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Draft Recertification Framework

Discussion in 'New Zealand' started by Greg Fyfe, Jun 14, 2005.

  1. Greg Fyfe

    Greg Fyfe Active Member


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    Hi All

    While the board has circulated this document to the profession for consultation, I think it is of some concern that there ( as far as I am aware) is no forum/venue for wide debate amongst podiatrists who may wish to share ideas/views.

    A common forum would ensure engagement of podiatrists who are in and out of the professional association.

    I think this sort of debate would contribute to a more informed, thoughtful and representative submission by individuals responding.

    In the spirit of this I invite "public" debate. If you have a submission , post it for comment or support.Do you wish to respond individually or enmasse?

    Below are some questions that arose for me while reading this document.

    I wondered how well the activities "matched" with what the "average' podiatrist does in the course of their usual work, in NZ.
    Are the compulsary activities appropriate?

    I wondered if the framework adequately accomodated part time practitioners

    If the demands of the framework reflected the life/work balance needs of practitioners.Particularly the given the numbers of females in the profession. s

    I wondered about the implications of uncapped cost of course provision.I could imagine that apart from the cost to the practitioner,it could affect expenditure on other professional activities/studies..

    I think there are also questions about the flow on affect to professional fees and our responsibility to provide an affordable accessable service both privatley and publicly.The question may be "Do we see ourselves as being a service available to only the wealthy?"

    I wondered about the workforce implications of taking a number of podiatrists away from practice for whatever the time frame is per year.On employers like dhb's and on private practices employing people. This I assume will have an economic effect on those employers.It also looks like it will reduce service provision to clients, particularly if the courses remove practitioners from practice.

    I wondered how such a framework may impact upon student intakes. The potential burden to a new graduate and their employer is an issue.

    How does this framework fit with practitioners who work in a narrow segment of thier scope of practice.

    While the Board states it has no control over course cost and is responsible for the safety of the public it does include the following statements,on it's website, as 'Functions of the Board"

    (d) to review and promote the competence of podiatrists:
    (f) to receive and act on information from health practitioners, employers, the Health and Disability Commissioner about the competence of podiatrists:
    (k) to promote education and training in the profession

    I wondered if it is correct to interpret that the Board must consider the personal and financial implications of the recertification framework upon practitioners.Clearly the Board is bound to " receive and act on information ..."
    If the costs of the framework upon practitoners is likley to deter participation, then the Board must consider it's duty to "..promote competence".. " ..education and training"...and respond accordingly.

    What do you have to say?

    Regards

    Greg


     
  2. Stephen Moore

    Stephen Moore Member

    Greg


    This is an interesting area, is it possible to post a link to this document so we can access it, as it might have influence (good or bad) on Podiatry outwith NZ in time.


    Cheers

    Stephen
     
  3. admin

    admin Administrator Staff Member

    The PDF file of the document is here.

    Some aspects of it are insane.
     
  4. Stephen Moore

    Stephen Moore Member

    Re-certification Framework

    Many thanks for this information

    Stephen
     
  5. Jbwheele

    Jbwheele Active Member

    Copy of my comments to the NZ Reg Board re PBRCF Draft

    These responses are written without prejudice and are only my thoughts, they are worst case based and may seem over emotional but imaginative, however they may be helpful for the board in the drafting process.


    Chap 1 (Page 2)
    Introduction
    Para 1
    The HPCA2003 Protects the ‘Health and Safety’ of the Public, therefore the Re-cert should only be focused on those activities which may provide enough risk to H&S to be assessable. Competence should not include unrelated activities such as business administration / management techniques and so on.
    An activity should be proven as a risk for inclusion otherwise practitioners are wasting money and time.

    Chap 2 (Page 4)
    Re-cert Activities
    Tends to make Society membership compulsory, although it is convenient to have, it is costly to new graduates wanting to start up there own practices or part timers / isolated / rural Pods.


    Chap 4 (Page 9)
    Practitioners are encouraged to seek advice from peers or others when carrying out personal assessments…..:

    Peer evaluation and assessment is a very non-business like process, as competition between Pods is very stiff, individuals do not want to give away there practice secrets or professional niches / techniques as a consequence of allowing competitors to assess them. The time and cost involved in getting suitably qualified Nurses / GP’s or similar to assess / comment would be a nightmare.

    Peer review opens a legal can of worms in that if a peer assesses you as being good at this / bad at that, but the Board (or the Courts) assess otherwise, reprise at the peer may be conceivable. A competitive business environment and hierarchy may cause mistrust and animosity among practitioners reviewing / commenting each other.

    Page 12 (Para2)
    Peer …..Senior Pod / Manager… comments”……. assumes the Boss is more competent than the subordinate.

    How many new Pods would assess their bosses truthfully without fear of reprisal or future workplace cohesion problems??

    Page 13 (Para 6)
    Is self declaration of competence just an indemnity for the board when they re-certify you?

    Chapter 3 (Page 6 to 8)
    Accreditation for Ed Providers:
    I have already sent a short notice wound care course to the board for approval. In rural / isolated areas, these courses are hard to come by and will often be at short notice. Surely if a course is accredit able, retrospective approval should be allowed depending on the individual case.

    4 weeks approval time may hinder short notice and flying visit courses, which often crop up through the health professional grapevine, that’s if you’re in the loop, many part timers and family busy working mothers / fathers may find it hard or inconvenient to keep up to date with courses passing through there town.
     
  6. Greg Fyfe

    Greg Fyfe Active Member

    compare nz Dr's recert programme and FAQ's

    Hi
    As a reference, folk may be interested in having a look at the medical council of nz's website where you can find the "continuing professional development and recertification booklet."

    mcnz.org.nz

    scroll to "maintaining competence"
    should display "BAB recertification"
    click on it and you'll find a link to the "recertification booklet"

    This has an interesting list of FAQ's

    There are also other items on the site that give you an idea of the possible future.

    How does it compare to our proposed framework?

    Regards
    Greg
     
  7. Greg Fyfe

    Greg Fyfe Active Member

    Extracts from NZGP recertification doc

    FYI Extracts from,NZGP recertification doc,including FAQ's

    Regards
    Greg

    What activities does
    continuing professional
    development (CPD) involve?

    9. CPD must provide a process for maintaining or
    improving competence and performance.

    10. CPD programmes must include:
    • quality audit, for example
    – external audit of procedures
    – quality assurance activity
    – analysis of patient outcomes
    • peer review, for example
    – peer review of cases
    – review of charts
    – practice visits
    • educational conferences, courses and workshops.

    11. CPD may include:
    – self-directed learning programmes and learning
    diaries
    – assessments designed to identify learning needs in
    areas such as procedural skills, diagnostic skills or
    knowledge
    – journal reading
    – examining candidates for College examinations
    – supervision, mentoring others
    – teaching
    – publications in medical journals and texts
    – research
    – committee meetings that have an educational
    content, such as guideline development.

    12. CPD requirements are the same whether you work
    full-time or part-time. However, if you take study or
    maternity leave in a particular year, the Council can
    review the requirements for that year.

    13. The Council expects most doctors to be participating
    in some form of CPD already, so the requirements
    should not be unduly onerous.

    Not in active clinical practice
    You will have to have a practising certificate, but you
    might not have to take part in CPD activities to recertify.
    If you think the work you do has no impact on public
    safety and you have a case for exemption from CPD
    activities, please write to the Council for a ruling, with
    full details of your situation.


    Outcomes
    18. When the Council reissues your practising certificate
    this means your certification is up to date. This will
    be the outcome for most doctors.

    12 C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T
    A N D R E C E R T I F I C A T I O N

    19. If the information you give is not adequate, the
    Council will not recertify you (HPCAA, s.27(1)(b)).
    Instead, we will refer you to the Council’s
    Professional Standards team for further action and
    give you an interim practising certificate so you can
    keep working during this process.

    20. Your recertification (ie, when the Council gives you
    an APC) will depend on the outcome of this referral.

    21. Outcomes might include:
    • recertification with another audit in 12 months’
    time
    • a full competence review
    • conditions limiting your scope of practice
    • referral for a health assessment
    • a remedial education programme.

    22. The Council will not recertify you if:
    • you give misleading information
    • you tell us you will no longer practise
    • you do not pay the annual fees
    • you do not participate in the recertification
    process
    • a review of your health or competence shows
    you should not be practising.

    23. The Act requires the Council to give you adequate
    notice if we propose to change or restrict your
    scope of practice, and to give you an opportunity
    to be heard.
    The role of doctors registered within a
    vocational scope

    24. To be effective, self-regulation requires a significant
    effort from all doctors. The Council acknowledges
    those who ensure ongoing self-regulation by
    contributing the necessary skills, knowledge and
    attitudes.

    13 C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T
    A N D R E C E R T I F I C A T I O N

    25. The particular roles of doctors registered within a
    vocational scope are:
    – to supervise and guide other doctors if asked and
    where practicable
    – to be willing to refer for a competence review any
    doctor whose competence is causing concern and
    to be willing to help the Council devise and
    implement educational activities for those doing a
    formal competence programme.

    My special case: frequently
    asked questions


    43. How do I establish a collegial relationship?
    Ideally, you will be able to do this with someone who is
    registered within the same vocational scope as you and who
    works at the same place as you. If this is not possible, you
    can set up the relationship at a distance. If you do work at
    a distance, you will have to arrange to meet face to face for
    an hour six times per year, at least initially, and to use
    internet and email technology to augment these meetings.
    Once the relationship is established, you can meet as often as
    necessary to maintain it. If necessary, duties may be shared
    with a suitable local doctor. If you cannot find a doctor
    registered within the vocational scope in which you work (eg,
    if you work in an emerging branch) you can set up a collegial
    relationship with a doctor from a branch that covers only
    some aspects of your work, with another appropriate person
    you report to, or, if you are in non-clinical practice, with an
    expert in educational supervision. This is appropriate as long
    as your peer review, quality audit and continuing medical
    education (CME) activities cover the work you are doing.

    44. I didn’t realise some people charge a fee for
    providing a collegial relationship.
    Doctors provide collegial review as part of their practice; some
    will see it as a professional responsibility, others will want to
    charge a fee. It is important to make this clear from the start.

    45. I am a MOSS in a provincial hospital and I
    work in more than one branch of medicine.
    Do I have to do a recertification programme
    for each branch?
    Not necessarily. The best approach will be to work with
    your consultants and/or hospital management to determine
    what best suits your situation. If you are credentialed by
    an approved credentialing committee, you will not have to
    set up a collegial relationship. However, it may also be
    useful to approach a consultant in a broad discipline (eg,
    general medicine or surgery) to give you collegial support.

    17 C O N T I N U I N G P R O F E S S I O N A L D E V E LO P M E N T
    A N D R E C E R T I F I C A T I O N

    46. I am a practising GP, now 70 years old; I was
    grandparented into vocational registration
    several years ago but have let it lapse because I
    didn’t want to be involved with the College
    recertification programme.
    Isolation is a proven risk factor for poor performance. You
    must set up a relationship with a colleague who can help
    you plan and review activities to maintain your competence
    and keep you involved with other doctors.

    47. I am a service registrar and am not enrolled in
    a vocational training programme. How do I
    recertify?
    You will be registered within a general scope of practice and
    therefore must set up a collegial relationship with one of
    your consultants. You will need to enrol in an approved
    recertification programme or work with a colleague to
    establish a CPD programme. Remember that your CPD
    programme must cover peer review, quality audit and CME.

    48. I am a solo rural GP and I cannot take the time
    to travel to collegial sessions or to CME events.
    Isolation is a proven risk factor for poor performance. If
    you are registered within a vocational scope, contact the
    RNZCGP to discuss how you can meet the requirements of
    its MOPS programme. If you have a general scope of
    practice, you must establish a collegial relationship and
    either join the RNZCGP MOPS programme, or, with the
    help of your colleague, devise a CPD programme with
    content and review to suit your needs. Remember your
    responsibility is to maintain your competence for your own
    benefit, as well as for the benefit of your patients.

    49. I am semi-retired; I just maintain my
    practising certificate so I can prescribe for my
    family and a few old friends. I don’t
    understand why I should have to undertake an
    extensive programme of professional
    development to stay on the register.
    Your name can stay on the register even if you do not
    practise, but if you do practise, you must recertify as this
    shows you are still competent to do the work you want to do.
    It is generally unwise for you to care for yourself or your
    family in all but minor and emergency health matters. Self
    care and family care is neither prudent nor practical due to
    the lack of objectivity and discontinuity of care. The
    Council recognises family treatment may occur in some
    situations, but maintains that this should happen only
    when overall management of care is being monitored by
    the patient’s own GP. Guidelines are available from the
    Council office.

    50. I took a career break last year to look after my
    children/travel abroad/study art history/etc.
    Can I reduce the amount of professional
    development activity I would normally have
    to do?
    If you are in an approved programme, this will depend on
    the policy of your branch advisory body. If you are not in
    an approved programme, you will need to justify the
    reduction if asked to do so during an audit of your records.


    51. I don’t get on with the doctors around here.
    They accuse me of trying to take over their
    patients and they won’t let me join their afterhours
    roster. I have a general scope of practice,
    so how can I find someone to provide a
    collegial relationship?
    Isolation is a proven risk factor for poor performance. You
    should enlist the help of your branch advisory body or
    Primary Health Organisation (PHO) to mediate between
    you and your colleagues and to help find an appropriate
    doctor to help you plan and review your CPD.


    52. I am aware of a doctor whose ‘collegial
    relationship’ is provided by one of his friends
    from a long distance. I know they never meet
    and I know they just sign the documents and
    send them in.
    If you have concerns about the doctor’s competence you
    should contact the Council. The Council will be auditing
    records of professional development activities and will
    regard falsification of documents as fraud.



    53. What is my legal liability when I review a
    colleague’s professional development
    activities? What if the doctor I am reviewing
    does something wrong?
    As long as you have provided the review responsibly and
    properly you need not worry: you could not be held
    responsible for the doctor’s clinical practice. On the other
    hand, if you have not provided a proper review, or if you
    were aware of a major deficiency and did not counsel the
    doctor to do some professional development in that area of
    practice, you could be held to have contributed to an
    adverse outcome.


    54. Can my spouse (or other close relative) provide
    collegial review of my professional
    development activities for me?
    No, this is not appropriate. Conflict may arise in a
    relationship where one family member reviews another’s
    practice. Doctors in this situation are expected to participate
    in peer group review, use email and internet technology
    and develop a collegial relationship with a doctor other
    than a member of their family.


    55. I work part-time/in a poverty area/solo
    rural/semi-retired/etc and I cannot afford the
    time/money/travel/fees/etc such a scheme
    would require.
    If you are in clinical practice you must engage in
    professional development activities in order to recertify.
    This is because it is your responsibility to maintain your
    competence and to ensure you and your patients are safe.
    You must justify how much or how little CPD you do, and
    where and when you will do it. These are matters you
    might profitably discuss with your colleagues.
     
  8. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    I finally got a moment to comment .... its bizarre!

    Here are my unstructured thoughts:

    The document ignores a number of key principles (and we have had numerous threads here on these) - YOU CAN'T FORCE PEOPLE TO LEARN!!!!

    Its somewhat paradoxical that as a profession we expouse the need for evidence based practice, yet when it comes to CPD so many choose to ignore the evidence!!! -- which is exactly what this document is doing in many places.

    The Board rightly point out that they are there to protect the public. I fail to see how forcing Podiatrists to go on courses that have been approved by the Board actually does that (the evidence is that this does not work). What the Board really wants is for patient outcomes to improve - the evidence is that if you force people to go on courses, then this just does not happen..... there is evidence on how this can actually happen.

    We have had previous discussions here in other threads on the two possible approaches - what I call the 'carrot approach' and the 'big stick approach'. The carrot approach is inclusive and positive. The big stick appraoch taken by the Board is punitive and negative.

    If we assume that competence is a bell-shaped curve, then the punitive big stick approach is to chop off all those who are more than 2 standard deviations below the mean. The carrot approach is to accept that there will always be those who are 2SD below the mean, but why not just move the mean to the right by being inclusive etc etc. (ie continuous improvement)

    The document produced by the Board for discussion is obviously largely based on the Accredited Podiatrist scheme put together by APodC (they acknowledge that), but it largely ignores the principles that were behind the decisions that led to the current format of the scheme.

    Courses, seminars etc are the worse way to lead to an improvement in patient outcomes which is why they were downplayed in the APodC scheme. The NZ Board have decided (contrary to the evidence) to put a great emphasis on them ---- thats the silliest part of the document, esp where the Board has to approve courses etc. Thats a bureaucratic nightmare that will do absolutely nothing to improve courses etc and someone has to pay for it). Original discussions on the APodC scheme considered that but was quickly dismissed for those reasons - especially to de-emphasize that form of learning as part of CPD. ...

    The positive part of the documents is the use of other forms of CPD (some actually have evidence to support them), but they are overshadowed by the emphasis on "courses".

    I was at an interesting mtg last week in which there was some discussion with the policy makers/analysts in the Department of Health here and I raised the contents of this document with them --- what was surprising was how up to speed they were with what was happening in NZ with the different boards regarding this issue .... they were equally quick to dismiss the appoaches being taken, mostly for the reasons I mentioned above.

    ....my $0.02
     
  9. Greg Fyfe

    Greg Fyfe Active Member

    Comments on Draft Recertification

    Hi
    For those who are interested I'm happy to share my comments to this document on a personal email contact basis.
    Although I will be away from e mail until June 7.

    Greg
     
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