Maintaining competencies: How do I keep my skills up?
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Maintaining competencies: How do I keep my skills up?
Liam BrennanAddenbrooke’s HospitalCambridge, UK
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Conflict of interest• I am an elected Council member of The Royal College of Anaesthetists• I am the former RCoA national CPD
adviser• Editor, CEACCP• No financial conflicts of interest
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Key learning points• Maintaining & developing competencies• How to select appropriate CPD activity• Quality assurance of CPD activity• Obstacles to maintaining competence
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Why maintain & develop competencies?
• Professional obligations• Pressure from medical regulators• High profile catastrophes• Increased expectations from patients• Life-long learning• Cross-border working
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Bristol heart inquiry 1999
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Cross border working – Dr Ubani
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How many cases?
Kestin et al, 1995
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Experiential learning• ~ 2500-3000 cases overall in 7 year
training• ‘Competence’ = ~ 30 cases in all sub-
specialities (Intermediate/higher training)• ‘Expert’ = 100+ cases in one sub-
speciality (Advanced training)• Mastery not achieved pre-CCT
CCT is only the start of life-long learning
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Which competencies do I need to maintain or develop?• Differences between CME and CPD• Need to consider:– maintaining basic standards ; clinical & non-clinical – keeping up to date in your chosen field of expertise– acquiring and developing new skills
• Guidance from regulator/professional organisations
• Results of MSF, audit & complaints• Should reflect your whole practice*
Whole Practice = clinical & non-clinical ; scheduled & out of hours; independent practice & voluntary work
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Rome group CPD recommendations (2004)
Accrediting body• Fair, valid & consistent• Set reasonable & credible standards• Quality assurance role• Encourage collaboration between accrediting bodies
Learner• CPD meets their educational needs• Ensure CPD is relevant to their whole practice• Evaluates the extent to which their needs have been met
Organiser/provider• Disclosure of commercial sponsorship• Commercial sponsors must not influence structure or content of educational activity
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Country CPD requirement
Credits/year CPD scheme delivered by
CPD activities accredited by
Sanctions
Belgium Voluntary 20 + 2 PR Accredited providers
Regulator None
France None - - - -
Germany Compulsory 50 Accredited providers
Regulator License loss↓ fees
Italy Compulsory 50 Accredited providers
Regulator None
Netherlands Compulsory 40 + 1 PR Accredited providers
Professional societies
Loss of registration
Poland Compulsory 40 Regulator Regulator None
Spain Voluntary - - - -
UK Compulsory Not specified + PR annually
Accredited providers
Professional societies
License loss
USA Compulsory 12-50 Accredited providers
Medical association
Varies – fine, reprimand
Australia Compulsory 40 Specialist societies
Societies or regulator
Suspension from register
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Level 1• Core knowledge & skills recommended
of all those who trained as anaesthetists• Combines clinical & non-clinical
components• Includes maintaining a broad knowledge
of scientific principles• Achievable via review of clinical activity,
local meetings, e-learning
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Level 2• Paediatric competencies relevant to non-
specialist anaesthetist who manages children ≥ 3 years old
• Excludes infant and neonatal practice (other than emergency stabilisation)
• Includes team working with retrieval teams and liaison with specialist referral centre
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Level 3Advanced 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
Team working
Neuromuscular problems
Oncology Burns Transportation & retrieval practice
Neurological
http://www.apagbi.org.uk/professionals/education-and-training/revalidation/cpd-matrix/level-3-matrix
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Level 3• Aimed at specialist paediatric
anaesthetists• UK advice developed by APA• Should reflect ‘state of the art’ practice• Likely to require attendance at national
and international meetings
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Resources to maintain competence• Multi-faceted learning methods are optimal• Recognise that people learn in different ways• Group learning (in clinical teams) is very effective• Methods:
– Traditional didactic lectures– Personal study– Experiential courses– Simulation e.g. MEPA– Sabbaticals– Working with colleagues– e-learning
• Personal reflection on learning essential
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How do we know our competence has improved?
• Re-audit of practice• Repeat multi-source feedback (inc
patient)• Before and after tests of knowledge• Simulator performance in test situations• Peer-review of practice
Peer Review
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Quality assurance• Ensures CPD activities meet educational,
organisational & probity standards• In UK, QA role coordinated by a CPD Board:– Speciality wide representation; RCoA & specialist
societies– Appoints CPD assessors– Decides CPD credit allocation– Periodically reviews content of CPD matrix– Reviews participant feedback from CPD activities
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Obstacles to
maintaining competence
Isolated practice
Inadequate clinical
workload
Single-handed working
Absence from
clinical practice
Physical & mental ill
health
Financial pressures
Weak clinical
governance
Lack of personal reflection
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Harmonisation of CPD• Many obstacles still to overcome: - Mandatory or voluntary - Statutory or professional regulation - Consequences of non-compliance• EACMME has made progress• Definite benefits for all stakeholders
CPD
For debate: Should APA & ESPA develop a European specialist paediatric anaesthesia CPD matrix?
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Key learning points• Maintaining & developing competencies• How to select appropriate CPD activity• Quality assurance of CPD activity• Obstacles to maintaining competence
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