Value of multisource feedback highlighted

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 Peter Roberts is an internal medicine specialist, prevocational educational supervisor and postgraduate mentor. Based at Wellington Hospital in New Zealand (NZ), Dr Roberts is also the RACP NZ CPD Director. He answered our CPD questions below.

Why is CPD important to you?

It’s in my blood. My father was a General Practitioner in the West Virginia mountains. Alongside all the potions and pills he had around his office – that looked more like a country store – were stacks of the Annals and the New England Medical Journal (NEMJ). In the 1950’s he showed me a NEJM graph by a chap named Jeghers that showed how hard it was for doctors to keep up with all that was being learned.  My dad was one of the founders of the American Academy of General Practice, now the American Academy of Family Physicians. (AAFP). 

CPD is part of what we swear when we say the oath and the prime directive to do no harm stems from knowing that we have done all we can to sharpen our skills and incorporate new knowledge.

We don’t get there alone, we work in teams and we depend on each other. That’s where RACP CPD comes into the picture – we work hard to pass an exam to become a Fellow, but then we work just as hard to help each other stay up-to-date. It’s what we do because of who we are.

How have patients benefited from your CPD activities?

I did a review of my outpatient clinic experience with Chronic Fatigue Syndrome(CFS)/ Myalgic Encephalomyelitis (ME) and presented the myriad of problems that I had encountered. They were initially thought to be CFS, but subsequently turned out to be other problems with treatable causes.  Subsequently I have had junior colleagues stop me in the hall to add to the list from their experiences. Around 250 patients have now had their problem approached in a more ‘open-minded’ way.

I did Multisource feedback with responses from junior and senior colleagues, as well as in and outpatients. I found some of the responses quite challenging and I now work a lot harder to explain why I do what I do. For instance, one of the house staff said they thought I probably consulted a lot more than other colleagues because of my North American background. But, in fact, I consult a lot for many reasons, such as being sure that neurology registrars get another chance to evaluate a patient in coma, for instance. I am never certain that I have it all right, so I express my doubt openly. I explain exactly why I want a consult to be sure that my reasoning is clearly stated. That can only benefit many patients in the long run.

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

Multisource feedback is my most recent foray into a new area. In my NZ CPD Director role, I sat down face-to-face to debrief with my favourite ‘crash-dummy’ who volunteers for, and engages in, everything going because he feels activities are “necessary evils”.  We got his results from patients and colleagues and as I read them over, I felt inadequate to be debriefing him because I had not been through the experience myself. So I also volunteered to be a ‘crash-dummy” as well. It took some organising and with the real heroes being my inpatient Registrar and my outpatient nurse, we got it done in a reasonable time. My results took a fair amount of processing and it was valuable to see myself as others see me.  Subsequently, I have done a number of face-to-face and telephone debriefs of colleagues in NZ and Australia.

At the end of the day, I have found the debriefing experience to be one of the most satisfying and encouraging things that an old doctor can do. We have such wonderful young Fellows coming into practice and I am amazed by their innovative and creative approaches to life as well as medicine. We are in good hands!

I still believe that our auditing of the outcomes of our clinical process is central to what we do and how well we do it.  Even though the effort of reviewing one services’ management of influenza patients in 2015 was not a highly scientific effort, the outcome and insights are influencing what we do today in major ways. The biggest lesson has been to beware of the bacterial infection that invariably follows the virus and recognising how to choose wisely in anticipation.

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

The activity meaningfully plans me. My interest and concerns raised by dealing with patients’ problems seem to carry me in the direction that I find I must go. I choose some top-flight focused meetings every year that I know will keep me up-to-date with medical education and various current clinical topics, but the projects, such as MSF or ultrasound use in medical wards, formulate themselves. When I did my annual review with my clinical leader, he was delighted that I wanted to spend my Continuing Medical Education (CME) allowance on gaining a skill more for teaching than to forward my own practice.  Why would that be a surprise?  It’s what we do.

Why is reviewing performance and measuring outcomes important?

It’s our duty to ourselves and our patients. We couldn’t not do it. I’m not convinced by the argument that we might get blamed if we don’t stay up to date. We might. However, it comes down to the difference between accountability and responsibility. In my Master of Public Policy course, when the professor asked my classmate, a Navy Frigate Captain, what is the difference, he said: “Accountability is explaining to the tribunal why you ran the ship aground.  Responsibility is not letting it happen on your watch.”

We want to be responsible and CPD helps us get there.