Public Health Physician highlights CPD benefits

Medical Board of Australia (MBA) changes to how Fellows undertake Continuing Professional Development (CPD) come into effect over the next few years. The RACP is preparing Fellows for these changes by updating its MyCPD Framework from 2019, to reflect the direction the MBA is heading with its changes.

As the new MyCPD Framework comes into effect, Fellows incorporating the changes into their practice and lifestyles speak to us about their approaches to CPD.

Dr Sharon O’Rourke is a Public Health Physician specialising in the treatment of patients with diabetes. Based in Cairns, Dr O’Rourke is a passionate CPD advocate. She answered our CPD questions below.

Why is CPD important to you?

I’ve always been interested in learning how to improve services and the health outcomes of the community.

When the federal government introduced key performance indicators for Indigenous health services in the 1980s, I was on a rapid learning curve to understand the concepts of evaluation. The support from, and collaboration with, more experienced colleagues was invaluable – especially during site visits to other services. These experiences could be described as a type of informal practice review as invariably they resulted in a change in practice, for example, introducing a process where all patients were assessed ;by Indigenous health workers before a medical consultation.

In recent years the National Safety and Quality Health Service (NSQHS) Standards for accreditation of health services has included an emphasis on patient safety which is a concept all clinicians relate to.

How have patients benefited from your CPD activities?

After participating in an evidenced based review of the management of diabetes complications, I collaborated with colleagues to develop a multidisciplinary team to support patients with diabetes to avoid amputation.

Working with Queensland Health’s Diabetes Clinical Network, we promoted evidenced based practice based on a National Institute for Health and Care Excellence (NICE) guideline to standardise management, data collection and outcome monitoring across the state.

The Cairns High Risk Foot Service has recently formalised the inpatient management of acute diabetic foot complications, including weekly multidisciplinary case conferences with surgeons, physicians and other members of the team.

Patient interviews confirmed their satisfaction with the process of care. Routine hospital data collection confirmed a decrease in the average length of stay without an increase in readmissions.

What are some of the CPD activities you choose to do and why?

Clinical audit is invaluable in evaluating care provided against the gold standard as defined in clinical guidelines or national safety and quality standards.

A core component of our service is a multidisciplinary case discussion. More recently we have identified a root cause analysis tool for diabetes related major amputations from the UK that includes feedback from the patient and the primary care team. Using this approach helps to improve the coordination of care necessary to prevent avoidable amputations in other patients.

How do you meaningfully plan your CPD activities and measure their outcomes?

As a public health physician, I have encouraged our team to appreciate the ‘big picture’ and align our practice to national, state and local health priorities, plans and standards. We participate in national benchmarking activities which have identified areas where we could improve our practice. Each individual in our health service is required to complete an Individual Development Plan and compliance is monitored for accreditation.

When considering what CPD activities to include in my last annual plan, I reviewed the MBA Professional Performance Framework (PPF) as well as the planning documents for the service and organisation. Discharge against medical advice (DAMA*) rates are high and indicate that our service could do more to meet the needs of our Aboriginal and Torres Strait Islander population.

Although cultural competency training is mandatory in our organisation, few medical staff have completed the session. I completed the training and advocated for the training to be delivered to physicians over two sessions within the department rather than off site. Hopefully, this modification will increase the number of physicians trained in cultural competency.

Why is reviewing performance and measuring outcomes important?

There is evidence that as we age, medical practitioners are less able to accurately assess our own performance.

We have a responsibility to protect patient safety and reassure the public that the health system is safe and that taxpayers are getting value for the 10 per cent of Gross Domestic Product (GDP) that funds our health services.

We know that some interventions are of little value and the Australian Atlas of Health Care Variation has identified opportunities where clinical outcomes could be improved.

Measuring outcomes in the management of conditions such as Chronic Obstructive Pulmonary Disease (COPD) can guide clinicians to optimise individual patient’s health as well as preventing admissions.

*DAMA is a national indicator for ‘Closing the Gap’ in addressing the poor health outcomes experienced by Indigenous Australians