Module 12: Professional Practice

Module 12 aims to build trainees' understanding of relevant non-clinical management issues. This is a comprehensive description of trainee aims, learning objectives and assessment, as well as ANZCA professional documents relevant to Module 12. Module 12 is to be undertaken during advanced training, in the course of normal clinical duties and concurrently with clinical modules.

Trainee's aims
Learning objectives
Assessment
Appendix

Trainee's aims

The aim of Module 12 is for trainees to understand relevant non-clinical management issues. These range from understanding the culture of the healthcare industry and the anaesthesia profession, to considering one's career development, combining learning, teaching, administration, professional activities with patient care, and integrating professional and personal lives.

Learning objectives

This module builds on work done in Module 2 and considers knowledge and skills in six components:

Health infrastructures.
Administration and management.
Quality assurance.
Ethical, legal and indemnity issues.
Skills in professional practice.
Career and life planning.

In Module 12, the trainee will demonstrate:

Knowledge of the relevant Australian, New Zealand or other ANZCA jurisdiction healthcare national and local (state level) infrastructure, and the role of Fellows in its continuing improvement.
Capacity to work within the framework of anaesthesia departments through a comprehension of their structure and their processes.
Capacity to organise one’s work and learning.
Capacity to organise local scientific meetings and research projects.
Comprehension of the legal obligations of professional practice in the relevant ANZCA region.
Understanding of ethical practice.
Communication skills in professional practice.
Commitment to lifelong quality assurance.
Understanding of a realistic life career plan.

Healthcare infrastructures

The trainee will understand the organisation and/or role and function in the trainee’s country of the following:

The health system (public, private and managed care).
Health care funding bodies.
Health insurance bodies.
The Australian Medical Council, or the Medical Council of New Zealand, or other equivalent bodies relevant to the trainee.
Australian state medical boards, or the Medical Council of New Zealand, or other equivalent registration bodies relevant to the trainee.
The relevant societies of anaesthetists in Australia, New Zealand, Hong Kong, Singapore and Malaysia.
The relevant medical associations in Australia, New Zealand, Hong Kong, Singapore and Malaysia.
The relevant medical colleges in Australia and New Zealand and relevant bodies in Hong Kong, Singapore and Malaysia.
Organisation of anaesthesia public and private practice.
Pharmaceutical benefits arrangements.
Therapeutics goods regulations.
Coding systems used.
Epidemiological issues relating to disease prevalence.

Administration and management

Professional practice

The trainee will demonstrate an understanding of the principles and requirements of:

ANZCA professional documents (see Appendix)

Duties of an anaesthetist.
Clinical services delivered.
Policies on clinical practice, for example, drug labelling and infection control.
Teaching and research responsibilities.
Staffing.
Allocation of duties and rosters and resolution of related conflicts.
Concept of clinical governance.
Continuing professional development for staff.
Budgeting relevant to a department.
Scheduling of operating rooms for elective and emergency surgery, determining priorities of surgeons’ requests, urgency of surgery, availability of anaesthetists, assistants and nurses, and appropriate work patterns.

Competence or professional assessment.
Minimum facilities for safe anaesthetic practice in operating suites.
Minimum facilities for safe anaesthetic practice outside operating suites (for example, labour ward, day surgery unit, radiology department).
Operations of a department of anaesthesia, intensive care and/or pain medicine:

Role of director and deputy director.
Role of supervisor of training.
Role of module supervisor.

Staffing

The trainee will demonstrate an understanding of:

Determination of the required staff and establishment of a department, with relevance to the clinical and non-clinical workload of anaesthetists, secretarial and technical staff.
Concept of safe work hours.
Occupational safety standards.
Processes in appointing consultants and trainees.
Organisation of anaesthesia assistants in a department of anaesthesia.
Evaluation of staff performance.
Recognition of impaired performance in self and how to seek help.
Recognition of impaired performance in self and in colleagues:

Identification of indicators of impaired clinical performance due to physical, domestic or other stress, mental impairment, or substance abuse.
Consideration of process of dealing with an impaired colleague.
Plan for assessing performance of an allegedly impaired anaesthetist.
Determination of risks of substance abuse in anaesthesia practice and how to reduce the risk.

Recognition of the trainee with difficulties and the process of managing each individual.

Equipment

The trainee will demonstrate an understanding of:

Mandatory equipment for conducting safe anaesthesia.
The anaesthesia delivery system.
Selection, ordering and maintenance of equipment.
Assessment of new and existing equipment for essential and desirable features, reliability, ease of maintenance, availability of parts, and durability.
Advantages and disadvantages of disposable/single use items.

Professional committees

The trainee will understand and/or contribute personally to:

ANZCA and professional committees in the trainee’s region.
Important hospital committees.
Rules of formal meetings.
Role of committee members.

Organisation of clinical scientific meetings

The trainee will understand and/or contribute personally to:

The value of clinical and scientific meetings and their organisational issues.
Steps to stage a successful meeting.
Advantages and limitations of different types of sessions, for example, oral and poster presentations, symposium, workshop etc.
Role and qualities of a chairman of a scientific session.
Rul es for the conduct of meetings.

Organisation and business management of individual practice

The trainee will understand the organisation and management of an individual medical practice such as:

Requirements and processes of practising as a full or part-time consultant in a public hospital.
Requirements of entering private practice, for example, hospital appointments, secretarial services.
Principles of business management, for example:

Book keeping.
Taxation planning.
Income protection insurance.
Staff employment.
Group practice.
Computerised systems.
Retirement planning.

Time-management strategies in determining methods of practice management.
Paid and pro bono work in the profession.

Quality assurance

The trainee will demonstrate an understanding of, and where relevant participation in, quality assurance (QA) processes in practice as a basis for continuing professional development. These include:

Principles of quality assurance.
Terms used, the processes, the measurement tools and the role of physicians in QA.
Interdisciplinary nature of QA.
Contribution by anaesthetists in relation to QA in healthcare.
Application of QA methods in clinical practice to find the standard of care, problems of care, corrective strategies and effectiveness of the strategies (“closing the loop”).
Risk management.
The approach of dealing with adverse events rather than individual performance errors.
Relationships between adverse events, system factors and human factors.
Literature searching, measurement and analysis in the QA process.
Evidence-based medicine and the Cochrane Collaboration.
Processes of managing change.
Critical incident monitoring and the Australian Incident Monitoring Study (AIMS).
ANZCA Continuing Professional Development program; aims, structure and process.

Ethical, legal and indemnity/insurance issues

Trainees will recognise that there are ethical, legal and indemnity issues common to all ANZCA training jurisdictions, but some might be specific to a country or Australian state. Trainees are expected to understand and practise by the following principles and standards:

Local requirements of registration to practise, recertification and credentialling.
Specialist recognition and registration.
Standards of care expected of a specialist in Australia and New Zealand.
Documents and guidelines on standards of care published by statutory bodies such as medical councils, the Health and Disability Commissioner Code of Consumers Rights (New Zealand), and the codes of ethics of medical associations.
Obligations of medical practitioners under various statutes, for example, Coroners Act.
Legal processes whereby patients can be compensated for injuries caused by medical treatment or negligence.
Legal processes whereby medical practitioners are held accountable for their actions (for example, New Zealand’s Health and Disability Commissioner and Medical Council of New Zealand Medical Practitioners Tribunal).
Standards for informed consent to all patients such as those contained in the New Zealand Code of Consumers Rights.
Legal processes regarding patient complaints and the anaesthetist’s obligation to assist such patients, for example, in New Zealand.
Legal and ethical issues involved in dealing with colleagues who are unfit to practise, and the legal obligation to report such colleagues, for example, in New Zealand.
Services provided by medical indemnity organisations in the relevant region.
Roles and powers of consumer and competition bodies, for example, the Australian Competition and Consumer Commission.
Legal processes regarding sexual harassment.
Roles of an expert witness and witness of fact, and when to seek legal advice before appearing as a witness.
Steps to be taken if an adverse event is liable for legal action.
Obligations to notify statutory bodies of adverse events and the nature and presentation of the information required.

Skills in professional practice

Trainees need to develop non-clinical skills in professional practice. They will demonstrate an understanding of or skills in the following:

Understanding ANZCA’s mission statement, which outlines the College’s focus and purpose.
Organising work, study, family, leisure in terms of time and commitment.
Developing a personal study plan, and using and building on the learning portfolio.
Recognising priorities in learning and tips in effective learning.
Organising duty rosters.
Organising continuing education meetings.
Chairing meetings.
Providing feedback of one’s view and junior staff colleagues’ views to consultants.
Dealing with a trainee with difficulties, an impaired colleague or troublesome consultant.
Teaching nurses, junior medical staff, anaesthesia assistants and other allied health workers.
Developing communication skills such as:
Normal patient consultations regarding anaesthesia information, informed consent and risks.
Talking to and providing support to patients and relatives after adverse events.
Consultations with other medical and professional colleagues.
Communications with operating suite and ward staff.
Oral presentations of professional topics.
Giving and receiving feedback.
Issuing orders to team members, especially in emergencies.
Writing skills, for example, minutes and letters of referral.
Good record keeping, for example, anaesthesia patient charting, adverse event, learning portfolio.
Dealing with an adverse event and aftermath rehearsals.
Drafting budgets, professional and personal.
Keeping track of one’s career plans.
Maintaining ethical professional standards in the roles as a medical expert, communicator, collaborator, manager, researcher, teacher and health advocate.
Developing skills in print, radio and television media; different presentations, their relative effectiveness, and how to present them.

Career and life planning

As trainees approach the end of their training program, they should:

Review plans developed in Module 2 and update the plans in their learning portfolios.
Consider the next career step after conferment of FANZCA.
Consider expected and contingency plans for a series of normal life events, for example, investments, life insurance and disability insurance.

Attitudes and behaviours

Trainees are expected to develop the attitudes and behaviours which are obligatory in specialist medical practice. Core attitudes and behaviours that trainees must cultivate during the whole period of anaesthesia training program include the following.

Specialist practice

To attain the attributes of a specialist as a:

Medical expert.
Communicator.
Collaborator.
Manager.
Health advocate.
Scholar and teacher.
Professional.

To practise good communication with colleagues, patients and others.
To work as a member of a team, but to assume responsibilities and/or delegate duties as a team leader when necessary.
To commit to, and believe in, a culture of safety and ethical, high quality care.
To accept that medical knowledge and skills are not the only requirements of specialist practice.
To be aware of medico-legal obligations relating to medical practice.
To have insight into one’s own limitations, abilities and areas of expertise.
To commit to lifelong continuing professional development.

Professionalism and ethics

To commit to, and believe in the ethical and professional principles of:

Altruism: the best care for the patient must be the principal driving force of practice.
Patient autonomy: patients’ ability to determine their treatment.
Beneficence: the principle of “doing good” to patients.
Non-maleficence: the principle of not doing harm to patients.
Fidelity: faithfulness to one’s duties and obligations. This principle underlies excellence in patient care, confidentiality, telling the truth, a commitment to continuing professional development and lifelong learning, and not neglecting patient care.
Social justice: the right of all patients to be fairly treated.
Utility: the principle of doing the most good for the greatest number of people.
Duty to oneself in terms of personal health care and maintenance of competence to practise.
Accountability: the anaesthetist is responsible for his or her actions.
Honour and integrity in all conduct, including the generation and use of resources.
Respect for others, including a responsibility to work as a team and to practise conflict resolution.
Appropriate response to clinical error.

Patient considerations

To commit to, and believe in, the rights of patients with respect to:

Autonomy.
Confidentiality of the doctor-patient relationship.
Appropriate, excellent clinical care, including pre-operative assessment.
Informed consent.
Comprehension of the risks of anaesthesia techniques.
Appropriate care irrespective of race, culture, gender and socio-economic status.

Research considerations

To value rigorous educational and scientific processes.
To distinguish between practice with a sound scientific basis and that which requires further objective assessment.
To commit to the ethical principles of research.

Assessment

The program of completed readings relating to Module 12 must be validated by your module supervisor or supervisor of training using the module completion form.

Aspects of Module 12 that are relevant to professional practice may be examined in the final examination (for example, ANZCA professional documents, quality assurance, requirements of space, staff, and equipment, and ethical, legal and indemnity issues).

The supervisor of training and other consultants will evaluate the trainee’s overall performance in the in-training assessment (ITA) process, reviewing aspects of clinical performance, education skills and attitudes. The ITA will remain a formative assessment conducted every six months, independent of module assessment.

The learning portfolio is an integral tool for self-assessment (as well as for recording clinical experience and developing study plans). The trainee is expected to self-evaluate his or her education skills and learning experience from the learning portfolio. For example, the learning portfolio should show the trainee’s progress through the module, as records of self-improvement courses undertaken, literature searches and topics reviewed.

The learning portfolio is mailed to each trainee upon their registration with ANZCA. A PDF copy can be downloaded from the ANZCA website.

Appendix

Relevant ANZCA professional documents for Module 12. These are periodically updated on the professional documents page on the ANZCA website and in the ANZCA Bulletin.

Technical

Training and educational

Professional standards

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