1. Appraisal and the CPD matrix
Dr Liam Brennan
RCoA Council Member and CPD Advisor
October 2011
CPD is one of the cornerstones of ‘strengthened appraisal’ which will inform the revalidation process resulting in the recommendation for re-licensing to the GMC by Responsible Officers

2. CPD – the GMC perspective Overview of CPD matrix CPD and appraisal
Quality assurance
Resources to support CPD
Online CPD system
Overview of the presentation

3. Personal responsibility for identifying CPD needs and planning how needs will be met
Doctors must remain competent and up to date in all areas of their practice
CPD activity should maintain and improve the standards of personal practice and that of any teams within which doctors work
CPD activities should be shaped by assessment of personal professional needs and the needs of the service and the people who use it
Doctors must reflect and record what they have learned through CPD activity
GMC - CPD Principles
These are the key principles of CPD in relation to revalidation from the GMC draft guidance
GMC - Draft CPD Guidance – October 2011

4. How much CPD activity is required ?
Minimum of 50 credits per year; 250 credits in 5 year revalidation cycle recommended
Internal
Minimum 20 credits
Minimum of 10 from local clinical governance meetings
External
RCoA encourages wide range of activities
These are the College’s minimum recommendations for the amount of CPD activity required for revalidation – we would hope that most will aim for significantly more than the minimum 50 credits per year. We strongly recommend that all anaesthetists gain at least 10 CPD credits/year from clinical governance meetings to emphasise the importance of face to face discussion of local issues.

5. Level 1 of the CPD matrix
Core knowledge recommended of all those who trained as anaesthetists
CPD evidence mostly via ‘internal’ activity
Includes maintaining a broad knowledge of scientific principles
Achievable via review of clinical activity, local meetings, e-learning
Many areas covered in mandatory training
Level 1 of the CPD matrix – should be easily achievable. The scientific principles aspect is not designed to be intimidating! It is simply to acknowledge that applied science underpins all aspects of anaesthetic practice. Nearly all CPD meetings include some aspects of applied science which would fulfill this goal.

6. Most of these domains are achieved by reviews and reflection on personal practice, mandatory training and departmental meetings.

7. Level 2 of the CPD matrix
Knowledge and skills relevant to a doctor’s whole practice*
Includes activity undertaken in on call duties
Will need careful planning for those who cover a wide range of clinical practice
Achievable via local meetings, e-learning and some external CPD activity
The whole practice principle is important - you are being revalidated against all aspects of your practice [as highlighted in the presentation slides entitled ‘New Developments in Appraisal’ by Dr Andy Tomlinson, October 2011] and your CPD evidence should reflect this.
Whole Practice = clinical and non-clinical; scheduled and out of hours; independent practice and voluntary work

8. Not all of these domains need to be covered
Not all of these domains need to be covered! The matrix at level 2 should be regarded as a menu to inform discussions with your appraiser as to which CPD activities you should consider including in your PDP for the forthcoming year.

9. Level 3 of the CPD matrix
Knowledge and skills required for a ‘special interest’ area of practice*
Applies to most consultant anaesthetists
Will rely heavily on external CPD activity
Early planning in revalidation cycle recommended
Suggestions for Level 3 activity via relevant specialist society/Faculty website
Review advanced level CCT curriculum
Most consultants (and some SAS doctors) will have a special interest area that will require level 3 CPD activity. Many special interest areas are self-evident – obs, paeds, neuro, etc. – but some are less obvious. The final decision on the need for level 3 CPD activity should be made between the appraisee and appraiser.
Special interest areas are as defined in advanced
level CCT curriculum although other clinical and non-clinical
areas may be suitable for Level 3 CPD

10. The level 3 matrix includes links to the relevant specialist societies who publish their recommendations for level 3 CPD on their websites. Where there is no link provided there are currently no published recommendations. In which case you may wish to consult the relevant section of the advanced level CCT curriculum for ideas for CPD in these areas of practice.

11. Level 3 CPD - Paediatric anaesthesia
Advanced management of acute pain
Periop care of babies & infants
Periop care of child with severe comorbidity
Periop care of child for specialist surgery
Care of child for non-operative procedures
Management of trauma in children
Current concepts of PICU management
Assessment
Pre-term
Common syndromes
Airway
Imaging (inc MRI)
Head injury
Common problems
Local & regional techniques
Ex-preterm
Airway problems
Cardio-thoracic
Interventional radiology
Thoracic injury
Respiratory support
Neuroaxial techniques
Term
Respiratory problems
Neuro (inc spinal surgery)
Advanced sedation techniques
Major skeletal injury
Cardiovascular support
Systemic analgesic drugs & techniques
Cardiac problems
Burns
Massive blood loss
Renal support
Neuromuscular problems
Oncology
Monitoring
Neurological
Team working
Transportation & retrieval practice
An example of level 3 CPD recommendations for paediatric anaesthesia produced by the Association of Paediatric Anaesthetists.

12. CPD and appraisal Realistic amount of CPD from relevant
matrix levels agreed at appraisal
Include CPD goals as part of PDP
Review evidence of completion at next
appraisal and sign off
Each appraisal discussion should include review of completion and reflection on the CPD goals set at the previous meeting and set new CPD goals for the next year’s PDP

13. CPD and the personal development plan
PDP
Job plan
Service/team developments
Wider practice
Mandatory requirements
Results of MSF, complaints, SUIs
Audit
Innovations in practice
Personal development
The drivers to what CPD to include in your PDP are outlined here. It is not solely about your job plan but has to acknowledge your learning needs arising from developments in the teams in which you work, reflection on multisource feedback (MSF), formal complaints and serious untoward incidents (SUIs) and innovations in practice (e.g. use of ultrasound technology).

14. Quality assurance RCoA coordinates quality assurance of
external CPD activities
Educational standards
Organisational standards
CPD assessors
RCoA examiners
Representatives from faculties/specialist societies
CPD Board
AoMRC criteria
How do you and your appraiser know that the external CPD activity you do is of appropriate quality? The College has coordinated this important aspect of CPD utilising Academy of Medical Royal Colleges (AoMRC) guidelines through a team of CPD assessors who will QA anaesthetic CPD events on behalf of the speciality-wide CPD Board. The ‘Revalidation for Anaesthetists’ logo is the kitemark for a CPD event that has successfully undergone this QA process

15. CPD Board Speciality-wide representation
Forum to discuss CPD related matters
Overall responsibility for approval and QA
Periodically review and revise CPD matrix
Business conducted mostly via
The terms of reference of the CPD Board

16. Types of CPD activity Multi-faceted learning methods are optimal
Recognise that people learn in different ways
Group learning (in clinical teams) is very effective
Importance of opportunistic learning
Methods:
Traditional didactic lectures
Personal study
Experiential courses
Simulation e.g. MEPA
Sabbaticals
Working with colleagues
E-learning
CPD activity can and should be multi-faceted to reflect the different ways in which people learn. Learning in teams (e.g. simulator based courses) is a particularly powerful learning method. You should not under estimate the value or legitimacy of learning from colleagues as very useful CPD. This is an inexpensive way to keep up to date and learn new skills.

17. Resources Map e-LA & CEACCP content to CPD matrix
Links to relevant websites for Level 3
CPD guidelines and RCoA Bulletin articles
Pen portraits
Pain specialist
DGH generalist
SAS doctor
Paediatric specialist
ICM specialist
The College have produced various resources to assist anaesthetists in planning their CPD including pen portraits of different types of clinician.
e-LA = e-Learning Anaesthesia (web-based resource); CEACCP = Continuing Education in Anaesthesia, Critical Care and Pain (journal)

18. Dr A is a full-time consultant pain specialist in a large DGH.
He undertakes outpatient clinics and pain block sessions as
well as conducting inpatient pain rounds. He has no routine or on call anaesthetic commitments and all of his independent practice is exclusively pain orientated.
Level 1 – all domains relevant to practice
– may need to do some ‘hands on’ airway management
Level 2 – consider which areas relevant to his practice
– e.g. sedation practice, developments in allied specialities, peri-procedure emergencies
– education and training domain
Level 3 – pain medicine
Example of a pen portrait (1) - full-time pain specialist

19. Dr B is a consultant anaesthetist in a small DGH with 10
consultants. She provides anaesthesia for a broad range of
surgical specialities and on call provides cover for emergency theatre work, obstetrics and ICU. She is the lead consultant for obstetric anaesthesia.
Level 1 – all domains
Level 2 – broad range at this level relevant to her practice
– will need to include ICM
– education and training domain
Level 3 – obstetric anaesthesia
Pen portrait (2) – anaesthetist working in a small DGH

20. Dr C is a staff grade anaesthetist working in a large DGH
Dr C is a staff grade anaesthetist working in a large DGH. He undertakes a broad range of day time sessions including covering the obstetric unit. He is a recognised teacher of trainees. Dr C is also part of the resident on call rotas for anaesthesia, obstetrics and ICM. He is a volunteer pre-hospital care doctor in his spare time.
Level 1 – all domains
Level 2 – broad range at this level relevant to his practice
– will need to include ICM and obstetrics as included in his on call
– education and training domain
Level 3 – pre-hospital care
Pen portrait (3) – SAS grade anaesthetist with a specialist interest

21. Dr D is a consultant paediatric anaesthetist working in a tertiary referral children’s hospital. She manages children of all ages for a broad range of surgical specialties but her special interest is paediatric cardiac anaesthesia. In independent practice she regularly manages an ENT list which includes children and adults.
Level 1 – all relevant domains including adult advanced life support
Level 2 – domains relevant to paediatric practice
– domains relevant to adult ENT practice
– education and training domain
Level 3 – paediatric anaesthesia
Pen portrait (4) - full-time paediatric anaesthetist

22. Dr E is a consultant anaesthetist specialising in adult intensive care medicine in a teaching hospital. Most of his clinical sessions are in ICM but he does a weekly all day hepatobiliary list which includes patients having liver resections. All of his on call duties are in ICM. He does regular independent anaesthetic practice for general surgical cases.
Level 1 – all domains
Level 2 – any ICM not covered by portfolio evidence in clinical practice
– relevant aspects of general, pain and regional anaesthesia
– education and training domain
Level 3 – ICM
– hepatobiliary surgery
Pen portrait (5) - anaesthetist with an ICM specialist interest

23. Online CPD system
Now available
Free of charge to registered RCoA Fellows and Members
Link on RCoA website to self-register
Features
Users
Providers
The online CPD system available via the College website is a resource to assist Fellows and Members in planning and documenting their CPD activity.

24. Online CPD system - features
Users
Providers
Submit applications for CPD approval
Dedicated help line for providers
Addition of event to database
Link to event website for more information and booking
Learning outcomes review by users
Searchable database of approved events
CPD diary and reflective review
Personal development plan
Breakdown of CPD credits
Integration to eLA
Depository for CPD certificates
Features of the online CPD system for users and CPD providers

25. Thank you Further information RCoA CPD guidelines:
RCoA Bulletin article:
GMC CPD guidance:
CPD administrator:
Some links for more information
Thank you