1. Recertification in New Zealand What you need to Know…
Vanessa Beavis
Director Perioperative Services Auckland District Health Board
Immediate past Chair, ANZCA CPD Committee

2. Purpose of CPD:
“Maintain and improve knowledge, skills and attitudes and to develop professional and personal attributes required throughout a career as a medical specialist” .

3. Evidence based
Formative in nature
Informed by: relevant data , public input
Based in workplace
Led by the profession
Supported by employers
Self directed
Available to Non Fellows
Cultural competence
Remedial action for non-compliance
Preferably annual
50 hours of CPD each year
Regular Practice Review
Participation in Audit

4. Enter ANZCA CPD

5. Aims - revised programme
Enhance patient safety and care
Align with new developments
Achievable and flexible
Meet the regulatory requirements
Convenient
Simple and pragmatic
‘Future proofed’

6. How we did it Reviews Gap analysis Two working groups Survey
Other Jurisdictions / Colleges
Contemporary education literature
Requirements of our regulatory authorities
Aligned with roles in practice
Gap analysis
Two working groups
Survey
Toolkit development

8. Changes Focus shifted to practice evaluation
Regular emergency response training
Audit streamlined if you upload as you go
ANZCA has tools, templates and support
The standard applies to all Anaesthetists practicing in New Zealand and Australia
Meets the MBA/MCNZ requirements

9. Evidence based
Formative in nature
Informed by: relevant data , public input
Based in workplace
Led by the profession
Supported by employers
Self directed
Available to Non Fellows
Cultural competence
Remedial action for non-compliance
Preferably annual
50 hours of CPD each year
Regular Practice Review
Participation in Audit

10. “…to protect the health and safety of the public by ensuring that doctors are competent and fit to practice.”

11. Problem…
CPD Compliance ≠ Competence Non-compliance ≠ Incompetence

12. Plymouth Group
Qualititative study based on feedback from main stakeholder groups and individuals
Competing Discourses
Regulation – summative, “catching bad doctors”
Professionalism – formative, maintain standards
Long-standing debate
Understanding the discourses key to development of revalidation specifics
Patient versus public – “discursive glue”
Paper title a quote

13. “No one argues with the proposition that all doctors need to be competent within their field of practice. The question is whether existing CPD programs and quality assurance processes are sufficiently robust to ensure that this is the case and, if not, how the gaps might be filled.”
Dr Joanna Flynn, Chair, Medical Board of Australia
Nov 2013

14. Proposed Model: Part one “Strengthened CPD”
Klass D. Assessing Doctors at Work- Progress and Challenges NEJM ; 4, 414-5

15. Proposed Model: Part one “Strengthened CPD”

16. 3- year timetable for Colleges to comply with accreditation standard
“Strengthening Recertification” proposal – 2017
3- year timetable for Colleges to comply with accreditation standard

17. Is that the end? …not really…

18. Part two:
Proactive identification and assessment of
“at risk” doctors in Australia.

20. BMJ Qual Saf 2013;22:532–540.
Down to individual practitioners

21. Complaints are sentinel events
BMJ Qual Saf 2013;22:532–540.
Complaints are sentinel events
3% of doctors account for 50 % of all complaints
80% risk of recurrence among high-risk doctors
Complaint recurrence highly speciality – related OR 2.04 ( plastic surgery) ( anaesthesia)
Replicated in recent study in the USA.
Complaints are the representative stats of a much larger harm signal

22. Can Complaints Improve Safety and Quality?
Peer messenger process
Non punitive “awareness “ feedback
High-risk doctors often unaware of adverse behaviours / practice
64% of high –risk physicians are responders
Some require targeted CPD or further interventions
Tiered interventions only for the non-responders to peer feedback
Beware psychological impact of complaints on practitioners

23. Identifying Risk of Poor Performance
EAG Recommendations
Strongest Risk Factors
Additional Risk Factors
Age ( >35 yr and increasing into middle and older age)
Male gender
Number of prior complaints
Time since last complaint
Primary medical qualification from some countries
Speciality
Poor response to feedback
Unrecognised cognitive impairment
Isolated practice
Low level of CPD engagement
Change in scope of practice

24. Assessment & Remediation – a Tiered Approach
Level of Risk
Remedial Intervention
Low –level
Identified risk cohort
“Outliers”
Speciality –specific MSF
Benchmark data from CPD program?
Higher complaints/notification rate
High risk cohort
Peer review requiring WBA
Medical Record review
Highest risk practitioners
Non- responders
Formal performance - assessment process

25. Assessment & Remediation
Who is responsible?

26. Challenges Better understanding of at- risk practitioners
“…to protect the health and safety of the public by ensuring that doctors are competent and fit to practice.”
Challenges
Better understanding of at- risk practitioners
Information sources
College / employer / regulator roles
Cost
Outcome measures
Screening tools
Management of non- responders

27. Take home messages The MCNZ is not the enemy
The CPD programme is well positioned to meet the future requirements.
Some tweaking, not whole scale change is likely to be needed