clear 2008 annual conference anchorage, alaska “approaches to continuing competency – challenges...
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CLEAR 2008 Annual Conference
Anchorage, Alaska
“Approaches to Continuing Competency – Challenges
and Opportunities”
Danielle Fagnan, Quebec Order of PharmacistsAshifa Keshavji, College of Pharmacists of British Columbia
Sandra Winkelbauer, Ontario College of PharmacistsModerator: Della Croteau, Ontario College of Pharmacists
Why Continuing Competency?
• public expectations
• increased accountability
• competency throughout practice
• governments now legislating
Three Different Approaches
• Description
• Outcomes and Challenges
• Future Directions
How does this compare to your program?
College of Pharmacists of British Columbia
Ashifa Keshavji
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
Professional and Legal Mandates
Code of
Ethics
PDAP
FPPLegisl
a-tion
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
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
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
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
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
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)
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
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
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
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
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
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
Phase 1, Phase 2 Participants
104 (87%)82 (48%)1258 (91%)Total
15 (80%)-OSCE
-PA
2 (100%)198 (90%)LPP
60 (83%)56 (36%)1060 (91%)KA
VolunteerPhase 2Phase 1Tool
Program Evaluation
Total
1 (0%)-OSCE
27 (96%)10 (60%)-PA
2 (100%)15 (80%)LPP
KA
VolunteerPhase 2Phase 1Tool
Program Evaluation
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
Ontario College of Pharmacists
Sandra Winkelbauer
OCP Program Description
Quality Assurance
Continuing Competency Department
Pharmacy Practice Department
1. Learning Portfolio 4. Pharmacy
Inspections
2. Self-Assessment
3. Peer Review and
Remediation
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
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
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
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
Peer Review
• Components assessed:– Clinical knowledge– Gathering information– Patient management and follow-up– Communication skills
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
Peer Review - Remediation
• Professional Development Advisor
• Peer Support Group
• Professional Development Workshop
Outcomes
• Quality Assurance program has been in place for 11 years
• 10 year review conducted last year
Outcomes – Place of Graduation
Peer Review Participants (n=1938)
Ontario, 53%Canada /
USA, 24%
International, 23%
Pharmacists in Part A (n=10,378)
Ontario, 48%
Canada / USA, 23%
International, 29%
Outcomes – Place of Practice
79.40%73.50%
16.60%16.50%
4%10%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Community Hospital Other
Place of Practice
Peer Review Participants Pharmacists in Part A
Outcomes - Results
Peer Review Results 1997-2007 (n=2013)
Peer-Guided, 12%
Self-Directed, 88%
Outcomes – Years since Graduation
1.10%
98.90%
4.40%
95.60%
8.10%
91.90%
25.10%
74.90%
0 - 5 6 15 16 - 25 > 25
Peer Review Results Based on Years Since Graduation (1997 - 2007)
Peer-Guided Self-Directed
Outcomes – Place of Graduation
10%
90%
5%
94%
23%
77%
Ontario Canada / USA International
Peer Review Results Based on Place of Graduation (1997 - 2007)
Peer-Guided Self-Directed
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
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
Speaker Contact Information
Sandra Winkelbauer
Manager, Continuing Competency
Ontario College of Pharmacists
416-847-8204
(insert OCP logo)
Quebec Order of Pharmacists
Danielle Fagnan
Mandatory statute of professional inspection in Quebec
• Supervise professional practice
• Inquire into the professional competence of any member of the Order
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
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
Evaluation in community pharmacies
• Professional practice (technical aspect)– Staff– Workload – Work organization– Hygiene– Equipment
Evaluation in community pharmacies
• Respect of laws and regulations– Standards of practice– Labeling– Outdated products– Confidentiality– Ethics, etc.
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
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
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
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
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)
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
Challenges
Urgent need to rethink our processes and develop a
strategic plan
Future
• Use benchmarks/best practices/pilot projects to set up and update standards of practice (pro activity and improvement of practice)
• Be able to target practice sites and individual pharmacists with problems (efficacy and efficiency)
• Develop different mechanisms to be able to evaluate our membership in order to sustain a 5-year cycle
• Link with self-assessment, CPD and prevention activities
• Develop strategies to address overall performance and the relative influence of these determinants
Speaker Contact Information
Danielle Fagnan
Director of professional services
Quebec Order of pharmacists
QUESTIONS?
Does anyone have any suggestions for improvement of these programs?
Do you think public safety is protected by such a program?
What are similar issues in your profession, and how have you approached quality assurance?