In 1999 the HPCSA introduced continuing Professional Development (CPD) for all members of the Medical and Dental Professions Board. It can be stated, without fear of contradiction, that we and our medical colleagues were the guinea pigs in the unfolding of CPD, a situation which has led to much frustration for practitioners and which has resulted in an apology to practitioners from the HPCSA. 1999 was to be a ‘trial’ year with any points gleaned that year being added to those earned in 2000, which would all count towards the required 250 points needed by the end of January 2004, a five year cycle (plus the trial year).
Before the end of this term three attempts to provide participants with point reconciliations were made. The first, a manual effort, yielded accurate results, but thereafter the two other electronic attempts resulted in inaccurate data being produced. At considerable expense to Council (i.e. you and me) the computer systems were ‘tweaked’ with no improvement. Before the initial 5 (6) year period had elapsed a new three-year ‘rolling’ total system was introduced which also proved to be unmanageable. A third system based on a two year cycle was then proposed , but no-one actually knows whether this is in fact operational or functional, and practitioners have been left with an instruction to continue accumulating CPD points, as it is business as usual with the status quo remaining. Unfortunately with the several changes made by Council, no-one knows what the status quo is and in fact many practitioners are floating rudderless in the CPD pool. Others flout the law – seemingly with impunity. Eventually Council decided to employ an expert, Prof Pistorius, to design a new electronic system. Tenders were called for to provide such a system with quotes reportedly varying from half a million to more than ten times that amount for a new system -money that would be forthcoming from you and me. Faced with this expenditure the HPCSA Registrar wisely decided to revisit the entire issue of CPD and the HPCSA simultaneously decided that CPD overarches all boards and that it would therefore become a committee of the HPCSA and not of every Board. In fact several Boards (including the largest, the Professional Board for Emergency Care Practitioners and the Professional Board for Dental Therapy and Oral Hygiene) have not yet implemented any form of CPD despite this being a requirement of the Health Professions Act 1974 as amended.
Furthermore those Boards who do enforce CPD requirement vary in the number of points required from 50 points per annum (MDPB and Dietetics) to 15 points in 2 years (Occupational Therapy assistants). In order to allow work on CPD to proceed a member from each Board was appointed to the HPCSA committee for CPD. The representative for the MDPB, Prof. M De Villiers was elected as chairperson of that Committee at its inaugural meeting which allowed the MDPB to elect a delegate to the Committee and I was appointed to the Committee. Under the chairpersonship of Ms S Swart, from the Board for Speech, Language and Hearing Professions a task team produced a draft document which contained the following basic suggestions:
There should be a movement away from ‘points gathering’ and an effort to ensure that some learning had indeed taken place during CPD. The requirement should be for 30 points per annum for all participants. There should be a hierarchy of activities which could allow CPD compliance. The hierarchy suggested 5 distinct ‘tiers’. Tier one with informal meetings of ‘approved’ providers or institutions only allowed a one hour session per day up to a maximum of 15 points (or credits) per year. This was meant to be for regularly recurring activities e.g. study groups.
At Level 2 a practitioner may be awarded a maximum of 15 annual credits for day or half day activities of with a maximum of 5 Credits per day. This tier includes conferences and seminars as we presently know them.
At Level 3 a practitioner may be awarded a maximum of 20 Credits from no more than 4 of the activities that are listed. The list includes publication in a peer-reviewed journal, authorship of a book or chapter in a book, research at an approved institution, membership of a research ethics committee or independent review Board, development of clinical protocols, paper or poster presentation, keynote speaker at an accredited conference, guest lecturer at an accredited institution, supervision of post graduate studies, supervising undergraduate clinical or technical training, presenters at short courses or workshops, and in service training of profession specific competencies under a supervisor.
At Level 4 a practitioner may be awarded a maximum of 25 Credits for the series of events that constitutes a formally presented and monitored year long programme. This includes discussion groups, journal clubs case study etc. The emphasis is on the monitoring of the event.
At Level 5 a practitioner may be awarded 30 Credits for any one of the activities that are listed per annum (for two years only). These are specialisation including fellowships, post graduate qualifications, short courses with a minimum of 35 hours contact time plus formal assessment, compilation of a learning portfolio, institutional performance appraisal in academic environments, publication of a book as sole author, practice audits and institutional audits.
The Credits will be valid (have a ‘shelf life’) for 24 months from the date that the activity took place or ended (in the event of post graduate studies). The implication of this decision is that practitioners should aim to accumulate a balance of 60 credits by the end of the second year and thereafter top up the balance as the ‘sell by date’ (24 month validity period) expires.
Having read the proposals in great depth (the full proposal is on the SADA web-site for comment from members) SADA has formed the following opinions:
On the positive side:-
the proposers have shown a great deal of lateral thought and have broken with some ‘inculcated and dated’ ideas; SADA supports the process of measuring outcomes of CPD activities as this will be to the benefit of our patients.
On the negative side:-
the proposed system is still complicated and may be even more complex than the system it seeks to replace; an expensive computer system is still necessary; there is an element of ‘policing’ rather than trust which the proposers sought to promote;
academics are again privileged in being ‘guaranteed’ their points; rural practitioners are again in a situation where compliance is more difficult for them than their urban colleagues;
commercial companies will be excluded as providers which will increase the cost of CPD to practitioners; categories are not easily distinguishable e.g. Level one and four (small group activities) and four and five (authoring a book);
despite a ‘will’ to move away from time and points gathering there are merely semantic changes such as ‘units’ and time is still an integral part of the exercise. SADA believes that time cannot be separated from CPD and that all other ‘Units’ should be discouraged, By sticking to time spent we can more easily engage in reciprocal CPD agreements with other countries.; the proposers rely heavily on the development of an expensive IT system which will again require development and testing.
SADA realises that CPD has been accepted by a large number of countries, although northern European and Scandinavian countries have steadfastly resisted compulsory CPD, and that it is a legal requirement for all South African Health Professionals for continued registration by the HPCSA. However we feel that the HPCSA is busy making similar mistakes in the implementation of the ‘new’ CPD programme to those made in trying to implement previous systems. If SADA is therefore critical of the ‘new’ CPD proposal it is necessary that we provide a viable alternative to the present proposal. I therefore place before you a suggestion based on one major premise – ‘KEEP IT SIMPLE !’
That participants in the CPD system be responsible for creating, safeguarding and maintaining their personal portfolio of CPD activities attended or acquired. This re-inforces the ‘trust’ element mentioned in the present proposal. This system is similar to the system currently in use in the U.K.
That the CPD accreditors continue to accredit courses provided by providers and maintain a data-base of all courses accredited. The accreditation process should be subject to periodic audit by Council or an Accreditors’ Forum.
That CPD providers continue to have courses accredited by accreditors and, besides organising the CPD activity, have two administrative responsibilities checking attendance at courses and providing compliant participants with a ‘certificate of attendance’.
providing the accreditor with a list of compliant attendees.
The CPD department of the HPCSA will, from its current registration list, randomly identify 10 % of practitioners per annum who will be required to provide proof of CPD compliance to the HPCSA. In cases where there is doubt that a practitioner has complied with CPD requirements accreditors will assist Council in its investigation. With approximately 105 000 registered practitioners on the HPCSA register 10 500 practitioners would be audited per year, or roughly 40 audits per day. This will ensure that CPD staff are not made redundant, while removing the need for any special computer system. An Excel data-base is all that is required. Previous clashes between practitioners and Council were due to discrepancies between points submitted by practitioners and those recorded by Council. In the SADA method, the practitioner remains responsible for maintaining his or her own points total.
SADA agrees that ‘measurable’ activities e.g. Journal CPD questions which are graded, post graduate courses which are evaluated, congresses with questions relating to content which are assessed, should attract more points than mere attendance at ‘events’ and suggests that such ‘measured’ activities receive more points than non-measured ones. SADA is also of the opinion that community service practitioners should be exempted from CPD requirements as should registrars and all academics who do not indulge in any form of private practice.
SADA does not believe in complicated CPD systems based on technologically sensitive systems. Accreditors should only accredit suitable courses which do not include ‘perverse commercial incentives’.
There should be no limits as to which ‘hierarchies’ of points can be obtained. The increased value of ‘measured’ points will create a bias towards obtaining points in the measured categories, but practitioners close to retirement could obtain points without having to learn new techniques which in any event they would not use in the year or two remaining until their retirement.
All interested parties have till the end of November to comment on the present CPD proposals. Please let us know what you think about what is proposed, SADA’s suggestions and (hopefully) your own better ideas. Its in your interests to formulate a workable CPD system which makes compliance for you, simple. Please send suggestion to SADA.