“Approaches to Continuing Competency – Challenges and Opportunities”

1. “Approaches to Continuing Competency – Challenges and Opportunities” Danielle Fagnan, Quebec Order of Pharmacists Ashifa Keshavji, College of Pharmacists of British Columbia Sandra Winkelbauer, Ontario College of Pharmacists Moderator: Della Croteau, Ontario College of Pharmacists

2. Why Continuing Competency? • public expectations • increased accountability • competency throughout practice • governments now legislating CLEAR 2008 Annual Conference Anchorage, Alaska

3. Three Different Approaches • Description • Outcomes and Challenges • Future Directions How does this compare to your program? CLEAR 2008 Annual Conference Anchorage, Alaska

4. College of Pharmacists of British Columbia Ashifa Keshavji CLEAR 2008 Annual Conference Anchorage, Alaska

5. Objective • To provide an overview of the College of Pharmacists of BC’s quality assurance program – the Professional Development and Assessment Program (PDAP) • To share the challenges faced CLEAR 2008 Annual Conference Anchorage, Alaska

6. Professional and Legal Mandates Code of Ethics PDAP Legisla- tion FPP CLEAR 2008 Annual Conference Anchorage, Alaska

7. Program Purpose • To support the college’s mission to ensure pharmacists provide safe and effective pharmacy care to help people achieve better health • To promote continuous learning and professional development CLEAR 2008 Annual Conference Anchorage, Alaska

8. Program Philosophy & Principles • Uses the Framework of Professional Practice as the foundation • Focus should be on professional development • Program must build on what pharmacists already do in their practices • Built-in opportunity for reflection and self-assessment • Pharmacists must have an opportunity to demonstrate their public accountability (essential to self-regulation) • Fair and valid assessments support the legislated mandate of the profession • Evaluate the program on a regular and on-going basis CLEAR 2008 Annual Conference Anchorage, Alaska

9. The Framework of Professional Practice (FPP) • A comprehensive description of the work pharmacists do • Based on the outcome of an occupational analysis, beginning with defining the purpose of the profession • Validated by registrants • Serves as BC’s standards of practice • Foundation for PDAP and all other college programs and services – including site visits/inspections CLEAR 2008 Annual Conference Anchorage, Alaska

10. Professional Development and Assessment Program (PDAP): Structure and timelines • Six-year cycle • One-half the membership participates every 3 years • The entire membership participates over a 6-year period • First cycle - September 2003 • Second cycle - September 2006 • Each cycle consists of three phases CLEAR 2008 Annual Conference Anchorage, Alaska

11. PDAP: Phase 1 (September 2003-February 2005) • Professional development and preliminary assessment • Complete a Self-Assessment • Select one of two options: • Knowledge Assessment • Learning and Practice Portfolio CLEAR 2008 Annual Conference Anchorage, Alaska

12. PDAP: Phase 2 (September 2005 – August 2006) • Professional development and secondary assessment • Complete a self-assessment • Select one of four options: • Knowledge Assessment • Learning and Practice Portfolio • Practice Audit • Objective Structured Clinical Examination (OSCE) CLEAR 2008 Annual Conference Anchorage, Alaska

13. PDAP: Phase 3(Began September 2006) • Individualized remediation and reassessment • Peer Practice Committee and college staff review assessment results • Work with participant to develop an individualized remediation plan and define re-assessment requirements CLEAR 2008 Annual Conference Anchorage, Alaska

14. Self-Assessment • Based on the Framework of Professional Practice • Compare one’s own standard of practice to those reflected in the FPP • Identify strengths and limitations and map out a professional development plan CLEAR 2008 Annual Conference Anchorage, Alaska

15. The Knowledge Assessment… • Linked to the Framework of Professional Practice • Standardized MCQ exam • 2&1/2 hours, 65 questions, open book • Covers clinical decision making and ethical issues in therapeutics, pharmacology and pharmaceutics • Scoring is criterion referenced • Feedback received: • Standards met/standards not met • Domain and disease states answered correctly or incorrectly CLEAR 2008 Annual Conference Anchorage, Alaska

16. Learning and Practice Portfolio… • Linked to the Framework of Professional Practice • Individualized to reflect one’s needs, PD preferences and practice priorities • A compilation of how one has planned, implemented and evaluated their learning and practice achievements • Feedback received: • Standards met/standards not met • Based on the published criteria • Individualized based on content and nature of the learning and practice achievements CLEAR 2008 Annual Conference Anchorage, Alaska

17. Practice Audit • On-site process where a trained peer auditor observes performance based on FPP • Includes follow-up interview, if required • Feedback includes: • Standards met/standards not met • Individualized report and overall summary of performance by FPP Role, on areas of strength and those needing improvement CLEAR 2008 Annual Conference Anchorage, Alaska

18. OSCE • Practical examination that assesses communication, problem-solving skills and overall performance • Series of 7-minute simulated tasks commonly encountered in practice • Feedback includes: • Standards met/standards not met • Individual average score in communication, outcome and overall performance • Overall score in competency areas • Comparison to group average CLEAR 2008 Annual Conference Anchorage, Alaska

19. Program Evaluation Program Evaluation Tool Tool Phase 1 Phase 1 Phase 2 Phase 2 Volunteer Volunteer KA KA 1060 (91%) 56 (36%) 60 (83%) LPP LPP 198 (90%) 15 (80%) 2 (100%) 2 (100%) PA PA - - 10 (60%) 27 (96%) OSCE OSCE - - 1 (0%) 15 (80%) Total Total 1258 (91%) 82 (48%) 104 (87%) Phase 1, Phase 2 Participants CLEAR 2008 Annual Conference Anchorage, Alaska

20. Challenges • Emphasize each tool follows the CPD cycle • Encourage participants to engage in an on-going PD cycle • Confirm the validity of the assessment tools in meeting the program purpose • Explore the motivational factors by which assessment tools are selected • Keep communicating with and engaging registrants CLEAR 2008 Annual Conference Anchorage, Alaska

21. Ontario College of Pharmacists Sandra Winkelbauer CLEAR 2008 Annual Conference Anchorage, Alaska

22. OCP Program Description CLEAR 2008 Annual Conference Anchorage, Alaska

23. OCP Program Description • A Quality Assurance program is mandated for all regulated health professions in Ontario • Based on Standards of Practice • Two-part Register • Part A – patient care • Part B – no patient care CLEAR 2008 Annual Conference Anchorage, Alaska

24. Learning Portfolio • All Ontario pharmacists, Part A and Part B, required to maintain a learning portfolio • On-line tool available • Tool helps to plan and document CE activities • Non-traditional learning activities are recognized • Submitted upon request CLEAR 2008 Annual Conference Anchorage, Alaska

25. Self-Assessment Tool • 20 % of Part A pharmacists each year (100 % of Part A pharmacists over 5 years) • On-line tool • Tool helps to identify learning needs and plan learning • Includes clinical knowledge assessment • Information is confidential CLEAR 2008 Annual Conference Anchorage, Alaska

26. Peer Review • ~ 2.3 % of Part A pharmacists each year • Randomly selected • Also for movement from Part B to Part A • Consists of: • clinical knowledge assessment • standardized patient interviews • learning portfolio sharing session CLEAR 2008 Annual Conference Anchorage, Alaska

27. Peer Review • Components assessed: • Clinical knowledge • Gathering information • Patient management and follow-up • Communication skills CLEAR 2008 Annual Conference Anchorage, Alaska

28. Peer Review - Validity • Clinical knowledge assessment cases • 3 different committees of practicing pharmacists write, review and set standards for each case • Standardized patient scenarios • 3 different committees of practicing pharmacists write, review and set standards for each scenario CLEAR 2008 Annual Conference Anchorage, Alaska

29. Peer Review - Remediation • Professional Development Advisor • Peer Support Group • Professional Development Workshop CLEAR 2008 Annual Conference Anchorage, Alaska

30. Outcomes • Quality Assurance program has been in place for 11 years • 10 year review conducted last year CLEAR 2008 Annual Conference Anchorage, Alaska

31. Outcomes – Place of Graduation CLEAR 2008 Annual Conference Anchorage, Alaska

32. Outcomes – Place of Practice CLEAR 2008 Annual Conference Anchorage, Alaska

33. Outcomes - Results CLEAR 2008 Annual Conference Anchorage, Alaska

34. Outcomes – Years since Graduation CLEAR 2008 Annual Conference Anchorage, Alaska

35. Outcomes – Place of Graduation CLEAR 2008 Annual Conference Anchorage, Alaska

36. Challenges • Resistance from members • Not assessing actual practice • Defining the number of pharmacists that should ideally undergo peer review • Cost • Difficult remediation cases • Need to create QA program for pharmacy technicians CLEAR 2008 Annual Conference Anchorage, Alaska

37. Future Directions • Evaluation and enhancement of the on-line Self-Assessment and Learning Portfolio • Evaluation of Peer Review process addressing: • Affect of changing scope of practice • Numbers chosen for quality assurance • Effectiveness versus other processes • QA program for pharmacy technicians CLEAR 2008 Annual Conference Anchorage, Alaska

38. Speaker Contact Information Sandra Winkelbauer Manager, Continuing Competency Ontario College of Pharmacists swinkelbauer@ocpinfo.com 416-847-8204 (insert OCP logo) CLEAR 2008 Annual Conference Anchorage, Alaska

39. Quebec Order of Pharmacists Danielle Fagnan CLEAR 2008 Annual Conference Anchorage, Alaska

40. Mandatory statute of professional inspection in Quebec • Supervise professional practice • Inquire into the professional competence of any member of the Order CLEAR 2008 Annual Conference Anchorage, Alaska

41. Pharmacy in Quebec • 7262 members (62,9% F – 37,1% M) • 1669 community pharmacies (1690 owned, 3354 pharmacists) • 128 health care facilities (1316 pharmacists) • 158 pharmacists (replacement) • 744 pharmacists (others) • 4 inspectors for community pharmacies • 2 inspectors for health care communities CLEAR 2008 Annual Conference Anchorage, Alaska

42. Professional inspection in Quebec • General assessment of practice sites and of pharmacists if needed • Evaluation according to specific indicators based on a minimum standard of quality practice • Self-assessment/pre-inspection questionnaire filled by each pharmacist CLEAR 2008 Annual Conference Anchorage, Alaska

43. Evaluation in community pharmacies • Professional practice (technical aspect) • Staff • Workload • Work organization • Hygiene • Equipment CLEAR 2008 Annual Conference Anchorage, Alaska

44. Evaluation in community pharmacies • Respect of laws and regulations • Standards of practice • Labeling • Outdated products • Confidentiality • Ethics, etc. CLEAR 2008 Annual Conference Anchorage, Alaska

45. Evaluation in community pharmacies • Evaluation of Clinical aspect • Assessment based on clinical indicators reflecting minimum standards of patient’s quality of care and pharmaceutical services (indicators related to antibiotic therapy, asthma, hormonal contraception, depression, diabetes, dyslipidemia, hypertension, hormonal replacement, insomnia, inflammatory diseases and palliative care) • Data collection from 25 patients’ chart CLEAR 2008 Annual Conference Anchorage, Alaska

46. Evaluation in community pharmacies • Self-assessment • On site assessment (data collection, observation, coaching and recommendations) • Evaluation report presented to our professional inspection committee • Discussion on general recommendations and official agreement on identified problems requiring more aggressive interventions such as follow up with written engagement from the owner, control inspection or information to Syndic CLEAR 2008 Annual Conference Anchorage, Alaska

47. Evaluation in health care facilities • Policies and procedures • Medication distribution and control • Sterile products and chemotherapy preparation • Services and clinical programs • Medication and clinical studies • Human and material resources • Quality control CLEAR 2008 Annual Conference Anchorage, Alaska

48. Evaluation in health care facilities • Clinical evaluation according to specific indicators of quality practice based on a level II of pharmaceutical care (selective monitoring of pharmacotherapy) • > 65 y. o • >7 drugs • Narrow therapeutic index • Major interactions • Duplication • Pertinence and clarity of communications with other health care professionals CLEAR 2008 Annual Conference Anchorage, Alaska

49. Assessment of individual competency • Request from Committee of discipline, Executive Committee/Bureau, Professional inspection Committee • Following a professional inspection • Thoroughly regulated process • Decisions with important consequences • Validity and reliability of tools • SOI (structured oral interview) used as a diagnostic tool • Individualized pedagogic prescription and remedial (course, training, limitation of practice) CLEAR 2008 Annual Conference Anchorage, Alaska

50. Challenges • 5-year cycle for inspection • More general inspection of sites and less pharmacists’ individual assessment • Evaluation according to specific minimum standards of quality practice • Regular updates of our standards of practice, practice guides, publications of professional information and clinical cases for SOI CLEAR 2008 Annual Conference Anchorage, Alaska