Sir, I was pleased to read the timely editorial on the nature of verifiable CPD.1 I share your views concerning the issues raised in what might be simplistically thought of as the task of 'getting the answers right'. They are, as you rightly acknowledge, far from easy to resolve.

For over 30 years as a part-time clinical teacher I have been involved with courses of differing levels serving many types of participant. I often ask myself what does everyone get from the experience and is there any way it can be reliably measured? The use of stated course objectives, questionnaires, interviews, quizzes, focus groups and the like are some of the standard tools used in order to demonstrate that the process is 'fit for purpose'. All are potentially helpful but none in my view can truly gauge the effect of any particular course content, teaching or instruction and indeed how it will influence the performance of any particular individual now or in the future. This is very inconvenient.

I do, however, share my colleague Martin Kelleher's concerns about a system which fails to encourage and reward those who diligently seek to improve and apply their skills and knowledge, acquired through genuine application and study.2 This unpleasant realism does somewhat undermine the credibility of the ethos of continuing professional development as seen here in the United Kingdom.

I do not have any ready panaceas to contribute to the debate save the observation that the process can be likened to an act of faith 'the substance of things hoped for; the evidence of things not yet seen'.3