Revalidation, new CPD requirements and Lewis Carroll

Revalidation, new CPD requirements and Lewis Carroll

August 25, 2016

I have written a draft submission to the Medical Board of Australia expressing significant concerns about revalidation.  The one area I have not included is probably the most important: What is the problem? Where is the evidence this complicated process is required? Is it just more Nanny state bullshit because the profession cannot be trusted?

These are the recommendations of thew Medical Board Expert Advisory Group. They are also present in the revised CPD program of the RANZCP

The recommendations include:

•  maintaining and enhancing the performance of all doctors practising in Australia through efficient, effective, contemporary, evidence-based continuing professional development (CPD) relevant to their scope of practice (‘ strengthened CPD’), and
•  proactively identify doctors at-risk of poor performance and those who are already performing poorly, assessing their performance and when appropriate supporting the remediation of their practice.
•  The Expert Advisory Group (EAG) proposes that medical practitioners in Australia should participate in three core types of CPD, with activities prioritised to strengthen individual performance. A summary is provided of the core types of CPD.

1. Undertaking educational activities:
   1. lectures
   2. conferences
   3. Reading
   4. research
   5. supervision
   6. workshops
   7. grand rounds
   8. online learning

 Reviewing performance:

2. • peer review of performance
   • peer-review of medical records
   • peer discussions of cases, critical incidents, safety and quality events
   • multisource feedback from peers, medical colleagues, co-workers, patients, other health practitioners.

 

3. Measuring outcomes

1. clinical audit
2. review of medical records
3. mortality and morbidity reviews
4. clinical indicators
5. comparison of individual data with local, institutional, regional datasets
6. review of individual and comparative data from de-identified large datasets e.g. Medicare, PBS

The problem is that this is a generic list that does not fit some groups. The people who do medicolegal work measuring outcomes is meaningless. All of the third component has no relevance. Reviewing performances is also problematical particularly multisource feedback from peers, medical colleagues, co-workers, patient, other health practitioners. How on earth do we do that.

Similarly peer-reviewed medical records. We have no medical records we have reports. The reports are assessed by the various statutory schemes and by lawyers and ultimately attested in court. There is no recognition of that. Peer review is something that we do anyway but again there are no medical records so how can there be peer review of medical records other than peer review of reports. Most of us read many reports from our colleagues and sometimes give feedback with regard to these. We also have peer discussion of cases but we don’t have to deal with critical incidents.

I urge you to make your views known if you agree with this analysis.

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