Commitments and obligations in return for privileges
Change in red
One might reasonably ask why did we choose to have nine not seven. However, for a surgical college it was thought that medical and technical expertise were different, and surgery is most certainly a procedural specialty and deserved a competency devoted to it. Also the decision to operate or not to operate, the decision to treat or palliate is so essential to surgery that clinical decision making and judgement were added to the Can Meds seven. CanMeds most certainly lacks the judgement competency so important to all medical specialties.There is also overlap between the comptencies which is displayed on the figure although obviously each competency can overlap with many of the others.
Each competency is described by three patterns of behaviour. There is no special order to the patterns of behaviour. One does not lead to another but there is often considerable overlap.
The assessment tool developed uses a 4 point leikert rating scale – poor, marginal, good, excellent. The behavioural markers are used to describe illustrative behaviours to guide the rating.Some examples of the different patterns of behaviourare shown in the following slides. Each pattern of behaviour is rated, making 27 patterns of behaviour to be assessed.
There is the option to make free text comments for each competency, combining comments for each of the three patterns of behaviour for that competency.
Case Study: Continuing Professional Development in Specialist Medical Colleges - Prof David Watters
Continuing Professional DevelopmentSpecialist Medical Colleges Professor David Watters S Royal Australasian College of Surgeons
Presented at the Wiley seminarProfessional Development Across the Professions Melbourne, 1 March 2012 #pdmelb wileyprolearning.wordpress.com
Continuing Professional DevelopmentS Why do CPD?S Principles of CPDS What do medical colleges do?S What’s new?S Compliance, Verification and Professional registration
Elements of ProfessionalismS Putting patients firstS Managing conflicts of interestS Honesty and confidentialityS Disclosing errorsS Self-regulationS Advocacy Gruen, Watters and Hollands. Surgical Wisdom. BJS 2011
The Social Contract in MedicineSociety Profession expectations Patient obligations Physician Professionalism Cruess R & Cruess S Linda Snell, 2012
Professionalism - expectations Social contractAutonomy Assured competenceSelf regulation Altruistic serviceMonopoly Morality, integrity, honestyTrust Accountability, transparencyRole in public policy Respect for patient autonomyRewards … Promotion of the public good .. Linda Snell 2012 Tricollege consensus, 2012, Cruess et al, McGill, 2005
What is expected with CPD?S Commitment to Lifelong LearningS Continuous improvement in performanceS Maintenance of Competence
Learning Management StrategyS Transitions and Stages of a careerS Competency-alignedS Aligned to scope of practice and context of practiceS Capable of AssessmentS Based on contemporary learning principles S Adult learning S Self-referenced/reflective S Work-based S E-learning tools RACS, RACP, RCPSC consensus, Feb 2012
Modern Principles of CPDS Educational principlesS Promoting quality not quantityS Learning and Development mapped to competenciesS Performance assessmentS Improving performance
Educational PrinciplesS Adult learningS Reflective practiceS Variety of Learning styles and preferencesS Self directed and individually tailoredS Lifelong learning
Evidence for Facilitating Professional LearningS The learner is motivatedS The learning is self directedS Learning is matched to recognised learning needsS The process encourages active participationS Learning involves reflectionS Evaluation of what has been learned Pam Montgomery, Council papers 2009 Continuing Professional Development – does it work?
Competency based CPDS Use practice information to identify learning prioritiesS Develop and monitor CPD (learning) planS Access information sources for new evidence or innovationsS Establish a personal knowledge management systemS Use tools and processes to measure competence and performanceS Improve practice Campbell C et al. Medical Teacher 2010;32:657-662
Effective CPDWhat do we want to achieve?S For all surgeonsS Compliance is mandatory but easy to document and verifyS Documentation and verificationS Reflection rewarded and reinforcedS Learning addressed to needsS Professional Development Plan aligned to competencies
Workbased Assessment toolsS Direct ObservationS Multisource feedbackS Audit and feedbackS SimulationS Reflective learning portfolios
Each RACS Competency hasThree Patterns of Behaviour
Performance Assessment mapped to competenciesS Multisource feedback toolS Based on the 9 competencies and 27 patterns of behaviourS Promotes reflectionS Opportunities for improvement can be recognisedS A learning/development plan can be devisedS Improved performance can be evaluated
CPD Points Annual and TriennialS Conferences,Workshops and CoursesS Audit and Peer reviewS Practice visitsS Multi-source feedbackS Teaching, Journals and ResearchS Clinical governanceS On-line learning modules
8 Categories of CPD compliance 2010 - 2012No Category Annual requirement1 Surgical Audit and Peer Review Both required ANZ Audit of Surgical Mortality2 Credentialed at a hospital Letter of appointment3 Clinical Governance and Evaluation of Care 30 pts4 Maintenance of knowledge and skills 210 pts for 4-75 Teaching and Examination6 Research and Publication7 Other professional development8 Medico-legal Workshop or Peer review
2010-2012 CPD Types of Surgical PracticeS Surgical practice in hospitals and day centresS Surgical procedures only in roomsS Surgical consultation onlyS Medicolegal (personal injury) – non clinicalS Medicolegal (negligence) – non clinicalS Research, Administration – non-clinical workS Locums & Surgical Assisting
My CPD - RACPS Lifelong LearningS A continual process of reflectionS AssessmentS Learner centred approachS Learner identifies needsS Ensures means of changeS Diary, Learner Log,S Integrated learning navigator
Supporting Physicians’Professionalism and Performance
AnaesthetistsS Participate on-line or off lineS CPD plan every 3 yearsS record activitiesS Write reflectionsS Write an evaluationS Produce statements for registration and re- credentialing
Regulatory expectationsS Re-certificationS Re-validationS Registration with AHPRA, MCNZ etc
VerificationS Significant percentageS EasyS Built in to CPD programS Electronically facilitated
Design Principles for CPDS Transitions and Stages of a careerS Competency-alignedS Aligned to scope of practice and context of practiceS Capable of AssessmentS Based on contemporary learning principles S Adult learning S Self-referenced/reflective S Work-based S E-learning tools RACS, RACP, RCPSC consensus, Feb 2012
SummaryS CPD is expected of us and is part of our social contract with the patient, society and the professionS CPD is required by the regulatory authorities but they have delegated verification to the Colleges (at present)S CPD can contribute positively to our professional lives and ensure we continuously improve through learningS We will know where we are at (self-referenced) and how we are doing