The RACGP’s lead for CPD says the key to managing the new requirements is to make CPD a part of everyday practice.
The new year ushered in significant changes to the way many medical professionals – including GPs – keep up to date with developments in their practice area.
CPD program providers are, understandably, upbeat about their offerings but they may have to wait a few months before receiving a final verdict from the professions.
TMR spoke to Professor David Wilkinson, the RACGP’s national clinical lead for CPD, to get the college’s take on the new requirements.
The professional performance framework
The new CPD is one “pillar” of the Medical Board of Australia’s Professional Performance Framework. According to the board, the framework is designed to support doctors in “taking responsibility for their own performance, and it encourages the profession to raise professional standards”.
However, that first aim has rankled some doctors, and others are sceptical of its ability to do the latter.
The framework comprises five “pillars”, although CPD is by far the most important. A second pillar concerns minimising risk, with the board proposing mandatory peer reviews and health checks for doctors at age 70 and every three years after.
The framework is being introduced progressively and not every area of medical practice is currently at the same stage. Some elements are already in place, or only require fine tuning, while others have involved significant planning, consultation and development.
Professor Wilkinson says GPs should give the new regime a little time to become bedded down.
“We’ve all got to get used to it before we can judge it,” he says. “I think change is always challenging – I get that – but I’ve had quite a lot of positive feedback from many of the GPs I’ve interacted with once they had got their head around things.
“These changes are mandated by the Medical Board, they apply to all doctors in Australia, not just GPs, and the job of the specialist colleges, including the RACGP, is to implement them in a sensible way. Our focus is on making CPD as useful as possible and as straightforward as possible.”
In his view, the time requirement has not really changed.
“What’s changed is how it all gets measured. And of course, the new reviewing performance and measuring outcomes part is a significant change, so I think it’s a case of getting our heads around that.”
What happened on 1 January 2023?
On the first day of the year, the RACGP, ACRRM and all other accredited specialist medical colleges became “CPD homes”, accredited to administer CPD.
All doctors doing CPD programs with colleges or other new, accredited CPD homes will be able to meet updated CPD requirements.
Doctors who do not have a CPD home in 2023 can keep doing the same type of CPD that they are currently doing. However, the board says they should keep their eyes peeled for any new, accredited CPD homes that might begin offering CPD programs relevant to their scope of practice.
All doctors will need a CPD home by 2024, with several alternative CPD homes likely to have been established by the time the new year comes around.
What will GPs need to do?
GPs now need to log 50 hours of CPD every year, complete a professional development plan and refresh their CPR skills.
The focus of the new changes, according to the RACGP, is on “regular performance feedback, collaboration with peers, self-reflection and reviewing patient outcomes”.
The 50 hours needs to be broken down based on the type of activity, with GPs needing to complete:
- 12.5 hours (25%) of hours recorded under educational activities
- 25 hours (50%) of hours recorded across reviewing performance and reflecting on practice and measuring and improving outcomes (with a minimum of five hours for each category)
- the remaining 25% (12.5 hours) distributed across any of the three types of CPD
While these tasks must be completed annually, GPs will have three years to update their CPR skills. This is an RACGP high-level requirement, not mandated by the board, but the college will also accept other courses that meet the Australian Resuscitation Council guidelines such as BLS and ALS courses that include CPR.
The board only allows CPR courses to be logged as an educational activity.
Time for reflection
While medical professionals would accept the need to keep up to date with developments in their practice area and are used to doing this, the need to review performance and reflect on practice has not been received as well in all quarters. These activities, along with measuring and improving outcomes, make up at least half of the hours required under the new framework.
“The medical board is very clear about what’s behind this: they want us to think about our practice and make sure that we are improving all the time,” Professor Wilkinson says.
He recently saw a patient who’d had a heart transplant eight years ago and had come to him for a skin check. During the check, Professor Wilkinson found some skin cancers.
“I realised I don’t see many patients who’ve had major organ transplants like that very often. And I realised I needed to just remind myself of what her risks really were and what her powerful immunosuppressant drugs were really doing.
“So, my CPD this weekend will be to look that up, have a bit of a think about it, and make sure I understand it. That’s reflection and that’s my CPD, which I’ll log on the CPD website.
“I don’t think anybody needs to get over-anxious about the word ‘reflection’ – it’s just thinking about how this applies to my practice and how I get better.
“I think the tougher challenge is measuring outcomes,” he says. “What the board is getting at there is for those of us in clinical practice, can we quantify the impact we’re having? For example, if you’re looking after a group of patients with diabetes, how do you know what their level of diabetic control is. And instead of just managing each patient as they come in, gather a little bit of data.
“You could, for example, gather six or seven patients’ records, look through them, remind yourself of the guidelines and check to see how many of your patients have achieved the recommended outcomes. Then you could think about whether there’s anything you need to change in your practice based on that. That’s it – that’s your measuring outcomes.
“Most of us do that all the time,” Professor Wilkinson says, “but what the board wants the profession to do is to be a little bit more rigorous about it.”
Other areas of practice have taken a similar approach.
“RANZCR (the Royal Australian and New Zealand College of Radiologists) recognises that many of our members would already be doing some of these activities in their daily work and have worked to shift the way of thinking to CPD being more than just attending conferences and traditional didactic forms of education,” says RANZCR president, Clinical Adjunct Professor Sanjay Jeganathan.
“Many of our members’ daily clinical activities are classified as eligible for claiming CPD hours.”
An unpaid box-ticking exercise?
While specialists in salaried positions can complete at least some of their CPD activities on their employer’s time, for GPs it’s unpaid work – and that’s just one of several concerns that GPs have about the time-based approach.
“That’s manifestly true, and I’m not going to defend that feature of the system,” Professor Wilkinson says, “but that’s why I think CPD should be integrated into our daily work as far as possible and for many of us, much of it is already. A practice meeting’s a good example. We’re not paid to attend a practice meeting, but we all recognise there’s value in doing so and it’s part of the CPD process.”
“I would urge you to identify what matters most to you in CPD and to get familiar with the RACGP’s resources because I think most doctors are asking these sorts of questions. They’ll realise once they get their head around it that actually it’s not too onerous. I think a lot of it is just getting used to the changes and understanding what they need to do.”
Dr Linda Calabresi, Sydney GP and TMR editor-in-chief, wrote in September that the time-based arrangement would simply place greater pressure on an already overburdened profession.
“Both the Australian College of Rural and Remote Medicine (which has already implemented the 150-hour minimum for this triennium) and the Royal Australian College of General Practitioners are muttering reassurances – ‘don’t worry, you’re doing all this stuff already’ and ‘we’ll help you through it’,” Dr Calabresi wrote.
“But the reality is the understanding, documentation and responsibility of ensuring that all the CPD pre-requisites are met represents a huge added bureaucratic burden to our already overburdened professional lives.”
Radiation oncology and general practice are entirely different disciplines so it might be unfair to compare one with another. But Professor Jeganathan says keeping up to date ultimately benefits the patient and is not a hollow exercise.
“It is imperative that clinicians are keeping up to date with advancements in their profession, which is particularly of importance in the fields of clinical radiology and radiation oncology with rapid changes in technologies,” says Professor Jeganathan.
“It should never be seen as box-ticking exercise that takes time away from patients. On the contrary, enabling ongoing learning to keep up with advancements in medical practices and technology is for the benefit of optimal patient care.”
Either way, 2023 will be a significant year for CPD – for GPs and thousands of other practitioners. What they have to say at the end of the year will be enlightening.
