I’m having trouble locating a position with an accredited supervisor. What are my options?
The program was piloted in 2021 with a small number of supervisors and endorsees to ensure the processes that were developed could be practically implemented with ongoing feedback collected to further enhance and refine the program. As with any new education program, it was anticipated that the number of supervisors and endorsees would slowly grow over the coming years to ensure these newly established processes could support much bigger numbers. We understand supervisor availability is a concern for future endorsees and recruitment of new supervisors and greater geographical spread is a main priority of the committee moving forward. As new supervisors are appointed, we will add to the website listing.
If you’re having trouble locating a position right now and wish to be endorsed in pain medicine procedures, we do encourage you to work with a fellow of the faculty who is experienced in pain medicine procedures to gain clinical experience and proficiency in planning, performance and management of procedures. Given the Supervised Clinical Experience Pathway is an apprenticeship-style program which doesn’t require volume of practice, proficiency gained by prior experience encompassing the selection, performance and follow-up of procedures, might provide quicker endorsement in those procedures should you enter the program under an accredited supervisor at a later date (noting minimum time durations in the handbook).
Alternatively, this experience could be accrued to be endorsed through the Practice Assessment Pathway (PAP). The PAP is open to Faculty fellows who wish to have their practice endorsed without being under the guidance of a supervisor or completing work-place based feedback. This pathway requires adherence to the clinical care standard and is undertaken through submission of a written application and peer review and will remain open until 2026.
I’ve never worked in private practice. What do I need to know?
If participating in the PEP will be your first experience of working in private practice, there are a number of important points to consider. Firstly, you are likely to have a different type of employment contract with your supervisor’s practice. Whereas public hospital contracts for trainees are employer/employee relationships, you will most likely have an associateship contract with the clinic you work at for PEP. The difference is that you will be paying a percentage of your revenue from billings to the practice as a service fee and keeping the balance. Typical service fees can vary from very low (perhaps 20% of revenue) to half of your revenue depending on the level of service provided by the practice and the amount of work they are doing on your behalf. Medical indemnity arrangements are different in private practice, and you should seek legal advice regarding any contract you sign to ensure you are happy with the arrangements. PEP Supervisors are forbidden from using their status as training supervisors to force unconscionable contracts onto endorsees. If you have any concerns that cannot be resolved by reasonable negotiation between you, your supervisor/practice owner and your lawyer, please notify the Chair of PPMC confidentially via the FPM staff. Just as FPM does not tolerate bullying, discrimination or other poor behaviour in our training program, we do not condone it in the PEP and we will respond to complaints of this nature with appropriate confidentiality and seriousness. If you are unsure whether a private practice experience is for you, it may be very helpful to discuss it informally with a mentor or senior Fellow who can provide a perspective from their own experience that may help you make an informed decision.
How do supervisors become accredited?
FPM fellows who are experienced in pain medicine procedures and have scope and case load to support an endorsee may apply to become an accredited supervisor. In order to be approved, they first must attain endorsement in pain medicine procedures through the Practice Assessment Pathway and ensure their practice complies with the clinical care standard. Supervisors are then trained at an orientation workshop, commit to teaching and providing supervision and feedback and are also required to have ongoing professional development.
How is my progress assessed?
There are three levels of assessment in the program, and all are workplace-based.
The program utilises an ePortfolio where the endorsee logs their self-rated cases, and the supervisor provides feedback on each case.
As the endorsee progresses from one level of required supervision to the next, they undertake a direct observation of procedural skills (or DOPS) assessment which supports the endorsees learning and assesses the overall development of an endorsee as a specialist and professional.
The Confirmation of Competence form is used when an endorsee can perform a procedure independently and is ready to for sign off by the supervisor. There are requirements around minimum duration of time for each procedure and some procedures have prerequisite procedures that need to be attained first. There is no exam component in the program.
What are the expectations for endorsees coming into the program?
As an endorsee, you will be undertaking FPM endorsed training, so the level of professional behaviour expected of SoTs will apply to PEP supervisors. You should expect consistent, constructive feedback appropriate to your level of development. Your supervisor should regularly discuss not just your procedural technique but your clinical decision-making outside of theatre. You should feel encouraged and supported to learn, and should be given opportunities to extend your learning beyond the weekly routine of lists and consultations. You should expect to have a fair employment relationship with your supervisor’s practice and be free of financial coercion or exploitation, if working in a private clinic. You should expect support for attendance at workshops and conferences to accelerate your learning. You can expect to have prompt and constructive interactions with FPM staff supporting the program, and timely answers to any queries.
Your supervisor will expect you to be a professional adult learner, who can take the initiative to identify and pursue your learning needs. You should acknowledge the expertise of your supervisor and ask constructive questions constantly. They will expect you to read around your cases, and should not need to prompt you to fully digest the recommended readings early in your learning journey. They will expect you to make progress from month to month towards attaining competence in the performance of procedures as well as your clinical judgement about how to use procedures as part of the sociopsychobiomedical paradigm. They will expect you to ask for help if you are in difficulty, but to be determined in pursuing excellence in the long term. Your supervisor will expect you to have become familiar with employment conditions in private practice and be a team player when difficulties emerge. Your supervisor will also expect you to take the lead in ensuring you meet the requirements for the training and that your paperwork with FPM is submitted correctly.
How can I network with other endorsees?
We want our endorsees to feel connected to one another given their geographical spread. Networking is easier now that face-to-face scientific meetings are back however, we want to ensure there are opportunities throughout the year. We have introduced an endorsee WhatsApp group which will allow easy sharing of information and engagement and we will soon offer endorsee tutorials where an expert will present on a relevant topic. We encourage our endorsees to engage with their regional committee and CME activities as these provide such good networking opportunities with a wide range of the fellowship and faculty executive.
As always, we welcome feedback on how we can best support the networking of our endorsees.
What resources are available to support my learning?
There are a number of resources available to support your learning and you are encouraged to familiarise yourself with them. The curriculum guides the learning, teaching and assessment of endorsees, and articulates the knowledge, skills, judgement and conduct that faculty-endorsed fellows are expected to demonstrate in their procedural practice. The program’s handbook and by-law 20 outline the requirements of fellows and trainees undertaking the program including the assessment tools. The ANZCA library has a Library Guide dedicated to the procedures endorsement program which can be accessed via the website.
Do I have to be endorsed to practice pain medicine procedures?
The rules around who can perform procedures and who gets reimbursed for them is largely determined by government bodies who rely heavily on medical colleges for guidance. Historically, anaesthesia was performed by surgical trainees as a Faculty of Anaesthetists within the Royal Australian College of Surgeons. It then became a speciality in its own right with the formation of ANZCA and now anaesthesia is only reimbursed for fellows of ANZCA. Similarly, the Joint Faculty of Intensive Care Medicine (now the CICM) and Faculty Pain Medicine have followed in similar ways where government bodies and public and private hospitals will only recognise what the colleges and faculties recognise.
At this point in time, Faculty endorsement is not mandatory and has no regulatory implications however if precedent is anything go by, there will come a time in your career that it will be required.
How does gaining endorsement fit into the CPD structure?
The annual CPD requirements for fellows who practise pain medicine and are endorsed under the Procedures Endorsement Program are included in the CPD handbook that is available on the College website.
Your CPD activities should be a balance of core activities relating to the sociopsychobiomedical framework of pain medicine, alongside specific procedures related activities.
For endorsed fellows you will specifically need to make sure that:
- A minimum of 12.5 hours of your practice evaluation activities must relate to procedures in pain medicine.
- A minimum of four hours of your knowledge and skills activities each year must relate to procedures in pain medicine, with no more than three hours accrued at industry events.
Endorsed fellows are strongly encouraged to undertake a clinical audit on a regular basis. It is recommended that an audit is undertaken at least every three years.
Supervisors who undertake DOPS assessments for endorsees will automatically have these activities added to their CPD portfolio if they are participating in the ANZCA & FPM CPD program.
Can you give me some guidance on using the ePortfolio?
If you are a current trainee of the faculty, you will already have access to the risr ePortfolio. If you are unable to see the procedures endorsement program assessment tools, it might be that you need to switch from the training program to the PEP – you can do this by clicking the down arrow in the white toolbar directly above your name. If you are a fellow and will be using the system fort the first time, you will receive an email with a link to the ePortfolio, your user ID and a temporary password to gain access to the system. Enter the credentials and press login. You can then reset your password by using the ‘forgot password’ feature on the login page.
You can add logbook entries by selecting ‘create’ in the ‘create new activity or assessment’ box. You then select logbook from the list and enter and submit the applicable fields.
In order to complete the Direct Observation of Procedural Skills (DOPS) and confirmation of competence forms; your supervisor will need to initiate these within their own ePortfolio by clicking ‘create new activity or assessment’; entering your name and clicking ‘create’. They can then select the applicable assessment.
Further information on the ePortfolio can be found in the user guides available on the PEP website, or by contacting Faculty staff.