OCNZ Paediatric Capabilities Stiofan Mac Suibhne London @OIAlliance Convention London Oct 2014
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#OCNZ @OsteoRegulation has an ongoing research project to develop capabilities of osteopathic paediatric practice. This presentation is an update on progress so far
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OCNZ Paediatric Capabilities Stiofan Mac Suibhne London @OIAlliance Convention London Oct 2014
- 1. Stiofán Mac Suibhne OCNZ Project Officer
- 2. Serious Complaint relating to a Child (2009) http://tinyurl.com/Rodriguez-Case Statutory duty to determine mechanisms for ensuring practitioners are competent Align the osteopathic scope of practice with the strategic direction Reduced doctor time will require maximising the services delivered in primary care by allied health professionals.
- 3. Indigenous health – closing the gap The changing demographic –Western societies are graying But NZ larger family sizes in Māori & Pasifika Staking a claim for the osteopathic skill set Inter-ministerial Working Party on Children Serious criminal case including a child victim (2012)
- 4. A vision for osteopathic paediatric practice not reverse-engineered from curricula We need to develop a knowledge, skills & attitudes framework for working with children in the NZ context How can we teach / assess paediatric manual therapy skills in osteopathy? Vocational Scope for Paediatric Practice – models of advanced practice
- 7. Overcoming barriers Osteopathic Exceptionalism & Magical Thinking – We are just different!
- 8. Health Practitioner Competence Assurance Act (2003) (1) The principal purpose of this Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.
- 9. Interprofessional Relationships Primary Healthcare Responsibilities Osteopathic Care &Scope of Practice Person Orientated Care & Commuication Clinical Analysis Professional & Business Activities
- 11. Survey Profession –conditions osteopaths are seeing in practice and how are they treating them (22% response rate) 81% Treated Children Data related to 289 children / 757 Treatments Review of international paediatric curricula Delphi Group of 10 osteopaths recognised as ‘expert’ paediatric practioners Identifying how experts developed their skills
- 12. Top 10 conditions for these patients (n=59) Colic 32% Feeding problem 31% Fussy baby 29% Sleep disturbance 27% Gastro-oesophageal Reflux 22% Abdominal pain 20% new baby check 15% Plagiocephaly 15% Torticollis 7% Constipation 5%
- 13. Top 10 conditions for these patients (n=53) Colic 32% Feeding problem 32% Fussy infant/baby 32% Sleep disturbance 30% Gastro-oesophageal Reflux 26% Plagiocephaly 21% Abdominal pain 19% Torticollis 11% Conjunctivitis 6% constipation 6%
- 14. Top 10 conditions for these patients (n=29) Otitis media (chronic) 28% Behavioural problems 14% Feeding problem 14% Upper respiratory infection 14% Neck pain 10% Sleep disturbance 10% Abnormality of gait 7% Colic 7% Failure to Thrive 7% Headache (not migraine) 7%
- 15. Top 10 conditions for these patients (n=71) Neck pain 30% Leg pain 25% Headache (not migraine) 23% Lumbar back pain 23% Thoracic back pain 23% Sports injuries 20% Muscle spasm 11% Behavioural problems 8% Abnormality of gait 7% Head Injury 7%
- 16. Top 10 conditions for these patients (n=59) Neck pain 53% Sports injuries 43% Lumbar pain 46% Thoracic pain 44% Headache (not migraine) 31% Leg pain 31% Muscle spasm 22% Head Injury 8% Uncomfortable defecation 8% Abdominal pain 4%
- 17. Globally no osteopathic regulator has developed set of capabilities for paediatric practice – whatever standards apply are embedded within a general set of capabilities Most paediatric patients are being treated non-cranially for musculoskeletal presentations Paediatrics has become somewhat confused with cranial osteopathy as a technique.
- 18. Youngest age 8 for HVLA Different presentations predominate at the various stages of child development University accreditation processes silent on paediatrics Exposure to paediatric patients in pre-registration training inadequate / happenstance International curriculum scan useful context but dominated by procedural / technical approaches
- 19. Review and update Osteopathic Capabilities to incorporate paediatric practicehttp://tinyurl.com/lya94hm Develop methodologies for identifying KSA for osteopathic paediatric practice Standard of Care / Treatment Pathways Develop assessment methodologies Restricted HVLA & Internal techniques in children
- 20. Normal child development Diagnostic competencies Pathophysiology Evidence / Biological Plausibility Other management strategies
- 21. 1. Colic & constipation 2. Suck and latch 3. Birth trauma 4. Plagiocephaly and altered head shape. 5. Congenital hip dysplasia. 6. Torticolis 7. Shoulder dystocia / brachial plexus injury. 8. Meningitis 9. Reflux
- 22. 1. Neck pain 2. Otitis Media / EENT 3. Minor mechanical trauma 4. Headaches 5. Asthma 6. Perthes 7. Dyspraxia 8. Juvenile RA 9. Sleep 10. Abnormal Gait
- 23. 1. Growing pains 2. Osgood Schlatters 3. Severs disease 4. Chondromalacia Patellae 5. Post fracture rehabilitation 6. Adolescent Scoliosis 7. Spondylolysthesis 8. Slipped Upper Femoral Epiphysis 9. Learning delay / autism spectrum 10. Headache
- 25. Using network of Primary Care professionals receiving / making referrals to osteopaths Wider focus on determinants of health & embedding osteopathic practice in the healthcare system Flesh out standard of care pathways Self-study & ePortfolio Assessment High Trust process Vocational Scope of practice for paediatrics - Advanced practice Acknowledge that for some Change is Pain
- 26. www.osteopathiccouncil.org.nz @OsteoRegulation Stiofán Mac Suibhne - OCNZ Project Officer stiofan@osteopathiccouncil.org.nz
Editor's Notes
- We are not educators or interested in academic excellence. A certain level of underlying knowledge is clearly required for competent practice but what that would be is contestable and as least as important is self-awareness of one’s own competencies and boundaries. Our registrants are not students. They are our peers. There has been an amazing amount achieved. Moving the focus of what the profession understands as competence beyond the boundaries and artificial subject areas of pre-registration training courses to professional practice. [A comprehensive capabilities framework to giving a unifying rational to assessment in pre-registration training, overseas assessment, return to practice and competency reviews The development of an work-based competence assessment portfolio]
- [NZ has a sophisticated healthcare regulatory system The central concerns are the human rights, health & wellbeing and cultural safety of the patient - rather than more narrowly defined professional interests and workforce supply concerns as is perhaps the case in comparable jurisdictions] An important event in the development of the NZ framework has come to be known as ‘The Unfortunate Experiment’. Over 3 decades in the 60s 70s & 80s a senior doctor, with the full knowledge of his peers, sought to establish that there was no relationship btwn abnormal cervical smears and early death from gynaecological cancer. Without consent arbitrarily he decided to treat or not treat women with abnormal smears. The subsequent enquiries and the sense of betrayal amongst the public has created a policy framework where health professionals would never again to be trusted within a self-regulatory context to protect the interests of the public.
- Resource constraints - that wont change – work with what is there Focus on the added value of reflection rather than the growing pains of different working practices. Reluctance of healthcare professionals to be assessed. Undoing the damage done by educational institutions! Assessment anxiety and overload
- Under the Act the Osteopathy Council is established as the regulatory authority for the NZ profession. There are also obligations to the Māori under the Treaty of Waitangi and the bicultural settlement. There are 450 osteopaths in NZ and the Council is entirely funded from the annual registration fee. They have no full time staff and are a council of 8 individuals appointed by the Minister of Health. One of the major challenges is diseconomies of scale. A legacy of the ‘Unfortunate Experiment’ is a STRONG Regulatory presence. Competence means something more that not doing harm but is nevertheless not easily defined. [The Council’s statutory duties: Determine scopes of practice Prescribe qualifications / accredit universities Determine Practice standards Operate systems that ensure ongoing maintenance of competence Assess international osteopathic graduates] Conduct Competence & Fitness to practice reviews]
- The Capabilities were developed in collaboration with Prof David Boud at UTS and are a distillation from representative groups of Australasian practising osteopath – not educators. We are very pleased with them! So whilst there is clearly a conditioned / conditioning relationship between underlying professional knowledge and competency in practice, it is practice itself that determines what knowledge, skills and attitudes support competence. Major consequences for university courses. A broad definition of practice is required to accommodate the range of practice styles and philosophies within the profession. The reality is each practitioner develops there own personal / professional scope of practice and in a sense the scope of practice for the profession emerges from this and is then shaped by the regulatory framework. [As osteopaths are primary care / primary contact practitioners there is a shared understanding of diagnostic competencies and knowledge with the wider healthcare system but there is an emergent nature to practice and it is simply not possible to predict all situations that will be encountered in practice.} [Osteopaths in NZ have a broad general scope of practice and number of vocational scopes Pain Management, Gerontology and Western Medical Acupuncture they may register in with appropriate post grad qualifications.] [Your patients and emphasis in practice determine what the underlying KSA and competencies should be not a pre-registration training curriculum] [A multiplicity of competencies and specific knowledge & procedural skills can then be accommodated within this framework. The Capabilities for Osteopathic Practice have become a unifying framework in: (1) university accreditation (2) assessing overseas trained osteopaths (3) shaping the approach to professional development processes and recertification.]