Hi All
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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
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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 -
The PDF file of the document is here.
Some aspects of it are insane. -
Re-certification Framework
Many thanks for this information
Stephen -
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. -
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 -
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. -
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 -
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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