RANZCP CPD – A major concern

RANZCP CPD – A major concern

May 3, 2016

Philip Morris has written a trenchant criticism of the new CPD program on the College Discussion site.

He write – Seems like regarding the College CPD program we are back to where we started from in 2002 when we fought and won a fight against the College making a (then) coercive CPD program compulsory.  The subsequent review liberalized the program and made it psychiatrist needs relevant rather than a coercive instrument.  

I now see that the College will be making its CPD program compulsory from 2017.  But of concern the program to be released at the end of the month will be making parts of it mandatory (beyond the current Peer Review Group component).  

There is a new compulsory section called Practice Development and Review with a five-hour mandatory minimum time allocation.  Things that must be done here include a practice audit (NZ style – as NZ Fellows have to do an annual mandatory practice audit as demanded by the NZ Medical Council, not the College), a ‘360 degree’ review survey (private practitioners will have to pay for an outside agency to do this for them at $200-300 a pop!), structured quality improvement, risk management projects, root cause analyses, online quality improvement, and research projects.  

Nearly all of these activities are ones done in public sector settings and where the participating psychiatrist will be paid by government salary to do the activity – very different to the compliance costs put on the shoulders of private psychiatrists.  

I am told by the College CPD staff the introduction of this section was in part to help our NZ colleagues overcome confusion about the practice audit requirements of their NZ Medical Council – if the College mandates a practice audit for all Australasian Fellows then NZ Fellows will not be confused by competing demands for CPD from their Medical Council and the College.  But this is no justification for making an onerous CPD component mandatory for Australian Fellows.  

I have enquired of the College CPD staff about the rationale behind these changes and what evidence there is to justify making one form of CPD mandatory over another form – no evidence base or explanation has been provided other than ‘it is a good thing for doctors to do’.  

The College has not asked the membership to comment on the new CPD program – it will be published as a ‘finished work’.  I am not against change in the CPD program but believe any compulsory change to the program must be justified by robust evidence of benefit to psychiatrist’s knowledge and skills or patient welfare before making sections mandatory in a now compulsory program.  

There was no detail on the College website about the new program so I talked to the College staff in the CPD office – Shudipta Saha and Ben Patterson (Manager).  That is where I found out the coercive nature of the changes, that they are largely of relevance to public sector psychiatry practice, and that there was no evidence base offered to support these changes showing how this form of compulsory CPD makes any change to physician knowledge and skills or patient outcomes better than other types of CPD.  An evidence base might be available but it has not been provided.  Nor has a justification been offered as to why the Practice Development and Review component of CPD now needs to be compulsory – previously it was optional.

My position (and one I stood by as far as I could when I was chair of the College CPD committee in the mid 2000s) is that any compulsory component of CPD should have a robust evidence base showing the advantage of the compulsory CPD activity over other CPD activities and that any introduction should be done in a consultative and collaborative way with the College membership, not as an imposition from above.

Unfortunately, this seems to be what has happened with this CDP change.  I was referred to the College Psych-e bulletin newsletters of the past year by the College CPD staff as evidence that the membership was notified of the changes.  

When I looked through these Psych-e bulletins the only reference to specifics of the now-to-be compulsory Practice Development and Review section was in the August 2015 Psych-e bulletin as follows “To further enhance the quality improvement of practices, the College is considering the inclusion of optional activity in multi-source feedback as an aspect of the CPD Program.  This exercise is widely used by many specialist medical colleges both nationally and internationally as it provides a valid and reliable assessment of one’s management and behaviour, which in turn leads to reflection, goal setting and further skill development.”  This is reference to the ‘360 degree review’ technique embedded in the Practice Development and Review section.  Note that in August the inclusion of this section is optional.  And there is no information provided to support the assertion that the multi-source feedback is valid and reliable.  

By the November Psych-e bulletin we are informed that the CPD program will now be compulsory from 2017 as follows “RANZCP makes Continuing Professional Development Program compulsory for all Fellows from 2017”.  

And by in the January 2016 Psych-e bulletin we are told that the now compulsory CPD program will have “a Practice Development, Quality Improvement and Review activity” with “required components of 5 hours of practice review / quality improvement activities”.  

So no where following the mention of an optional multi-source feedback activity in August 2015 is there any discussion about the details of the proposed compulsory five hours of Practice Development and Review section and certainly no attempt to consult the College membership more broadly about theses changes or to offer any evidence base to support these changes.  

In my view this is a very poor way to introduce a compulsory change that has implications for the medical registration of fellows.  I wonder if this reflects a ‘corporatist’ and paternalistic attitude of the College to its members – we are to be ‘managed’ rather than consulted about change – I hope I am wrong. 

I was told by the College CPD staff I was the only one so far to voice any concerns about the changes.  I encourage any who have similar concerns to me about these imposed changes to CPD to you make formal and written representations to the College CPD staff (email Shudipta Saha at Shudipta.Saha@ranzcp.org) and to your College state and territory and NZ representatives. 


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