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Continuing
   Professional
   Development
Specialist Medical Colleges



        Professor David Watters           S
 Royal Australasian College of Surgeons
Presented at the Wiley seminar


Professional Development
 Across the Professions

      Melbourne, 1 March 2012


              #pdmelb
  wileyprolearning.wordpress.com
Continuing Professional
         Development

S Why do CPD?

S Principles of CPD

S What do medical colleges do?

S What’s new?

S Compliance, Verification and Professional
  registration
Professionalism



S Competent
S Fit
S Safe
Elements of Professionalism


S Putting patients first

S Managing conflicts of interest

S Honesty and confidentiality

S Disclosing errors

S Self-regulation

S Advocacy

                Gruen, Watters and Hollands. Surgical Wisdom. BJS 2011
The Social Contract in Medicine

Society                              Profession


                      expectations
          Patient     obligations                 Physician




                     Professionalism
                                         Cruess R & Cruess S
                                         Linda Snell, 2012
Professionalism - expectations

                 Social contract
Autonomy                            Assured competence
Self regulation                            Altruistic service
Monopoly                        Morality, integrity, honesty
Trust                         Accountability, transparency
Role in public policy        Respect for patient autonomy
Rewards …                   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 Learning

S Continuous improvement in performance

S Maintenance of Competence
Learning Management
          Strategy
S Transitions and Stages of a career

S Competency-aligned

S Aligned to scope of practice and context of practice

S Capable of Assessment

S 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 CPD


S Educational principles

S Promoting quality not quantity

S Learning and Development mapped to
  competencies

S Performance assessment

S Improving performance
Educational Principles


S Adult learning

S Reflective practice

S Variety of Learning styles and preferences

S Self directed and individually tailored

S Lifelong learning
Evidence for Facilitating
      Professional Learning

S The learner is motivated

S The learning is self directed

S Learning is matched to recognised learning needs

S The process encourages active participation

S Learning involves reflection

S Evaluation of what has been learned

               Pam Montgomery, Council papers 2009
        Continuing Professional Development – does it work?
Competency based CPD

S Use practice information to identify learning priorities

S Develop and monitor CPD (learning) plan

S Access information sources for new evidence or
  innovations

S Establish a personal knowledge management
  system

S Use tools and processes to measure competence
  and performance

S Improve practice      Campbell C et al. Medical Teacher 2010;32:657-662
Effective CPD
What do we want to achieve?
S For all surgeons

S Compliance is mandatory but easy to document and
  verify

S Documentation and verification

S Reflection rewarded and reinforced

S Learning addressed to needs

S Professional Development Plan aligned to
  competencies
Workbased Assessment tools


S Direct Observation
S Multisource feedback
S Audit and feedback
S Simulation
S Reflective learning portfolios
Competency based CPD
Competence and Performance
Assessing Performance


S Observable behaviours

S Performance
  markers/descriptors

S Based on workplace
  and real practice
  situations

S Aligned to
  competencies
Nine RACS Competencies
Each RACS Competency has
Three Patterns of Behaviour
Performance Assessment
   mapped to competencies

S Multisource feedback tool

S Based on the 9 competencies and 27 patterns of
  behaviour
S Promotes reflection

S Opportunities for improvement can be recognised

S A learning/development plan can be devised

S Improved performance can be evaluated
Performance Assessment
Communication
Performance Assessment

S Performance
 Development
S Performance
 Review
S Performance
 Management
CPD Points
                Annual and Triennial

S Conferences,Workshops and
  Courses

S Audit and Peer review

S Practice visits

S Multi-source feedback

S Teaching, Journals and Research

S Clinical governance

S On-line learning modules
8 Categories of CPD
     compliance 2010 - 2012
No   Category                                     Annual requirement
1    Surgical Audit and Peer Review               Both required
     ANZ Audit of Surgical Mortality
2    Credentialed at a hospital                   Letter of appointment
3    Clinical Governance and Evaluation of Care   30 pts
4    Maintenance of knowledge and skills          210 pts for 4-7
5    Teaching and Examination
6    Research and Publication
7    Other professional development
8    Medico-legal                                 Workshop or Peer review
2010-2012 CPD
     Types of Surgical Practice
S Surgical practice in hospitals and day centres

S Surgical procedures only in rooms

S Surgical consultation only

S Medicolegal (personal injury) – non clinical

S Medicolegal (negligence) – non clinical

S Research, Administration – non-clinical work

S Locums & Surgical Assisting
My CPD - RACP

S   Lifelong Learning

S   A continual process of reflection

S   Assessment

S   Learner centred approach

S   Learner identifies needs

S   Ensures means of change

S   Diary, Learner Log,

S   Integrated learning navigator
Supporting Physicians’
Professionalism and Performance
Anaesthetists

S Participate on-line or off
  line

S CPD plan every 3 years

S record activities

S Write reflections

S Write an evaluation

S Produce statements for
  registration and re-
  credentialing
Regulatory expectations


S Re-certification
S Re-validation
S Registration with AHPRA, MCNZ etc
Are Specialist Colleges the
       policeman?
Breaching the code of conduct
Verification


S Significant percentage
S Easy
S Built in to CPD program
S Electronically facilitated
Design Principles for CPD

S Transitions and Stages of a career

S Competency-aligned

S Aligned to scope of practice and context of practice

S Capable of Assessment

S 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
Summary

S CPD is expected of us and is part of our social
  contract with the patient, society and the profession

S 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
  learning

S We will know where we are at (self-referenced) and
  how we are doing

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Case Study: Continuing Professional Development in Specialist Medical Colleges - Prof David Watters

  • 1. Continuing Professional Development Specialist Medical Colleges Professor David Watters S Royal Australasian College of Surgeons
  • 2. Presented at the Wiley seminar Professional Development Across the Professions Melbourne, 1 March 2012 #pdmelb wileyprolearning.wordpress.com
  • 3. Continuing Professional Development S Why do CPD? S Principles of CPD S What do medical colleges do? S What’s new? S Compliance, Verification and Professional registration
  • 5. Elements of Professionalism S Putting patients first S Managing conflicts of interest S Honesty and confidentiality S Disclosing errors S Self-regulation S Advocacy Gruen, Watters and Hollands. Surgical Wisdom. BJS 2011
  • 6. The Social Contract in Medicine Society Profession expectations Patient obligations Physician Professionalism Cruess R & Cruess S Linda Snell, 2012
  • 7. Professionalism - expectations Social contract Autonomy Assured competence Self regulation Altruistic service Monopoly Morality, integrity, honesty Trust Accountability, transparency Role in public policy Respect for patient autonomy Rewards … Promotion of the public good .. Linda Snell 2012 Tricollege consensus, 2012, Cruess et al, McGill, 2005
  • 8. What is expected with CPD? S Commitment to Lifelong Learning S Continuous improvement in performance S Maintenance of Competence
  • 9. Learning Management Strategy S Transitions and Stages of a career S Competency-aligned S Aligned to scope of practice and context of practice S Capable of Assessment S 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
  • 10. Modern Principles of CPD S Educational principles S Promoting quality not quantity S Learning and Development mapped to competencies S Performance assessment S Improving performance
  • 11. Educational Principles S Adult learning S Reflective practice S Variety of Learning styles and preferences S Self directed and individually tailored S Lifelong learning
  • 12. Evidence for Facilitating Professional Learning S The learner is motivated S The learning is self directed S Learning is matched to recognised learning needs S The process encourages active participation S Learning involves reflection S Evaluation of what has been learned Pam Montgomery, Council papers 2009 Continuing Professional Development – does it work?
  • 13. Competency based CPD S Use practice information to identify learning priorities S Develop and monitor CPD (learning) plan S Access information sources for new evidence or innovations S Establish a personal knowledge management system S Use tools and processes to measure competence and performance S Improve practice Campbell C et al. Medical Teacher 2010;32:657-662
  • 14. Effective CPD What do we want to achieve? S For all surgeons S Compliance is mandatory but easy to document and verify S Documentation and verification S Reflection rewarded and reinforced S Learning addressed to needs S Professional Development Plan aligned to competencies
  • 15. Workbased Assessment tools S Direct Observation S Multisource feedback S Audit and feedback S Simulation S Reflective learning portfolios
  • 18. Assessing Performance S Observable behaviours S Performance markers/descriptors S Based on workplace and real practice situations S Aligned to competencies
  • 20. Each RACS Competency has Three Patterns of Behaviour
  • 21. Performance Assessment mapped to competencies S Multisource feedback tool S Based on the 9 competencies and 27 patterns of behaviour S Promotes reflection S Opportunities for improvement can be recognised S A learning/development plan can be devised S Improved performance can be evaluated
  • 24. Performance Assessment S Performance Development S Performance Review S Performance Management
  • 25. CPD Points Annual and Triennial S Conferences,Workshops and Courses S Audit and Peer review S Practice visits S Multi-source feedback S Teaching, Journals and Research S Clinical governance S On-line learning modules
  • 26. 8 Categories of CPD compliance 2010 - 2012 No Category Annual requirement 1 Surgical Audit and Peer Review Both required ANZ Audit of Surgical Mortality 2 Credentialed at a hospital Letter of appointment 3 Clinical Governance and Evaluation of Care 30 pts 4 Maintenance of knowledge and skills 210 pts for 4-7 5 Teaching and Examination 6 Research and Publication 7 Other professional development 8 Medico-legal Workshop or Peer review
  • 27. 2010-2012 CPD Types of Surgical Practice S Surgical practice in hospitals and day centres S Surgical procedures only in rooms S Surgical consultation only S Medicolegal (personal injury) – non clinical S Medicolegal (negligence) – non clinical S Research, Administration – non-clinical work S Locums & Surgical Assisting
  • 28. My CPD - RACP S Lifelong Learning S A continual process of reflection S Assessment S Learner centred approach S Learner identifies needs S Ensures means of change S Diary, Learner Log, S Integrated learning navigator
  • 30. Anaesthetists S Participate on-line or off line S CPD plan every 3 years S record activities S Write reflections S Write an evaluation S Produce statements for registration and re- credentialing
  • 31. Regulatory expectations S Re-certification S Re-validation S Registration with AHPRA, MCNZ etc
  • 32. Are Specialist Colleges the policeman?
  • 33. Breaching the code of conduct
  • 34. Verification S Significant percentage S Easy S Built in to CPD program S Electronically facilitated
  • 35. Design Principles for CPD S Transitions and Stages of a career S Competency-aligned S Aligned to scope of practice and context of practice S Capable of Assessment S 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
  • 36. Summary S CPD is expected of us and is part of our social contract with the patient, society and the profession S 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 learning S We will know where we are at (self-referenced) and how we are doing

Editor's Notes

  1. Commitments and obligations in return for privileges
  2. Change in red
  3. 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.
  4. 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.
  5. 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.
  6. 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.