Prof Marietjie de Villiers Chairperson: HPCSA CPD Committee

1. Principles and practice of the new HPCSA CPD system - and how it relates to the Health and Human Rights agenda Prof Marietjie de Villiers Chairperson: HPCSA CPD Committee Vice-Chair: Medical and Dental Professions Board

2. Outline • Health Professions Act and CPD • CPD – aim, evidence & models • Proposals for new system • Prioritising HHR in the system • Challenges

3. Health Professions Act and CPD Heath Professions Act of SA, 1974 (Act no. 56) Section 26 states that the Council may from time to time make rules which prescribe • conditions relating to continuing education and training to be undergone by persons registered in terms of this Act in order to retain such registration; • the nature and extent of continuing education and training to be undergone by persons registered in terms of this Act; and • the criteria for recognition by the council of continuing education and training courses and education institutions offering such courses.

4. CPD policy making Since April 2004 one overarching Council CPD Committee was established & works with Professional Boards to: • develop policy proposals for a uniform but flexible system of CPD that will accommodate the diversity amongst health professions; • facilitate continuing assessment of all health practitioners registered with Council and the Professional Boards; • to deal with all CPD related issues, within the existing policy parameters of Council and the Professional Boards; • to report thereon to Council and the Professional Boards.

5. CPD - Aim To: • Provide opportunities to health care professionals for maintaining and enhancing professional skills, knowledge and attitudes • Enforce principle of continuous life-long learning • Change professional behaviour • Optimise and improve practice and patient outcomes • Improve quality of patient care

6. Historically • CME has been lecture based • bums on seats important • points accumulation • "a means of transferring notes from the pages of the speaker to the pages of the audience, without going through the mind of either"

7. Three models of CPD • Update model – merely facilitates the dissemination of knowledge and skills (most commonly model used in SA). • Competence model - ensures that minimum standards for knowledge, skills and attitudes are attained. • Performance model - aim to help professionals to overcome barriers to successful change in practice, and also to resolve clinical concerns and improve health outcomes.

8. Evidence for effective CPD • Little evidence that CPD as currently offered (update model) is effective in changing practice. • Evidence from educational research underscores the need to develop interventions that focus on the learning needs and practice problems of the individual learner. • Effective CPD programmes include learning modalities and principles of adult education (self-directed learning, reflection, contextual learning, direct relevance etc).

9. Therefore –a paradigm shift ….. • Research shows the greater the involvement of the participant the more effective the learning strategy will be to develop knowledge and skills • Why not focus on the level of involvement of the practitioner? • What about a staged approach to activities? • What about accumulating blocks of units not related to time spent?

10. Proposed new CPD System • More effective learning strategies • Hierarchy of activities (1 – 3) • Not always related to time spend • Levels of activity from brief (time) and easy (no effort) to longer (time) and complex (great effort) • Continuing educational units - CEUs - maximum of 30 per year (all professions) • Continuous- valid for 2 year period (60 CEUs on record at any point in time) • Simplified recording and administration

11. Hierarchy of activities 3 levels of activities organised into a hierarchy to distinguish between the different types of learning activities: • Non-measurable outcomes, once-off • Measurable outcomes, continuing programme • Formally structured learning programmes Although a practitioner may obtain all of the CEUs in one level or the number of CEUs across different levels, moving up on the hierarchy is promoted

12. Level 1 activities Once-off activities without clear measurable outcome – CEUs linked to time spend • Wide variety of traditional CME activities • Such as: small group meetings; seminars; journal clubs; breakfast meetings; hospital or departmental meetings; case studies discussions; teaching ward rounds; lectures; congresses; seminars; symposia; short courses • CEUs are earned at 1 per hour up • Daily maximum of 8

13. Level 2 activities Measurable outcomes, continuing programmes – CEUS not linked to time spend but awarded in blocks Education, Training, Research and Publications i.e. • Journal clubs with continuing programmes and outcomes assessed • Ethics, Health and Human Rights, and Medical Law • Principal author peer reviewed publication • Presenter of a paper/poster at a congress • Interactive skills workshop with evaluation Journal with MCQs • Clinical supervision of under/postgraduate training

14. Level 3 activities Structured Learning • Formal programmes - planned and recorded, measurable outcome by an accredited assessor • Degrees, diplomas, exit exams, appropriate basic certification, short courses (minimum of 25 hours contact time plus formal assessment) • Practice audit • Learning portfolio • Earn the required CEUs for a year i.e. 30.

15. Health and Human Rights New CPD system prioritises it through: • Set out as priority in the principles of the policy document • Being placed in higher order learning category • More CEUs to be earned • Accredited providers to describe on regular basis the extent of HHR and ethics in their CPD “curriculum”

16. Challenges • CPD system’s educational philosophy versus obligatory content stipulations • HHR involves a lot learning, delearning of attitudes • How to assess content of proposed HHR learning activities as appropriate • “Competes” with ethics and medical law • Will it make a difference? • How will we know that it has made a difference?

17. Compliance • Practitioner to maintain official HPCSA Individual CPD Activity Record • Compliance with CPD requirements tested in terms of random audit of practitioners from all boards • Audit Report compiled according to audit results and submitted to relevant Boards • Non compliance by practitioners addressed in cooperation with the Board

18. Time frames • Compulsory CPD accepted by most Professional Boards (Sec 26 of the Health Professions Act, 1974 Act No.56 of 1974.) • Council approved CPD programme in April 2005. • All Boards to institute January 2006 • All practitioners to be awarded 30 CEU’s at the outset • Legal compliance only kicks in on 31 December 2008 – thus after 2 years.

19. Enkosi Thank you Dankie