lifelong , self-directed learning and the maintenance of competence: the triple helix of continuing professional development

abstract it has been proposed that we think of continuing medical education (cme) as a two-stranded helix, in which one strand represents the internal characteristics of the learner-physician, the other strand the culture and environment in which he or she practices and lives. in many countries, the product of these two strands has been increasingly termed ‘continuing professional development’, (cpd). this model holds implications for cme providers and programs of maintenance of competence: what we know about lifelong, self-directed learning (sdl) and the role of culture, environment and setting on learning. this paper proposes an expanded role for cme or cpd providers, constructed on an understanding of self-directed learning, the environment or setting in which physicians work, and, on the evidence about effective cme methods. finally, these concepts will provide a springboard to describe an idealized or conceptualized vision of the role of the cme provider - the third strand in a triple helix - building on self-directed learning, expanding the definition of maintenance of competence and attempting to effect optimal health care.