Doctors have a professional and legal requirement to provide safe quality care to their patients, and so have a responsibility to keep up-to-date in their practice. The Medical Council of New Zealand (MCNZ) and the NSW Medical Board require all their doctors to participate in Continuing Professional Development (CPD). CPD may be defined as:

“Any activity to maintain and improve knowledge, skills, and attitudes, and to develop professional and personal attributes required throughout a career as a Specialist Anaesthetist.”

CPD differs from vocational training in that it involves mainly self-directed and practice-based learning activities rather than supervised training¹. The scope of CPD extends past maintenance of knowledge and skills (ie CME and QA), to include improving professional attributes and attitudes throughout one’s career. It incorporates much of the theory and practice of adult learning, self-directed learning, and reflective practice.

Learning can occur inside and outside the conference room. Daily work provides learning opportunities to gain new knowledge, update skills, and improve attributes like communication with patients and interaction with health professionals. As we link learning with routine practice, we should view CPD as a strategy to upgrade professional capabilities rather than as a time-demanding impediment.

The ANZCA CPD Program has been devised to promote and implement proven and accepted educational standards, strategies and tools to assist Fellows to plan and participate in CPD activities that meet their learning needs, to improve their practice. The program is simply a framework for anaesthetists to participate in CPD. It is a program to help Fellows. It is not a program to assess or address competence, fitness to practice, codes of conduct, or professional standards.

Does CPD Work?

Doctors represent themselves as being competent to practise, as having mastered a body of knowledge and skills to deliver quality health care. A belief that learning beyond qualification is unnecessary to maintain knowledge and skills to deliver quality health care is not credible. Indeed, experienced doctors who practise longer may be at risk of providing lower quality care². The literature reports many publications on the benefits of CPD on doctor performance, patient outcome, and the process of care.^3-7 These have been reviewed and analyzed.^3,4,6,7 Effectiveness varies with CPD activities or interventions⁵, but there is good randomized control trial (RCT) Level 1 and Level 2 evidence that overall CPD improves doctor performance and the process of care.

Principles of a CPD Program

These principles are important in a CPD Program, as they provide the foundation for the program to achieve its objectives:

· Open Participation – All anaesthetists are eligible to enroll.

· Participation by All – All anaesthetists, whether working full time or part time in clinical or non-clinical

practice, or are retired, are catered for.

· Individual Focus – Participants plan their own program according to their needs.

· Application to Professional Practice – All activities relevant to the participant’s roles and responsibilities

and the ANZCA (and AMC and CanMEDS) Attributes of a Specialist Anaesthetist (below) are recognized:

Medical Expert

Communicator

Collaborator

Manager

Health Advocate

Scholar

Professional

· Effective Interventions – Emphasis is given to activities and interventions that have been proven to be

effective in learning.

· Life-Long Learning - CPD is an ongoing commitment to promote excellence in professionalism.

ANZCA CPD Program Objectives

The Objectives of the ANZCA CPD Program are:

· To promote and facilitate the participation of Fellows in effective CPD within the scope of their practice;

· To encourage a culture of self-directed learning, review, and reflection on professional practice among

Fellows;

· To consider and embrace acknowledged international standards in CPD and to contribute to knowledge in

this field;

· To demonstrate the accountability of anaesthetists to the community by monitoring participation and

evaluating the effectiveness of the program.

Participation

Only registered medical practitioners are eligible to enroll in the ANZCA CPD Program. Enrolment is not necessary for Fellows and there is no fee. Fellows who wish to participate in another CPD program in lieu of the ANZCA program need to contact the College for guidance. Anaesthetists who are not Fellows of ANZCA are welcome to participate, for which a fee will be payable. Although at present not all jurisdictions require participation in CPD for Recertification, the forthcoming Australian single national registration to be implemented by the Council of Australian Governments (COAG), heralds mandatory participation.

Exemptions and Special Considerations

Fellows who are fully retired and still remain on the register, and Fellows engaged only in research or administration are encouraged to participate. Jurisdictions and a future single national registration may demand their continuing participation in CPD to remain on the medical register. The Program will accommodate the non-clinical nature of their work Fellows in part time clinical practice are expected to participate in the whole program. However, in special circumstances, exemptions and special considerations may be granted. See Requirements of Program below.

Key Elements

The Key Elements of the ANZCA CPD Program are:

· The Program has a three-year cycle, with Fellows submitting annual returns if they wish to receive a

Statement of Participation that may be used for Recertification or Credentialling.

· Fellows submit their final triennial return and, if satisfactory, receive a Certificate of Completion.

· Participation is guided by individualized CPD planning, based on each Fellow’s needs, learning style, and

chosen activities.

· Learning activities are classified under four readily recognized and understood Categories, each with two

Levels of interactivity, the higher one being more effective in learning.

· Fellows select activities that are most appropriate to their plan, learning style, and practice.

· All learning activities relevant to a Fellow’s practice are recognized (and are not limited to those listed in

the program).

· Self-reflection and evaluation are important activities.

· Credits are claimed for activities, and are time-based and weighted towards interactive and more

effective learning strategies.

· Activities in three Categories must be undertaken, and minimum Credits are required each year.

· The Program accommodates retired Fellows or those in non-clinical practice.

Program Framework

The four Categories in the triennial program are:

Category 1. Group Learning

Category 2. Self-Learning

Category 3. Practice Assessment

Category 4. Education Development

Each Category has two Levels of activities. Level 1 is generally passive learning. Level 2 activities are interactive, or are more effective in transferring knowledge to practice, or require more involvement from the Fellow.

Activities earn Credits that are time-based and weighted towards those of Level 2. Participants must attain 40 Credits per year (or 120 Credits over the triennium), or for those in non-clinical practice or in retirement, 20 Credits per year. (See Requirements of Program below).

A CPD Plan (Category 2, Level 2) must be undertaken at the start, and an Evaluation of participation (Category 3, Level 2) at the end of each Fellow’s triennium. Reflection activities are encouraged but are not mandatory.

The Framework is shown in the Table below. At the end of each year participants submit an annual return of their activities (see Documentation, Verification, Statement below).

Requirements of Program

Fellows need to obtain 40 Credits per year (or 120 Credits over the triennium) in any combination of activities, but must include at least 10 Credits each from Categories 1, 2, and 3. A cap (of 10 Credits) only applies to passive self-learning (Category 2, Level 1). A shortfall of Credits (less than 40) in a year can be made up with surplus Credits in the following year, or the preceding year of the triennium.

In Year 1, Fellows must develop a CPD Plan at the start of their program and should tailor their Plan to meet the requirements of their jurisdictions. Fellows are encouraged to practise Reflection* each year. (*In this context Reflection means thinking carefully about.) In the final year of their triennium, Fellows must evaluate their CPD participation to decide the effectiveness of their learning. CPD planning, Reflection, and evaluation earn Credits.

The same requirements apply to Fellows in full time and part time clinical practice. Fellows unable to comply due to special circumstances such as illness, parental leave, leave of absence, lack of opportunities, etc may be granted exemptions or special considerations on a case-by-case basis.

Fellows who are retired and are still registered, or engaged in non-clinical work, participate on a year-by-year basis (ie not over a triennium). They are required to obtain at least 20 Credits per year, 10 Credits each from Category 1 and Category 2. For those fully retired who do not intend to return to the workforce any time soon, a CPD plan and an evaluation report may be omitted, but they are encouraged to engage in Reflection in Category 3.

Requirements of Jurisdictions

All Fellows are advised to check with their jurisdiction on their CPD requirements for Recertification. They may need to tailor their program to fulfil the requirements specified by their jurisdiction.

Accredited Activities

As the Framework supports a broad variety of learning activities, Fellows can choose those that best suit their plan, learning style, and practice. Activities eligible to earn Credits are not necessarily limited to those listed in the Framework, and activities in rural and remote practices will be given encouragement and favourable consideration. All activities for which CPD points can be earned must meet CPD educational standards and observe the Principles of the Program. For privately organized activities (eg industry-sponsored lectures and courses by professional education providers) and organized activities outside the Framework, organizers are encouraged to apply for accreditation well in advance of the event.

Documentation

Fellows are required to document their CPD learning process in their CPD Portfolio. This will enable the Fellow to review the effectiveness of his/her learning. The Portfolio also validates his/her CPD participation for any audits and compliance with jurisdictions. The Portfolio can be kept online or as a hardcopy folder. Recording activities undertaken is no different than that of MOPS. A Toolkit on the CPD Portfolio is provided to help Fellows maintain their Portfolio. A summary of what needs to be documented for an activity is shown in the Table below.

The CPD Plan is required to be recorded only once, at the beginning of each program. A Toolkit to Develop Your CPD Plan is provided to help Fellows write a brief plan in about an hour, in one A4 page or less to get started. The participant may modify his/her plan at a later date when circumstances change (e.g. moving from full time to part time practice).

Reflection notes may be recorded as often or as rarely as one is inclined. The intention is to understand an event so as to reinforce learning. An entry should be brief, and normally takes up one or a few paragraphs. A Toolkit on Reflection is provided to help Fellows with this.

An evaluation of one’s program is undertaken only once in three years, at the end of the triennium. This is important for Fellows to assess their own CPD participation. This may take one to two hours in one to two A4 pages. A Toolkit to Conduct an Evaluation of Your CPD will help Fellows to do this.

Credits may be claimed for the CPD Plan and Reflection notes and Evaluation.

Documenting a CPD Activity

	Cat 1		Cat 2		Cat 3		Cat 4
	L1	L2	L1	L2	L1	L2	L1	L2
Date of activity	·	·	·	·	·	·	·	·
Duration of activity (and Credits)	·	·	·	·	·	·	·	·
Name, nature, and/or topic of activity	·	·	·	·	·	·	·	·
Name and nature of meeting or provider	·	·					·
Confirmation of enrolment (receipt)	·	·		·			·
List of attendees by organizer - unaccredited activity	#	#					#
Minutes of committee meetings							·
Summary of report or full report if audited					·	·
Define goals of activity and what was actually done		·			·	·		·
Name of reviewer/committee - Audit /Peer review						·
Title of article, book, journal							·
Proof of research involvement								·

# Responsibility rests with organizers, not participants. Compliance may not be met.

Verification

Fellows are required to submit an annual return that records their CPD participation for the completed year, by the end of February the following year. Those not in clinical practice need to submit returns for their required 20 Credits each year. Participants can then be issued with an annual Statement of Participation without audit.

Audit

The College will sample up to 5% of Fellows who have completed their triennial program to audit the accuracy of their returns, compliance with requirements, and relevance of activities claimed. This is a necessary requirement of some jurisdictions, and indeed, of participatory learning programs. The audit will be satisfied once the minimum requirement of 120 Credits has been validated from among the total Credits claimed. Those randomly chosen for audit need only provide evidence of participation to earn the minimum required Credits. Those audited are exempt from further audits in the next six years (two CPD cycles), ie excluded from the random selection process.

Statement and Certificate

Fellows with valid annual returns will be issued with a Statement of Participation for that year, to enable Recertification with jurisdictions. Fellows who have completed the full triennium will be issued with a Certificate of Completion of CPD Program.

Support for Fellows

The College will provide support for Fellows to participate effectively in the CPD Program. Guides are available as:

· Toolkit to Develop Your Individual CPD Plan

· Toolkit on the CPD Portfolio

· Toolkit on Reflection

· Toolkit on Practice Assessment Activities

· Toolkit to Conduct an Evaluation of Your CPD

· Toolkit on Preparing for CPD Audit.

Pro formas will be developed as necessary.

Recognition by Australian and New Zealand Authorities

The ANZCA CPD Program will be submitted to all relevant New Zealand, and Australian Federal and State health authorities for recognition as a protected quality assurance activity.

Confidentiality Legislations in Australia and New Zealand

ANZCA will seek the privilege of confidentiality legislations for the ANZCA CPD Program before its implementation, similar to the protection of information currently afforded to MOPS. The MOPS Program has been "declared under Part VC of the Health Insurance Act 1973" (Australia), and "declared under the Health Practitioners' Competence Assurance Act 2003, Section 54"(New Zealand).

The MOPS Committee is authorised under the following: New South Wales Health Administration Act 1982, Victorian Health Services Act 1988, Queensland Health Services Act 1991, Western Australian Health Services (Quality Improvement) Act 1994, and Tasmanian Health Act 1997.

The MOPS Officer is authorised under: the South Australian Health Commission Act 1976 and T.E. Oh (as the then MOPS Officer) under the Australian Capital Territory Health Act 1993. The Program has qualified privilege under both Australian Federal and New Zealand legislation, while the State and Territory legislations cover the activities of the Committee, or in the case of two of them, a Committee of one person. Australian Federal legislation does not override State and Territory legislation in this area.

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Contents

Introduction