Maintaining competencies: How do I keep my skills up?

Liam BrennanAddenbrooke’s HospitalCambridge, UK

Conflict of interest• I am an elected Council member of The Royal College of Anaesthetists• I am the former RCoA national CPD

adviser• Editor, CEACCP• No financial conflicts of interest

Key learning points• Maintaining & developing competencies• How to select appropriate CPD activity• Quality assurance of CPD activity• Obstacles to maintaining competence

Why maintain & develop competencies?

• Professional obligations• Pressure from medical regulators• High profile catastrophes• Increased expectations from patients• Life-long learning• Cross-border working

Bristol heart inquiry 1999

Cross border working – Dr Ubani

How many cases?

Kestin et al, 1995

Experiential learning• ~ 2500-3000 cases overall in 7 year

training• ‘Competence’ = ~ 30 cases in all sub-

specialities (Intermediate/higher training)• ‘Expert’ = 100+ cases in one sub-

speciality (Advanced training)• Mastery not achieved pre-CCT

CCT is only the start of life-long learning

Which competencies do I need to maintain or develop?• Differences between CME and CPD• Need to consider:– maintaining basic standards ; clinical & non-clinical – keeping up to date in your chosen field of expertise– acquiring and developing new skills

• Guidance from regulator/professional organisations

• Results of MSF, audit & complaints• Should reflect your whole practice*

Whole Practice = clinical & non-clinical ; scheduled & out of hours; independent practice & voluntary work

Rome group CPD recommendations (2004)

Accrediting body• Fair, valid & consistent• Set reasonable & credible standards• Quality assurance role• Encourage collaboration between accrediting bodies

Learner• CPD meets their educational needs• Ensure CPD is relevant to their whole practice• Evaluates the extent to which their needs have been met

Organiser/provider• Disclosure of commercial sponsorship• Commercial sponsors must not influence structure or content of educational activity

Country CPD requirement

Credits/year CPD scheme delivered by

CPD activities accredited by

Sanctions

Belgium Voluntary 20 + 2 PR Accredited providers

Regulator None

France None - - - -

Germany Compulsory 50 Accredited providers

Regulator License loss↓ fees

Italy Compulsory 50 Accredited providers

Regulator None

Netherlands Compulsory 40 + 1 PR Accredited providers

Professional societies

Loss of registration

Poland Compulsory 40 Regulator Regulator None

Spain Voluntary - - - -

UK Compulsory Not specified + PR annually

Accredited providers

Professional societies

License loss

USA Compulsory 12-50 Accredited providers

Medical association

Varies – fine, reprimand

Australia Compulsory 40 Specialist societies

Societies or regulator

Suspension from register

Level 1• Core knowledge & skills recommended

of all those who trained as anaesthetists• Combines clinical & non-clinical

components• Includes maintaining a broad knowledge

of scientific principles• Achievable via review of clinical activity,

local meetings, e-learning

Level 2• Paediatric competencies relevant to non-

specialist anaesthetist who manages children ≥ 3 years old

• Excludes infant and neonatal practice (other than emergency stabilisation)

• Includes team working with retrieval teams and liaison with specialist referral centre

Level 3Advanced management of acute pain

Periop care of babies & infants

Periop care of child with severe comorbidity

Periop care of child for specialist surgery

Care of child for non-operative procedures

Management of trauma in children

Current concepts of PICU management

Assessment Pre-term Common syndromes

Airway Imaging (inc MRI)

Head injury Common problems

Local & regional techniques

Ex-preterm Airway problems

Cardio-thoracic Interventional radiology

Thoracic injury Respiratory support

Neuroaxial techniques

Term Respiratory problems

Neuro (inc spinal surgery)

Advanced sedation techniques

Major skeletal injury

Cardiovascular support

Systemic analgesic drugs & techniques

Cardiac problems

Burns Massive blood loss

Team working

Neuromuscular problems

Oncology Burns Transportation & retrieval practice

Neurological

http://www.apagbi.org.uk/professionals/education-and-training/revalidation/cpd-matrix/level-3-matrix

Level 3• Aimed at specialist paediatric

anaesthetists• UK advice developed by APA• Should reflect ‘state of the art’ practice• Likely to require attendance at national

and international meetings

Resources to maintain competence• Multi-faceted learning methods are optimal• Recognise that people learn in different ways• Group learning (in clinical teams) is very effective• Methods:

– Traditional didactic lectures– Personal study– Experiential courses– Simulation e.g. MEPA– Sabbaticals– Working with colleagues– e-learning

• Personal reflection on learning essential

How do we know our competence has improved?

• Re-audit of practice• Repeat multi-source feedback (inc

patient)• Before and after tests of knowledge• Simulator performance in test situations• Peer-review of practice

Peer Review

Quality assurance• Ensures CPD activities meet educational,

organisational & probity standards• In UK, QA role coordinated by a CPD Board:– Speciality wide representation; RCoA & specialist

societies– Appoints CPD assessors– Decides CPD credit allocation– Periodically reviews content of CPD matrix– Reviews participant feedback from CPD activities

Obstacles to

maintaining competence

Isolated practice

Inadequate clinical

workload

Single-handed working

Absence from

clinical practice

Physical & mental ill

health

Financial pressures

Weak clinical

governance

Lack of personal reflection

Harmonisation of CPD• Many obstacles still to overcome: - Mandatory or voluntary - Statutory or professional regulation - Consequences of non-compliance• EACMME has made progress• Definite benefits for all stakeholders

CPD

For debate: Should APA & ESPA develop a European specialist paediatric anaesthesia CPD matrix?

Key learning points• Maintaining & developing competencies• How to select appropriate CPD activity• Quality assurance of CPD activity• Obstacles to maintaining competence