Workbased Competence Assessment

1. Workbased Competence Assessment Stiofán Mac Suibhne

2. Overview • NZ Regulatory Framework • Statutory Duties • Work-based Assessment - e-Portfolio / PebblePad • Implementation

3. New Zealand Healthcare Regulation • Legacy of the ‘Unfortunate Experiment’ • Health & Disability Commission • Strong regulatory presence – Common Law right to litigate removed • No blame compensation / rehabilitation regime • Health Practitioner Competence Assurance Act (2003) • Osteopathy is one of 17 healthcare professions subject to statutory regulation • Treaty obligations / biculturalism

4. Section3 Purpose of the Act (1) The principal purpose of this Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.

5. Statutory Duties • Determine scopes of practice • Prescribe qualifications / accredit institutions • Determine Competency Frameworks • Operate systems that ensure ongoing maintenance of competence • Assess international osteopathic graduates • Competence reviews • Fitness to practice reviews • Professional conduct

6. Tasks / Applications for PebblePad • Workbased competence programmes • Return to practice • Overseas assessment • Scope of Practice development • Advanced practice • Upskilling • Grandparenting

8. Reflective Practice Reflective practice: ‘the capacity to reflect on action so as to engage in a process of continuous learning’ (Donald Schön 1930 – 1997). One of the defining characteristics of professional practice.

9. Assessment Methodology An understanding of the nature of ‘Practice’ is central to designing an assessment process which is capable of capturing evidence of an individual’s ability to practice. • The first step in designing the assessment process was accepting a conceptual model for osteopathic practice. • Then developing an analysis / deconstruction of practice from the perspective of process - rather focussed on academic knowledge – Osteopathic Capabilities Framework. • Identifying assessment tools to assess the various components of practice. K S A

10. Focus on Practice • A form of assessment that aligns learning and assessment was required allowing the practitioner to identify and develop a reflective approach. • Defensible mechanism that allows evidence to be assembled and, notwithstanding the diversity of approaches to practice, allows competencies to be identified within a flexible capabilities framework. • Creating an understanding of reflective practice and a commitment to lifelong/lifewide learning - training and dialogue with the profession.

11. Focus on Practice • Three year cycle of regional conferences to raise awareness amongst the profession. • Problematising current approaches and sharing an understanding of the theoretical framework supporting the use of PebblePad • Migrating from a p-portfolio to an e-portfolio: • Encouraging practitioners to creatively develop and use PebblePad as a personal learning space. • Creating allies and project champions. Identifying potential pilot sites for trialling professional development/recertification processes.

12. Scope of Practice

14. Osteopathic Capabilities

15. Domain 1: Clinical Analysis Descriptor This capability incorporates an osteopath’s ability to gather information about a patient’s health from a bio-psychosocial perspective. This should inform examination and screening, diagnosis, prognosis, condition and health management from a patient-oriented context. This diagnosis and care plan should reflect the complex bio-psychosocial nature of the presentation and include ongoing review. It incorporates an understanding of clinical complexity and uncertainties and the professional commitment to manage these components within patient care

16. Elements 1.1 gathers organises and records a focused personal health record 1.2 synthesizes information into a suitable working diagnosis and an understanding of general health status 1.3 devises and instigates a plan of care addressing the person’s presenting disorder and their general health, in consultation with that person (or their representative or carer) 1.4 establishes a prognosis, appropriate outcome measures, reviews patient progress and modifies plan of care as required 1.5 recognises when further information is required 1.6 critically reflects on clinical challenges and uncertainties

17. Criteria 1.1.1 critically uses a variety of information retrieval mechanisms, including osteopathic physical examination and palpation techniques 1.1.2 Compiles a health care record that is personal to the individual 1.1.3 Incorporates bio-psychosocial components within the health record 1.1.4 Ensures patient-centred orientation of case analysis

18. Integrating Theory & Practice • Conventional wisdom of evidence based practice applies theoretical knowledge to practice. • In reflective practice theory and practice are seen as being reciprocally inter-related. • Professional identity / knowledge is complex and is not merely assembled from discreet knowledge base. • Professional knowledge / identity arises from a synthesis of natural and social sciences

19. R U a Reflective Practitioner?

20. Reflection and Action Reflection-in-Action: as we work identifying learning needs / opportunities Reflection-on-Action: After the fact seeking theoretical perspectives and integrating them into our thinking Reflection-for Action:Applying knowledge to practice Creating Personal reflective space / Organisational Context. Thinking>Analysis>Self>Awareness

21. R U an Ultra-Positivist?

22. Comply or Excel? • OCNZ needs to be realistic • Broad church • Freshen up - maintain interest in practise • Skills acquisition: Cognitive - Associative - Autonomous - "OK" Plateau - Fitts & Posner • Honesty & Openness to change / development

23. Portfolio / e-Portfolio • Miller’s pyramid of competence indicates that assessment of ‘does’ reflects professional authenticity. • Whatever one ‘does’ in the assessment must reflect practice in order for that assessment to be authentic. • The portfolio’s purpose is to guide learning and capture evidence • Portfolio was the Hoorah word of ‘90s • Evidenced Based Practice ’oos • e-Portfolio is current Hoorah! • Trial the e-Portfolio for the overseas assessment processes • Reference Group to look at applications for CPD / Recertification Processes

24. ePortfolio Assessment Tools • Learning Needs Analysis • Personal Development Plan • Learning Outcome Reports • Case based Discussion • Critical Incident Report • Critiquing journal articles • Literature reviews • Reflective statements from training courses

25. Implementation Timeline • Scope of Practice Reform 2007 - 12 • Osteopathic Capabilities Framework 2007-09 • Development of work-based competence assessment 2010 • PebblePad Preceptor Training Nov 2013 • Unitec – Clinical Practicum 2013 • Trialled for overseas assessment 2013 • Overseas Assessment Process from Jan 2014 • Peer Group Training August 2014 • Recertification - Voluntary adoption by registrants 2015 • Recertification Mandatory 2016

26. Overcoming barriers • Resource constraints • Conventional thinking amongst administrative staff. • Focus on the added value of reflection on practice over the growing pains of different working practices. • Reluctance of osteopaths to be assessed. • Osteopathic Exceptionalism - the ultra-positivists & the insider / outsider problem. • An advantage of the slow burn approach with the profession has been time for the conceptual framework to be understood and producing practitioners that are keen to push forward with innovation.

28. From the Ivory Towers to the swampy lowlands of practice Move the focus of what the profession understands constitutes competence beyond the boundaries and artificial subject areas of traditional pre-registration training courses to professional practice. Progress not perfection