this topic, the effectiveness and impact of continuing education remains underexplored.

Method: A literature search was conducted in January 2005 using CINAHL, Medline, the Cochrane databases and the Internet. Keywords used were: 'continuing education', 'professional development', 'viability of continuing education/professional development programmes', 'evaluation of continuing education/professional development programmes' and 'effectiveness of continuing education/professional development programmes'. No date restrictions were imposed.

Results: Factors that facilitate the implementation of continuing education in nursing arise from individual, professional and organizational perspectives. While the philosophy behind continuing education is to encourage nurses to become lifelong learners, the learning method chosen for such programmes is often didactic in nature, as opposed to encouraging nurses to take initiative and direct their own learning. Continuing education is intended to ensure healthcare practitioners' knowledge is current, but it is difficult to determine if those who attend these courses are implementing what they have learnt.

Conclusion: To make continuing education programmes more effective, nurses need to have a more participatory role in their learning. A concerted effort should be made to make continuing education attainable and realistic.

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Supervisors’ emotion regulation in research supervision: navigating dilemmas in an accountability-based context

• Open access
• Published: 18 May 2024

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• Jiying Han 1 ,
• Lei Jin 1 &
• Hongbiao Yin   ORCID: orcid.org/0000-0001-5424-587X 2  

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Given the complexity and high demands of research supervision and the intricate emotional experiences of supervisors, there is a need to explore how they regulate their emotions, particularly across various disciplinary backgrounds. The current study explored the emotion regulation strategies employed by research supervisors during the process of supervising graduate students. Based on data collected through semi-structured interviews, observations, and documentation from six research supervisors in different institutions in China, seven emotion regulation strategies employed by research supervisors were identified and further categorized into two groups, that is, antecedent-focused (prevention, intervention, reinterpretation, reconcentration, and detachment) and response-focused (suppression and expression) emotion regulation strategies. The findings shed light on the dilemmas faced by supervisors and the paradox aroused from the context-dependent and non-standardized nature of research supervision within an accountability-based managerial context. The implications for supervisors’ emotion regulation in authentic supervisory situations are discussed, and insights for universities’ policy-making are offered.

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Introduction

Since the 1990s, educational research has undergone an “affective turn” as a result of the critique of the long-standing Cartesian dualism between emotionality and rationality (Zembylas, 2021 ). Over the following three decades, the dynamic and complex nature of teacher emotion has been explored from various perspectives and approaches (Agudo, 2018 ). Since emotion can significantly impact various stages of the teaching process, either facilitating or hindering it (Yin, 2016a , 2016b ), opportunities for emotion regulation can be identified in educational contexts at any time (Taxer & Gross, 2018 ). In higher education, although emotion regulation has been proven significant to teacher development and well-being (Xie, 2021 ), the majority of research has been conducted within the context of classroom instruction (Tao et al., 2022 ), leaving that of research supervision in graduate education unexplored.

In graduate education, emotion plays an important role in the supervisory process and relationship building which involves a series of emotional interactions essential for both supervisors and graduate students. The existing research has demonstrated an increasing need for supervisors to develop emotion regulation skills to cope with the challenges and provide emotional support in research supervision (Wollast et al., 2023 ). On the one hand, supervisors need to employ emotion regulation strategies in the challenging supervisory contexts, as accountability-based policies and the blurring of personal and academic relationships between supervisors and graduate students may trigger complex emotional experiences such as anxiety and worry for supervisors (Xu, 2021 ). On the other hand, the provision of support from supervisors is strongly linked to the emotional well-being and research success of graduate students (Janssen & Vuuren, 2021 ; Wollast et al., 2023 ). Specifically, supervisors’ emotion regulation plays a crucial role in providing emotional support to graduate students, which in turn has a positive impact on graduate students’ well-being and their belief about their further academic pursuits (Han & Xu, 2023 ; Wollast et al., 2023 ).

Of the limited research on emotion in graduate education, much has been conducted to investigate the influence of graduate students’ emotion regulation on their mental health and academic engagement (Saleem et al., 2022 ). However, there is a paucity of studies which have researched supervisors’ emotions and emotion regulation during the supervisory process. With the aim of unpacking how research supervisors employ emotion regulation strategies in real supervisory scenarios to effectively fulfill their roles, and to gain insights into the nature of research supervision, this qualitative study explores the emotion regulation strategies used by supervisors in the process of research supervision.

Literature review

Teacher emotion and emotion regulation.

Emotion, once considered inferior to cognition, has gained increasing attention in the social sciences, including in educational research (Han & Xu, 2023 ). The current recognition of the intricate interplay between emotion and cognition in teaching and learning highlights the importance of emphasizing teacher emotion in both teacher development and teacher well-being (Chen & Cheng, 2022 ). Emotion is complex and difficult to define (Chen & Cheng, 2022 ), and the connotation of emotion has shifted from an intrapersonal perspective to a relational one, emphasizing interactions between individuals and their environment during emotion generation (Campos et al., 2011 ).

Under the relational view of emotion, individuals can achieve social goals in most jobs involving interpersonal interactions through emotion regulation (Brotheridge & Grandey, 2002 ). Emotion regulation refers to “the processes by which individuals influence which emotions they have, when they have them, and how they experienced and expressed their emotions” (Gross, 1998 , p. 275). In the educational field, a growing interest of research in emotion regulation has emerged since the 1990s (Yin, 2016a , 2016b ; Zembylas, 2021 ), as teaching has been viewed as “an emotional practice” (Hargreaves, 1998 , p. 835). Due to the importance of emotion in teachers’ professional lives, it is crucial for teachers to regulate their emotions to achieve improved teaching and learning outcomes. Specifically, enhancing positive emotions can foster better teacher-student relationships, promote creativity in teaching, and strengthen students’ learning motivation; inappropriately managed negative emotions can have adverse effects on these aspects (Hargreaves, 1998 ). Although teachers’ emotion regulation has been widely examined (e.g., Taxer & Frenzel, 2015 ; Yin, 2015 , 2016a , 2016b ; Yin et al.,  2018 ) most studies, influenced by the concept of emotional labor, have mainly focused on two types of emotion regulation strategies: deep acting (the act of internalizing a desired emotion, matching expressed emotion with felt emotion) and surface acting (the act of altering emotional expression without regulating inner feelings) (Grandey, 2000 ; Hochschild, 1983 ). Comparatively, Gross’s ( 1998 ) process model of emotion regulation provides a more nuanced framework to examine teachers’ employment of a wider range of emotion regulation strategies. According to Gross ( 1998 , 2015 ), emotion regulation could be achieved through two main approaches: the antecedent-focused and response-focused approach. The former entails strategies that seek to avoid or regulate emotions by modifying the factors triggering emotion generation, which include situation selection, situation modification, attention deployment, and cognitive changes. The latter modifies an individual’s expressions and responses after the emotions have fully manifested, directly influencing physiological, experiential, or behavioral responses.

In recent years, the predominant focus of studies, guided by Gross’s ( 1998 ) process model, has been on investigating the motivations, strategies, and outcomes of teachers’ intrapersonal emotion regulation (e.g., Taxer & Gross, 2018 ; To & Yin, 2021 ; Xu, 2021 ). Teachers’ motivations for emotional regulation stem from their diverse teaching goals, including managing the impressions that various parties have of them, adapting to intensive educational reforms for survival, and enhancing students’ concentration levels (Hosotani, 2011 ; Xu, 2021 ). As for emotion regulation strategies, the existing literature has mainly been conducted under Gross’s ( 2015 ) model, and revealed a series of antecedent-focused (e.g., situation selection, attention deployment, and cognitive change) and response-focused strategies (e.g., suppression, relaxation, and avoidance) to cope with the ambivalent demands and enormous workload faced by teachers. Remarkably, certain strategies that reflect the unique nature of teachers’ work, such as genuine expression (Yin, 2015 ; Yin, 2016a , 2016b ) and interpersonal strategies (To & Yin, 2021 ), have been identified. Regarding outcomes of emotion regulation, genuine expression of emotion and cognitive appraisal strategies were found helpful to improve the effectiveness of classroom teaching and to maintain a balance between teachers’ professional and personal dimensions of their identities (Yin, 2016a , 2016b ). In contrast, suppressing, pretending, and restraining emotions may cause emotional dissonance and less received social support (Yin, 2015 ).

Emotion regulation and research supervision

In graduate education, supervisors’ emotional experiences are triggered by the complexity and high demands of research supervision (Han & Xu, 2023 ). The conflicting roles of taking responsibility for both supporter and supervisor simultaneously, the contradiction between supervisors’ high expectations of students’ learning autonomy and graduate students’ unsatisfactory performance, and the blurred boundaries between supervisory relationship and friendship (Han & Xu, 2023 ; Parker-Jenkins, 2018 ) are major challenges encountered by research supervisors. These challenges lead to various emotional experiences on the part of supervisors, including positive emotions, such as joy and love (Halse & Malfroy, 2010 ), and more prevalent negative emotions, such as anger, and disappointment (Sambrook et al., 2008 ). Given the diverse range of emotions that emerge during the supervision process, it is necessary for supervisors to employ various emotion regulation strategies to accomplish effective research supervision.

According to literature, emotion regulation is strongly associated with research supervision in three areas. First, effective research supervision requires a constructive and supportive supervisory relationship, which is facilitated by supervisors’ emotion regulation. As poorly managed supervision relationships contribute to low academic completion rates, supervisors are required to establish a respectful and caring relationship with their students (Halse & Malfroy, 2010 ). However, creating and maintaining such relationships can be challenging. Specifically, during the interactions with graduate students, supervisors are expected to offer emotional supports, including encouragement, motivation, and recognition based on students’ individual needs while ensuring that any critical feedback is delivered constructively (Lee, 2008 ). However, excessive emotional engagement or close relationships with students may hinder their ability to provide constructive criticism (Lee, 2008 ). As such, supervisors must strike a balance between offering emotional support and providing constructive feedback, thereby developing a successful educational partnership with their students.

Second, the emotional support provided by supervisors plays a positive role in facilitating graduate students’ research productivity and emotional well-being (Han & Wang, 2024 ; Wollast et al., 2023 ). In terms of research success, supervisors who encourage critical thinking and support constructive controversies tend to produce higher achievement and retention rates than those who adopt a directive and authoritarian approach (Johnson, 2001 ). Furthermore, emotional support from supervisors has been linked to higher levels of research self-efficacy and emotional well-being among graduate students (Diekman et al., 2011 ). Specifically, structure and autonomy support strongly influence graduate students’ feelings and expectations about their future academic success. Thus, in academic settings, supervisors should adopt effective emotion regulation strategies, offering constructive feedback, close guidance, and attentiveness to maintain graduate students’ motivation and mental well-being.

Third, effective emotion regulation is also critical for the well-being of research supervisors themselves. When faced with repeated frustrating events such as a lack of student progress and demanding requirements in accountability-based supervisory contexts, supervisors may experience feelings of exhaustion, particularly when they perceive their supportive efforts as being ineffective (Xu, 2021 ). Failing to regulate these negative emotions with effective strategies can lead to the accumulation and intensification of undesirable feelings, resulting in detrimental effects on supervisors’ well-being and job satisfaction, which may ultimately lead to their emotional burnout and disengagement (To & Yin, 2021 ).

So far, the very limited research on research supervisors’ emotion regulation in medical and scientific disciplines found that although supervisors use instructional strategy modification (e.g., directly pointing out students’ writing deficiencies), cognitive change (e.g., reappraising the relationship between students’ underachievement and their supervision), and response regulation (e.g., lowering their voice to calm themselves) to deal with negative emotions (Han & Xu, 2023 ), they still have difficulties in stepping out of negative emotions (Sambrook et al., 2008 ). Meanwhile, supervisors from different disciplines may use different emotion regulation strategies due to disciplinary differences in occupational challenges, societal expectations, and specific work environments (Veniger & Kočar, 2018 ). Therefore, it is necessary for researchers to investigate the emotion regulation of supervisors with different disciplinary backgrounds.

Based on the literature, underpinned by Gross’s ( 2015 ) process model, the present qualitative multi-case study aims to investigate the emotion regulation strategies employed by research supervisors from different disciplinary backgrounds. Specifically, the study seeks to answer this core research question: What strategies do research supervisors use to regulate their emotions during the supervision process?

As the in-depth understanding of supervisors’ emotion regulation strategies relies on the narratives of their journey of research supervision, we used narrative inquiry to explore supervisors’ lived experiences in supervising graduate students. Narrative inquiry emphasizes the co-construction of specific experiences by the researcher and participants (Friedensen et al., 2024 ; Riessman, 2008 ), which allows us to co-construct the meaning of emotion regulation with participants through qualitative data including interviews, observations, and documents.

Research context: Emphasizing the accountability of research supervision

The Chinese research supervision system has its roots in the nineteenth century, evolving alongside the development of graduate education (Xie & Zhu, 2008 ). Within this system, research supervisors play a crucial role in research-based master’s and doctoral education. In 1961, a supervisor accountability system was formalized, placing the responsibility on supervisors for overseeing students in research projects, journal publications, and dissertation completion. Under the guidance of supervisors, students engage in specialized courses, master the latest advancements in a specific field, and conduct research (Peng, 2015 ).

In recent years, with the rapid growth of graduate education in China, both supervisors and graduate students have expressed concerns about the quality of research supervision (Xu & Liu, 2023 ). Thus, national policies have been introduced to stipulate supervisors’ responsibilities and enhance the overall supervision quality, with a particular emphasis on the accountability of research supervisors. In 2020, the Accountability Measures for Educational Supervision, released by China’s Ministry of Education ( 2020 ), outlined a code of conduct for supervisors, emphasizing that supervisors bear the primary responsibility for cultivating postgraduate students. Specifically, supervisors are held accountable for various aspects of graduate students’ academic progress, including the quality of dissertations, academic conduct, and the appropriate utilization of research funds. Failure to fulfill these responsibilities may result in serious consequences, such as disqualification from supervising students or the revocation of teaching credentials.

Participants

To explore a wide range of emotional experiences and emotion regulation strategies that arise when supervising students at various stages of their academic journey, participants were purposively selected based on the following three criteria: (1) doctoral supervisors with the qualifications to oversee research-based master’s students and PhD candidates were considered, which allows us to gain insights into their emotions in supervising students at different academic stages; (2) supervisors with a minimum of 5 years of supervision were selected, as their long-term experience would provide a comprehensive understanding of the depth and evolution of emotion regulation strategies; (3) supervisors of both hard and soft disciplines were involved, as disciplinary features may significantly shape supervisors’ styles, potentially leading to their diverse emotions and emotion regulation strategies. Finally, six doctoral supervisors from four universities in China agreed to participate in the study voluntarily and were informed of the research purpose and ethical principles before the study. Table 1 provides a summary of the demographic information for all participants.

Data collection

The positionality statement is essential as the authors’ roles may influence the data collection process. Specifically, two authors are doctoral supervisors with rich experience in research supervision, and one author is a doctoral student. Participants for this study were recruited from the authors’ colleagues or recommendations from friends. In the spirit of self-reflexivity, we acknowledge our positions in research supervision and recognize that our relationships with participants may impact our collection and interpretations of the data. However, the authors had attempted to minimize the possible influence through continuous reflection, crosscheck, and discussions during the data analysis and interpretation.

To produce convincing qualitative accounts, collecting data from multiple sources including semi-structured interviews, observations, and documentation was employed in the current study from November 2022 to April 2023.

The primary source of data was individual interviews with each participant. To gather participants’ narratives of critical events in their research supervision, an interview protocol was designed according to our research purpose, but the interview questions were sufficiently flexible to enable the interviewer to adapt the content according to the specific interview situation. The interviews lasted between 120 and 150 min, during which the participants were asked to describe critical events in their research supervision, their emotional experiences, and whether and how they regulated their emotions. Follow-up questions were asked to gain a more profound understanding of their emotion regulation strategies when they provided surprising and ambiguous responses. Sample interview questions included “What emotions do you typically experience as a research supervisor?” and “Do you regulate your emotions induced by research supervision? If so, how?” All interview questions were presented in Chinese, the participants’ first language, and were audio-recorded and transcribed verbatim.

Observation was used to complement the data obtained from interviews. Before the observation, all supervisors and their students were informed about the research purpose and ethical principles. Then non-participant observation during their group and individual meetings proceeded only with their voluntary participation. Supervisors’ supervisory methods, activities, meeting atmosphere, and emotions of meeting members were recorded to supplement and validate the data collected through the interview. A short follow-up interview was then conducted with supervisors, focusing on their reflections on emotional events that occurred during the observed group and individual meetings.

Documentation was also used as a supplementary method. With the consent of the participants and their students, supervisors’ annotations and feedback on graduate students’ manuscripts, unofficial posts about supervision on social media (e.g., WeChat moments sharing), and chat logs between supervisors and students were collected to obtain additional information about the participants’ emotional experiences and supervisory practices. Table 2 presents the interview durations, the total minutes recorded during observations, the length of follow-up interviews, and the specific number and types of documents reviewed by both supervisors and students.

Data analysis

The analysis involved a three-level coding process (Yin, 2016a , 2016b ). First, interview transcripts were repeatedly read to label data excerpts that addressed the research questions. Initial codes were based on participants’ original perspectives and then iteratively refined and combined. Second, the coding system was organized according to Gross’s ( 2015 ) process model of emotional regulation, which distinguishes between antecedent-focused and response-focused strategies. Meanwhile, the study also remained open to other emotion regulation strategies that were evident in the empirical data. Third, the coding system was distilled to capture the nature of the identified strategies, resulting in three types of emotion regulation strategies. During the analysis process, the data were classified and organized using the NVivo software.

To strengthen the credibility of the data analysis, the interview transcripts were carefully examined multiple times to ensure that the data were accurately reflected in the coding scheme. Moreover, the coding scheme was collaboratively developed by the authors, and any discrepancies in classification were thoroughly deliberated to achieve mutual agreement. The final coding system, along with sub-categories and patterns, is presented in Table 3 .

In sum, seven emotion regulation strategies in research supervision emerged from the empirical data, which can be grouped into two categories, namely, antecedent-focused strategies and response-focused strategies.

Antecedent-focused strategies

Supervisors used antecedent-focused strategies to regulate the external situation and their internal cognition before the emotions were generated.

Prevention involves the prediction and avoidance of situations that may lead to undesirable emotional experiences during supervision prior to the generation of emotions. Prevention strategies were frequently utilized in the graduate student recruitment process and early stages of supervision, as a means of avoiding undesirable situations. On the former occasion, supervisors identified multiple recruitment indicators, such as research experiences and GPA, to avoid supervisory situations that may lead to negative emotions. This is commonly related to their former supervisory experience: “It was frustrating to supervise a student who was not invested in her work, so I have to implement a rigorous recruitment process to prioritize candidates who are truly interested in research, rather than rashly recruiting students” (P1-interview).

Supervisors remain vigilant once a supervisory relationship was established, as they are required by accountability-based policies to be responsible for students’ research performance and safety. Many supervisors stressed the significance of “establishing rules and regulations” (P4-interview) in the early stages of supervision to avoid infuriation and disappointment with students’ academic misconduct. Therefore, establishing an academic code of conduct is an effective prevention strategy for supervisors: “I’m frustrated by academic misconduct among students, as discovering data falsification in student-published articles holds me accountable, risking serious consequences for my academic career. So I frequently emphasize the need for high academic honesty and integrity standards” (P2-interview, observation).

Another concern that worried supervisors, especially those of science and technology, is student safety: “Whenever I hear about a laboratory explosion that causes student injuries, it makes me very nervous” (P3-interview, documentation). It is crucial for the institutions and supervisors to establish comprehensive laboratory safety rules and educate students on safety protocols before conducting experiments: “I told my graduate students: Failure to obey laboratory rules and lack of safety awareness can lead to immediate accidents that not only affect yourself but also pose a risk to other students” (P3-interview).

Intervention

Intervention is the most commonly employed strategy by supervisors to enhance the effectiveness of their supervision once a supervisory relationship is established. They employed various intervention strategies to improve students’ academic attitude and develop their academic ability.

Specifically, supervisors improved their students’ engagement and altered procrastination either by scaffolding their research or enforcing discipline and prohibitions. On the one hand, our participants acknowledged the importance of instructional scaffolding in the supervisory process.

We need to cultivate students’ interest so that they can actively engage in research. For instance, I often demonstrate interesting phenomena between the English and Chinese languages to generate my students’ curiosity. Then I am delighted to see their willingness to immerse themselves in linguistic research. (P5-interview)

On the other hand, some supervisors emphasized the enforcement of discipline in supervision. One supervisor expressed disappointment and dissatisfaction with the lackadaisical research atmosphere within the entire research group. In response, she implemented strict discipline and prohibitions to restrict students from engaging in activities unrelated to research in the office (P2-observation).

Finding a student watching a movie in the office angered me as it may disturb other students trying to focus on their studies. So, activities like watching movies and listening to music are not allowed in our office. By rigorously enforcing these rules, our research group was able to collaborate more effectively and ultimately achieve satisfactory results. (P2-interview)

Furthermore, intervention strategies were also used to enhance graduate students’ academic competency. Modifying supervisory activities was considered as a useful method. One supervisor shared: “We used to read literature in our group meeting together, but it was not effective. I felt frustrated and decided to change our meeting activities this semester.” As a result, the supervisor organized students to provide feedback on each other’s manuscripts in weekly group meetings, because “it was very effective in improving their writing abilities” (P1-interview, observation).

Interestingly, some supervisors opted to micromanage students’ research processes when they were disappointed with their research performance

At first, I encouraged students to independently identify research topics, but I later realized with disappointment that it was challenging for them to identify gaps in the existing literature. To make things more efficient, I started assigning research projects directly to help them complete their dissertation and meet the graduation requirements. (P5-interview)

Reinterpretation

Reinterpretation refers to the process of cognitively reappraising a supervisory situation from different perspectives to change its emotional impact. Supervising a graduate student who lacks interest in research was described as a “prolonged and painful undertaking” (P4-interview). However, one supervisor noted that: “Dwelling on negative emotions can be unproductive as it does not necessarily solve problems. Despite the challenging experience, I have gained valuable insights and will be better equipped to handle such situation” (P4-interview).

In addition to explaining the meaning of the situations from supervisors’ viewpoints, they reconsidered the events from graduate students’ perspectives to rationalize their unsatisfactory performance and procrastination. For example, supervisors understood students’ time arrangements when they procrastinated: “I used to become annoyed when students failed to submit assignments punctually… Now I know that students need a balance between work and rest. They need adequate time for rest” (P5-interview).

On occasion, supervisors reappraised the connection between students’ misbehaviors and the effort they invested from the perspective of the teacher-student relationship.

I felt angry when things happened, but I wouldn’t let that emotion affect my life. I see myself as a supervisor to students, not a parent, so I don’t hold high expectations for them. If students choose not to follow my guidance, it’s not my concern anymore. (P6-interview)

Reconcentration

Reconcentration is the strategy by which supervisors focus on another aspect of supervision or divert attention away from supervision with the intent of changing emotional consequences. Specifically, during the supervisory process, supervisors prepared themselves to be optimistic by reminding themselves of their students’ strengths: “I was anxious about a student who always made slow progress in research. But when I later realized that his incremental results were consistently good, indicating that he was very meticulous, I felt much better” (P2-interview, observation).

Apart from diverting attention during supervision in working environments, the participants highlighted the importance of balancing personal and professional life to manage negative emotions that may arise during supervision.

After giving birth, I realized that caring for a child demands a considerable amount of time and energy. Then I redirected my attention from supervising students to my family. Thankfully, my family provides a supportive environment, and the pleasant moments shared with my family members helped me overcome negative emotions associated with work. (P4-interview)

Detachment refers to the act of separating from or terminating the supervisory relationship to disengage from negative emotions. This strategy was often employed when intervention, reinterpretation, and reconcentration strategies were ineffective. When supervisors found that various proactive measures failed to resolve the challenges in research supervision, they experienced enduring feelings of helplessness, confusion, and distress. One supervisor expressed deep frustration, stating, “I’ve exhausted all efforts—careful communication with her and her parents, and providing my support during her experiments. Yet, she continued to resist making progress with her experiments and dissertation. I felt lost in supervising this student” (P4-interview). As a result, they have to release themselves from the emotionally harmful supervisory relationships.

Some supervisors chose to disengage, meaning they no longer actively push the student: “Continuing to push a student who refused to participate in research despite all my efforts would only increase my frustration. I have decided to let him go and will no longer push him” (P5-interview).

In some extreme cases that evoke negative emotions, supervisors even terminated the supervisory relationship.

Supervising this student was a painful experience as his inaction negatively affected the entire research team. Other students started following his behavior and avoided conducting experiments. It made me feel suffocated. I had to terminate my supervision to avoid any further negative impact on the team and myself… I felt relieved after he left. (P3-interview)

Response-focused strategies

Response-focused emotion regulation involves the use of strategies after an emotion has already been generated.

Suppression

Suppression involves consciously attempting to inhibit behavioral and verbal emotional responses. Although supervisors experienced negative moods during research supervision, some refrained from expressing these emotions to students. Certain supervisors believed that criticism hinders problem-solving. One participant explained, “While interacting with students, I found some are genuinely fearful of supervisor authority. In such cases, venting emotions on students only heightens their fear, makes them hesitant to express themselves or their confusion in research, and ultimately hinders their progress” (P1-interview). In addition, some supervisors believed that expressing anger or disappointment toward students could harm their self-efficacy in research. One supervisor stated, “Obtaining a master’s degree is a challenging journey, especially for novice researchers. Confidence is crucial for their success. As a supervisor, I refrain from expressing negative emotions as it can hurt students’ feelings and even damage their confidence” (P3-interview).

As mentioned by the supervisors above, expressing anger and disappointment to graduate students may not resolve issues but damage their self-efficacy. In challenging situations where negative emotions were hard to suppress, supervisors opted to temporarily suspend supervision activities or introduce new tasks to regain composure: “Sometimes revising students’ manuscripts can be a painful task. To avoid the risk of expressing negative emotions to them, I often temporarily suspend the revision. Sometimes I take a walk until I feel calmer and more collected” (P1-interview).

In supervision, expressing emotion is another effective strategy for regulating supervisors’ emotions. Although supervisors were aware that expressing negative emotions may sometimes negatively affect students’ feelings, the importance of their own emotional well-being was emphasized, as “expressing feelings helped me recover from negative moods faster” (P6-interview). However, supervisors had different expressive styles when interacting with their students.

Some supervisors expressed their anger and dissatisfaction to their students directly, through behavioral or verbal emotional responses. A supervisor recounted an incident, “During a phone call with her, I lost my temper because of her terrible attitude, and ended up throwing my phone” (P4-interview).

Interestingly, given that “graduate students are all adults” (P6-interview), some supervisors expressed their emotions more tactfully, taking care not to lose their temper and cause distress to their students. One supervisor “felt angry with a student’s poor writing.” However, instead of scolding the student directly, he made a joke during a one-to-one meeting, saying “It’s not that you wrote poorly. It’s that I am not clever enough to comprehend your writing.” The student laughed, and then the supervision was conducted in a relaxed atmosphere. The supervisor explained: “I do not hide my emotions but prefer to avoid losing my temper and instead use humor to guide my students better” (P5-interview, observation).

This study contributes to the existing literature on emotion regulation by providing detailed insights into how emotion regulation strategies were utilized by research supervisors. It also sheds light on the dilemmas supervisors encounter and the paradox between the context-dependent nature of research supervision and the accountability-based managerial context.

Supervisors’ dilemmas in research supervision

Our study demonstrated supervisors’ capacity to proactively employ diverse emotion regulation strategies when coping with difficulties in research supervision. It also revealed some paradoxical phenomena within the supervisors’ utilization of these emotion regulation strategies, highlighting the dilemmas they encountered in the context of research supervision.

In general, supervisors in our study demonstrated a higher tendency to employ antecedent-focused strategies for emotion regulation rather than response-focused strategies, which can alleviate their emotional burnout and enhance their well-being. Specifically, participants utilized intervention strategies as antecedent-focused strategies to improve the effectiveness of research supervision, rather than seeking consolation to alleviate generated emotions. Previous research has indicated that antecedent-focused strategies were associated with increased life satisfaction (Feinberg et al., 2012 ). By intervening in the emotion generation process at an early stage, these strategies can potentially alter the emotional trajectory, contributing to improved well-being among supervisors (Gross & John, 2003 ).

While supervisors displayed a strong inclination to utilize diverse strategies to enhance the effectiveness of their supervision, our findings unveiled two paradoxical phenomena in their emotion regulation strategies, indicating the dilemmas that supervisors faced in authentic supervisory situations. First, in antecedent-focused strategies aimed at modifying situations that may trigger negative emotions, numerous interventions and detachments highlighted the conflicts supervisors encountered as they strived to balance adequate assistance and excessive interference. Specifically, while participants in our study “inspired students through scaffolding” or “encouraged students’ autonomous learning,” they also “micromanaged students’ research process” or “enforced discipline” to enhance supervision efficiency. This pedagogical paradox concerning the choice between intervening and non-intervening approaches has generated ongoing debate in existing research (Janssen & Vuuren, 2021 ). Both approaches have the potential to evoke negative emotional experiences for supervisors and graduate students. Research found that a highly intervening approach has negative implications for both supervisors and graduate students (Lee, 2020 ). Students who have encountered autonomy-exploitative behavior from their supervisors, such as being restricted to specific research topics and methodologies, have reported experiencing negative emotions (Cheng & Leung, 2022 ). For supervisors, the burden of an intervening approach, the dissonance between supervisors’ expectations and students’ actual research progress, as well as students deviating from conventional practices (Han & Xu, 2023 ), all contribute to feelings of frustration, sadness, and exhaustion. Nevertheless, non-intervening approaches do not always fulfill the expectations of both parties either. Supervisors who encouraged graduate students’ autonomous action acknowledged the value of promoting their independent thinking, which has been identified as a significant predictor of students’ research self-efficacy (Gruzdev et al., 2020 ). However, students who initially expected their supervisors to play a leadership role felt dissatisfied and disappointed when supervisors were reluctant to offer explicit guidance (Janssen & Vuuren, 2021 ). This misunderstanding of supervisors’ intentions can ultimately generate negative effects on supervisors’ emotional experiences (Xu, 2021 ).

Another evident paradoxical phenomenon arises in the response-focused strategies employed after emotions have already been triggered. Although supervisors opted to suppress their negative emotional expression to safeguard the confidence and self-esteem of mature learners, there were instances when they outpoured their disappointment and anger to students, aiming to swiftly step out of their negative moods. The act of expressing and suppressing emotions highlights the dilemma of cultivating a mutually beneficial relationship that promotes emotional well-being for both supervisors and students. On the one hand, the existing literature emphasizes the importance of supervisors being sensitive to students’ emotional experiences (Bastalich, 2017 ). The inherent power imbalance in supervisor-student relationships may create a sense of student dependency on their supervisors (Friedensen et al., 2024 ; Janssen & Vuuren, 2021 ). Excessive criticism from supervisors can potentially lead to feelings of loss, and alienation throughout students’ academic journey, which highlights supervisors’ responsibility to manage their emotional criticism in supervisory interactions (Parker-Jenkins, 2018 ). On the other hand, although pursuing a research degree is a challenging journey for graduate students, it is important to acknowledge the vulnerability of research supervisors and their need for support (Parker-Jenkins, 2018 ). Power dynamics within supervisory relationships, particularly when students challenge or disregard supervisors’ advice, can lead to repression and disengagement for supervisors if negative emotions are not effectively regulated (Xu, 2021 ). Thus, recognizing supervisors’ needs and allowing for emotional expressions are also essential in developing a relationship that is mutually beneficial and conducive to the well-being of both parties (Parker-Jenkins, 2018 ).

The conflicts between research supervision and institutional policies

The dilemmas present in supervisors’ emotion regulation strategies inherently illustrate the context-dependent and non-standardized nature of research supervision. However, as modern higher education institutions move toward implementing accountability-based policies that aim to standardize and quantify research supervision (Jedemark & Londos, 2021 ), conflicts between the nature of supervision and these institutional policies not only place an emotional burden on supervisors, but also endanger the quality of graduate education.

The dilemmas observed in supervisors’ emotion regulation strategies highlight the divergent understandings between supervisors and graduate students regarding their respective responsibilities and the boundaries of the supervisor-student relationship. This divergence is influenced by context-dependent factors in research supervision, including the beliefs, motivations, and initiatives of the individuals involved (Denis et al., 2018 ). Due to the difficulty in achieving a perfect agreement on these context-dependent factors, it becomes challenging to establish a standard for what constitutes an ideal beneficial research supervision (Bøgelund, 2015 ). In authentic supervisory situations, the relationships between supervisors and graduate students can range from formal and distant to informal and intimate in both academic and social interactions (Parker-Jenkins, 2018 ). Therefore, research supervision is a highly context-dependent and non-standardized practice that relies on the capabilities of supervisors and students, which are shaped by their individual experiences and personalities.

This nature of research supervision underscores the significance of avoiding standardization and a “one size fits all” approach. However, as higher education institutions move toward a corporate managerial mode, research supervision is increasingly perceived as a service provided within a provider-consumer framework, and the fundamental aspects of research supervision are being reshaped to align with a culture of performance measurement, control, and accountability (Taylor et al., 2018 ). In modern academia, universities and institutions have established specific guidelines and protocols for research supervision, which require supervisors to follow diligently and take accountability in the supervision process (Figueira et al., 2018 ).

The presence of extensive external scrutiny or accountability ignored the context-dependent and non-standardized nature of research supervision, leading to adverse effects on both supervisors and graduate students. On the one hand, supervisors face significant pressure within an accountability-based context. They are expected to serve as facilitators of structured knowledge transmission, which is enforced through the demanding requirements and time-consuming tasks associated with supervisory practices (Halse, 2011 ). However, the distinctive characteristics of various disciplines and the interdependent relationship between the supervisory context and graduate students’ learning process are neglected (Liang et al., 2021 ). Such a narrow focus on knowledge transmission may pose potential threats to supervisors’ autonomy and academic freedom, generating their feelings of self-questioning, helplessness, and demotivation (Halse, 2011 ). Supervisors in our study reported many examples of emotion regulation strategies utilized to cope with performative and accountability pressures in their workplace. Specifically, the responsibility to ensure timely doctoral completions, prioritize students’ safety, and maintain accountability for those experiencing delays or violating research codes evoked feelings of nervousness, pressure, and insecurity among supervisors.

On the other hand, interventionist supervision within accountability-driven supervisory contexts is perceived as detrimental to students’ academic innovation (Bastalich, 2017 ). The prevailing environment of heightened performativity and accountability alters supervisors’ attitudes toward academic risk-taking, thereby influencing their supervisory practices (Figueira et al., 2018 ). For example, participants in our study utilized prevention and intervention strategies to mitigate potential negative occurrences. This included adopting a directive approach to supervise students’ work and dissuading them from undertaking risky or time-consuming methods to ensure timely completion. However, such micromanagement may stifle innovation, thereby inhibiting doctoral students’ development as independent researchers (Gruzdev et al., 2020 ). Providing pre-packaged research projects or excessive support may hinder students’ acquisition of essential knowledge, skills, and expertise required for their future pursuits, potentially obstructing their progress toward independent thinking (Gruzdev et al., 2020 ).

The conflicts between the prevailing shift from autonomy to accountability in higher education and the context-dependent and non-standardized nature of research supervision highlight the necessity for practice-informed evaluations for research supervision. This finding resonates with previous studies on policy-making in graduate education (Taylor et al., 2018 ), which emphasized the challenges of establishing evidence-based institutional policies to capture the intricate realities of supervision in practice.

Limitations

This study contributes to the understanding of research supervisors’ work by examining their emotion regulation strategies in authentic supervisory situations. However, certain limitations should be addressed for future research. First, the small sample size is a significant limitation, as only six supervisors participated. Future studies may increase the sample size and enhance diversity within the sample. Second, as our study only involved perspectives from research supervisors, future studies may consider incorporating the perceptions of both supervisors and graduate students and analyzing the level of convergence and divergence between the obtained results to enhance the validity of data collection.

Implications for practice

Despite being situated in China’s supervisory accountability system, our study holds broader implications in the global context. As the shift toward corporatized management models in higher education worldwide reshapes research supervision to align with performance measurement and accountability culture (Jedemark & Londos, 2021 ), our results offer implications for research supervision and policy-making beyond the Chinese context.

First, for research supervisors and graduate students, the intricate and dynamic nature of research supervision revealed in our study makes it challenging to offer direct recommendations for optimal emotion regulation strategies. Instead, supervisors are encouraged to adaptively employ a range of emotion regulation strategies in different supervisory situations to enhance their emotional well-being. Additionally, recognizing the context-dependent nature of research supervision, both research supervisors and graduate students are urged to take into account factors such as each other’s beliefs, motivations, and initiatives in their research and daily interactions.

Second, in light of the discrepancy between the current standardized accountability measures in higher education and the context-dependent nature of research supervision, it is imperative for universities and institutions to develop practice-based policies that are tailored to supervisors’ and students’ academic development, avoiding generic and assumed approaches. To effectively address the distinctive requirements of research supervision, policy-makers are strongly encouraged to implement multi-dimensional, discipline-oriented evaluation systems for supervisors in the future.

Data Availability

Data from this study cannot be shared publicly because participants may still be identifiable despite efforts to anonymise the data. Therefore, data will only be made available for researchers who meet criteria for access to confidential data.

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Acknowledgements

The authors would like to thank the participants who made this publication possible.

This work was supported by the Project of Outstanding Young and Middle-aged Scholars of Shandong University, Shandong University Program of Graduate Education and Reform (grant number XYJG2023037) and the General Research Fund of Hong Kong SAR (grant number CUHK 14608922).

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Han, J., Jin, L. & Yin, H. Supervisors’ emotion regulation in research supervision: navigating dilemmas in an accountability-based context. High Educ (2024). https://doi.org/10.1007/s10734-024-01241-x

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Securities and Exchange Commission

• [Release No. 34-100785; File No. SR-SAPPHIRE-2024-17]

Pursuant to the provisions of Section 19(b)(1) of the Securities Exchange Act of 1934 (“Act”)  [ 1 ] and Rule 19b-4 thereunder, [ 2 ] notice is hereby given that on August 9, 2024, MIAX Sapphire, LLC (“MIAX Sapphire” or “Exchange”) filed with the Securities and Exchange Commission (“Commission”) a proposed rule change as described in Items I, II, and III below, which Items have been prepared by the Exchange. The Commission is publishing this notice to solicit comments on the proposed rule change from interested persons.

The Exchange proposes to amend Interpretation and Policy .01 to Exchange Rule 1903, Continuing Education.

The text of the proposed rule change is available on the Exchange's website at https://www.miaxglobal.com/​markets/​us-options/​miax-sapphire/​rule-filings , at the Exchange's principal office, and at the Commission's Public Reference Room.

In its filing with the Commission, the Exchange included statements concerning the purpose of and basis for the proposed rule change and discussed any comments it received on the proposed rule change. The text of these statements may be examined at the places specified in Item IV below. The Exchange has prepared summaries, set forth in sections A, B, and C below, of the most significant aspects of such statements.

The Exchange proposes to amend Interpretation and Policy .01 to Exchange Rule 1903, Continuing Education, to clarify participation requirements and deadline dates of the continuing education program.

The Form 1 Application of MIAX Sapphire was approved by the Securities Exchange Commission to register as a national securities exchange on July 15, 2024. [ 3 ] MIAX Sapphire intends to begin trading operations on August 12, 2024. In anticipation of the launch of the Exchange MIAX Sapphire is in the process of updating rules so that they are current.

Policy .01 of Exchange Rule 1903 describes the conditions and timeframes for certain individuals registered with the Exchange to participate in the continuing education program under paragraph (c) of Rule 1903. FINRA amended their Continuing Education (“CE”) Program requirements in FINRA Rule 1240 in 2021 to establish a Maintaining Qualifications Program (MQP). [ 4 ] Under FINRA Rule 1240.01, FINRA designated a look-back provision for the two years immediately prior to March 15, 2022 for meeting the requirements of the MQP.

In 2023, FINRA again amended FINRA Rule 1240.01, to provide eligible individuals a second opportunity to elect to participate in the MQP. [ 5 ] This change required eligible individuals who elected to participate in the MQP during the second look-back period to complete any prescribed continuing education content by March 31, 2024. For technical reasons related to the mechanics of registering in the MQP via FINRA's Financial Professional Gateway (“FinPro”) account some eligible individuals may have been precluded from properly registering for the MQP, therefore, FINRA again amended its rule to extend the requirements completion period to July 1, 2024. [ 6 ]

The Exchange proposes to amend its Rule to provide that individuals enrolled in the continuing education program under Interpretation and Policy .01 of Rule 1903 who have completed their prescribed 2022 and 2023 continuing education content by July 1, 2024 shall be eligible to continue their ( print page 68485) participation in the continuing education program. The time period extensions provided by FINRA beginning in 2021 for maintaining registrations have all concluded, therefore the Exchange believes that this change will provide clarity in regards to the eligibility requirements for participation in the continuing education program.

The Exchange believes the proposed rule change is consistent with the Act and the rules and regulations thereunder applicable to the Exchange and, in particular, the requirements of Section 6(b) of the Act. [ 7 ] Specifically, the Exchange believes the proposed rule change is consistent with the Section 6(b)(5)  [ 8 ] requirements that the rules of an exchange be designed to prevent fraudulent and manipulative acts and practices, to promote just and equitable principles of trade, to foster cooperation and coordination with persons engaged in regulating, clearing, settling, processing information with respect to, and facilitating transactions in securities, to remove impediments to and perfect the mechanism of a free and open market and a national market system, and, in general, to protect investors and the public interest. Additionally, the Exchange believes the proposed rule change is consistent with the Section 6(b)(5)  [ 9 ] requirement that the rules of an exchange not be designed to permit unfair discrimination between customers, issuers, brokers, or dealers. The Exchange's rule proposal is intended to harmonize the Exchange's supervision rules, specifically with respect to the continuing education requirements with those of FINRA, on which they are based. Consequently, the proposed change will conform the Exchange's rules to recent changes made to corresponding FINRA rules, thus promoting application of consistent regulatory standards with respect to rules that FINRA enforces pursuant to its regulatory services agreement with the Exchange.

The Exchange believes that the proposed rule change will bring consistency and uniformity with FINRA's recently amended CE Program, which will, in turn, assist members and their associated persons in complying with these rules and improve regulatory efficiency. The proposed rule change makes ministerial changes to the Exchange's CE rules to align them with the CE rules of FINRA, in order to prevent unnecessary regulatory burdens and to promote efficient administration of the rules.

The Exchange does not believe that the proposed rule change will result in any burden on competition that is not necessary or appropriate in furtherance of the purposes of the Act. The Exchange believes that the proposed rule change, which harmonizes its rules with the recent rule change adopted by FINRA, will reduce the regulatory burden placed on market participants engaged in trading activities across different markets. The Exchange believes that the harmonization of the CE program requirements across the various markets will reduce burdens on competition by removing impediments to participation in the national market system and promoting competition among participants across the multiple national securities exchanges.

Written comments were neither solicited nor received.

Pursuant to Section 19(b)(3)(A) of the Act  [ 10 ] and Rule 19b-4(f)(6)  [ 11 ] thereunder, the Exchange has designated this proposal as one that effects a change that: (i) does not significantly affect the protection of investors or the public interest; (ii) does not impose any significant burden on competition; and (iii) by its terms, does not become operative for 30 days after the date of the filing, or such shorter time as the Commission may designate if consistent with the protection of investors and the public interest. [ 12 ]

At any time within 60 days of the filing of the proposed rule change, the Commission summarily may temporarily suspend such rule change if it appears to the Commission that such action is necessary or appropriate in the public interest, for the protection of investors, or otherwise in furtherance of the purposes of the Act.

Interested persons are invited to submit written data, views and arguments concerning the foregoing, including whether the proposed rule change is consistent with the Act. Comments may be submitted by any of the following methods:

• Use the Commission's internet comment form ( https://www.sec.gov/​rules/​sro.shtml ); or
• Send an email to [email protected] . Please include file number SR-SAPPHIRE-2024-17 on the subject line.
• Send paper comments in triplicate to Secretary, Securities and Exchange Commission, 100 F Street NE, Washington, DC 20549-1090.

All submissions should refer to file number SR-SAPPHIRE-2024-17. This file number should be included on the subject line if email is used. To help the Commission process and review your comments more efficiently, please use only one method. The Commission will post all comments on the Commission's internet website ( https://www.sec.gov/​rules/​sro.shtml ). Copies of the submission, all subsequent amendments, all written statements with respect to the proposed rule change that are filed with the Commission, and all written communications relating to the proposed rule change between the Commission and any person, other than those that may be withheld from the public in accordance with the provisions of 5 U.S.C. 552 , will be available for website viewing and printing in the Commission's Public Reference Room, 100 F Street NE, Washington, DC 20549, on official business days between the hours of 10:00 a.m. and 3:00 p.m. Copies of the filing also will be available for inspection and copying at the principal office of the Exchange. Do not include personal identifiable information in submissions; you should submit only information that you wish to make available publicly. We may redact in part or withhold entirely from publication submitted material that is obscene or subject to copyright protection. All submissions should refer to file number SR-SAPPHIRE-2024-17 and should be submitted on or before September 16, 2024.

For the Commission, by the Division of Trading and Markets, pursuant to delegated authority. 13

Sherry R. Haywood,

Assistant Secretary.

1.   15 U.S.C. 78s(b)(1) .

2.   17 CFR 240.19b-4 .

3.   See Securities Exchange Act Release No. 100539 (July 15, 2024), 89 FR 58848 (July 19, 2024) (File No. 10-240) (order approving application of MIAX Sapphire, LLC for registration as a national securities exchange).

4.   See Securities Exchange Act Release No. 93097 (September 21, 2021), 86 FR 53358 (September 27, 2021) (Order Approving File No. SR-FINRA-2021-015). Other exchanges, including the Exchange's affiliate, MIAX, subsequently filed copycat rule filings to align their continuing education rules with those of FINRA. See Securities Exchange Act Release No. 95140 (June 22, 2022), 87 FR 38438 (June 28, 2022) (SR-MIAX-2022-23) (Notice of Filing and Immediate Effectiveness of a Proposed Rule Change To Amend Exchange Rule 1900, Registration Requirements, Exchange Rule 1903, Continuing Education Requirements, and Exchange Rule 1904, Electronic Filing Requirements for Uniform Forms).

5.   See Securities Exchange Act Release No. 97184 (Mar. 22, 2023), 88 FR 18359 (Mar. 28, 2023) (SR-FINRA-2023-005) (Notice of Filing and Immediate Effectiveness of a Proposed Rule Change to Amend FINRA Rule 1240.01 To Provide Eligible Individuals Another Opportunity to Elect to Participate in the Maintaining Qualifications Program). The Exchange notes that the second look-back period does not appear in Sapphire Rule 1903 as it concluded prior to the Exchange's Form 1 Application being approved.

6.   See Securities Exchange Act Release No. 100067 (May 6, 2024), 89 FR 40520 (May 10, 2024) (SR-FINRA-2024-006)(Notice of Filing and Immediate Effectiveness of a Proposed Rule Change To Amend FINRA Rule 1240.01 To Reopen the Period by Which Certain Participants in the Maintaining Qualifications Program May Complete Their Prescribed Continuing Education Content).

7.   15 U.S.C. 78f(b) .

8.   15 U.S.C. 78f(b)(5) .

9.   Id.

10.   15 U.S.C. 78s(b)(3)(A) .

11.   17 CFR 240.19b-4(f)(6) .

12.  In addition, Rule 19b-4(f)(6) requires a self-regulatory organization to give the Commission written notice of its intent to file the proposed rule change, along with a brief description and text of the proposed rule change, at least five business days prior to the date of filing of the proposed rule change, or such shorter time as designated by the Commission. The Exchange has satisfied this requirement.

13.   17 CFR 200.30-3(a)(12) .

[ FR Doc. 2024-19014 Filed 8-23-24; 8:45 am]

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