LAST week, the Medical Board of Australia released a Professional Performance Framework, designed for patient safety. We believe it is a fair and practical approach to ensure that all doctors in Australia practise safely.
Surveys in Australia repeatedly show that patients trust their doctors. Trust is precious, and each medical practitioner has a role in building and preserving it. This trust is based on community confidence that doctors will keep their knowledge and skills up to date and practise ethically and safely throughout their working lives. The Professional Performance Framework will support doctors to take responsibility for their own performance and encourage the profession collectively to raise professional standards and build a positive, respectful culture in medicine that benefits patients and doctors.
The Professional Performance Framework is the Board’s response to the report of its Expert Advisory Group (EAG) on revalidation. The Board has accepted the evidence provided by the EAG and its recommendation to adopt an integrated approach that will improve public safety and better identify and manage risk in the Australian health care setting. The EAG advised the Board to maintain and enhance the performance of all doctors practising in Australia through efficient, effective, contemporary, evidence-based continuing professional development (CPD) relevant to their scope of practice, and to proactively identify doctors who are either performing poorly or are at risk of performing poorly, by assessing their performance and supporting their remediation whenever this is possible. The EAG identified that age, professional isolation and multiple complaints are all risk factors for poor performance.
Under the five pillars of the Professional Performance Framework:
- Strengthened CPD includes practitioners having a “CPD home” and participating in its CPD program; ensuring that their CPD is relevant to their scope of practice and based on their own professional development plan, and completing at least 50 hours of CPD per year that includes reviewing their performance, measuring their outcomes and educational activities.
- Active assurance of safe practice involves identifying practitioners at risk of poor performance and managing that risk.
The Board expects that the vast majority of doctors with identified risk factors will demonstrate their ability to provide safe care to patients and remain in active clinical practice.
The EAG has identified increasing age as a risk factor for poor performance. The Board is proposing to require practitioners who provide clinical care to undergo peer review and health checks at 70 years of age and 3-yearly thereafter. The outcome of health checks and peer reviews will not be reported to the Board unless there is serious risk to patients.
The EAG also identified professional isolation as a risk factor. The Board plans to provide guidance to help practitioners identify the hallmarks of professional isolation and manage the risk from it, including by increasing peer review in their CPD.
- Strengthened assessment and management of medical practitioners with multiple substantiated complaints includes formal peer review of performance for practitioners with multiple substantiated complaints.
- Guidance to support practitioners involves the Board continuing to develop and publish clear, relevant and contemporary professional standards to support good medical practice. This includes a revised Code of Conduct, as well as revised and new registration standards.
- Collaborations to foster a positive culture of medicine that is focused on patient safety, based on respect and encourages doctors to take care of their own health and well-being. This includes the Board working with the profession and others to reshape the culture of medicine and build a culture of respect. This also includes encouraging doctors to take care of their own health and wellbeing and to support their colleagues, and urging governments and other holders of large data to make it accessible to individual practitioners to support practice improvements.
The Board’s Professional Performance Framework is evidence-based, integrated and builds on existing initiatives. It will be implemented progressively, with some elements already in place and others requiring significant planning, consultation and development. Nothing is going to change tomorrow for doctors in Australia.
We will work with the profession and the community to develop the detail. Already, most specialist colleges are taking their CPD programs in the direction we propose. We will encourage sharing of best-practice approaches across the profession and work to develop mechanisms for recognising approved CPD activities between colleges and employers to minimise duplication for doctors.
The EAG report clearly sets out the evidence about predictable risk of poor performance from age, professional isolation and multiple substantiated complaints. However, we have more work to do to develop and implement effective and practical ways of screening for these risks. We will develop and provide guidance about the hallmarks of professional isolation and how these can be managed, including by increasing the peer review components of CPD. We will require practitioners who are subject to multiple substantiated complaints to participate in formal peer review, recognising that there may be differentiation in notification rates between fields of practice and that it will take time and experience to identify appropriate thresholds for this action.
We recognise that introducing a requirement for peer review and health checks for doctors over the age of 70 is the most contentious of our proposals.
We are not seeking to drive older doctors out of practice or place undue burdens on them. We believe that the evidence about potential risks associated with ageing requires us to assure older doctors and their patients of their continuing capacity to provide safe care. We will commission expert clinical advice about what kind of health checks will be helpful, what kind of cognitive screening is useful and when it is warranted, and then work with the profession to develop these.
We believe that there is no place for a compulsory retirement age for doctors and we value the contribution older doctors make. Our approach is designed to provide both assurance and support for their continued safe practice.
Read more about the Board’s Professional Performance Framework and the full report of the Expert Advisory Group on revalidation.
Dr Joanna Flynn, AM, is the Chair of the Medical Board of Australia.
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