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“Approaches to Continuing Competency – Challenges and Opportunities”. Danielle Fagnan, Quebec Order of Pharmacists Ashifa Keshavji, College of Pharmacists of British Columbia Sandra Winkelbauer, Ontario College of Pharmacists Moderator: Della Croteau, Ontario College of Pharmacists.

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approaches to continuing competency challenges and opportunities

“Approaches to Continuing Competency – Challenges and Opportunities”

Danielle Fagnan, Quebec Order of Pharmacists

Ashifa Keshavji, College of Pharmacists of British Columbia

Sandra Winkelbauer, Ontario College of Pharmacists

Moderator: Della Croteau, Ontario College of Pharmacists

why continuing competency
Why Continuing Competency?
  • public expectations
  • increased accountability
  • competency throughout practice
  • governments now legislating

CLEAR 2008 Annual Conference

Anchorage, Alaska

three different approaches
Three Different Approaches
  • Description
  • Outcomes and Challenges
  • Future Directions

How does this compare to your program?

CLEAR 2008 Annual Conference

Anchorage, Alaska

college of pharmacists of british columbia
College of Pharmacists of British Columbia

Ashifa Keshavji

CLEAR 2008 Annual Conference

Anchorage, Alaska

objective
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

professional and legal mandates
Professional and Legal Mandates

Code of Ethics

PDAP

Legisla-

tion

FPP

CLEAR 2008 Annual Conference

Anchorage, Alaska

program purpose
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

program philosophy principles
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

the framework of professional practice fpp
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

professional development and assessment program pdap structure and timelines
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

pdap phase 1 september 2003 february 2005
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

pdap phase 2 september 2005 august 2006
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)

CLEAR 2008 Annual Conference

Anchorage, Alaska

pdap phase 3 began september 2006
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

self assessment
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

the knowledge assessment
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

learning and practice portfolio
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

practice audit
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

slide18
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

phase 1 phase 2 participants

Program Evaluation

Program Evaluation

Tool

Tool

Phase 1

Phase 1

Phase 2

Phase 2

Volunteer

Volunteer

KA

KA

1060 (91%)

56 (36%)

60 (83%)

LPP

LPP

198 (90%)

15 (80%)

2 (100%)

2 (100%)

PA

PA

-

-

10 (60%)

27 (96%)

OSCE

OSCE

-

-

1 (0%)

15 (80%)

Total

Total

1258 (91%)

82 (48%)

104 (87%)

Phase 1, Phase 2 Participants

CLEAR 2008 Annual Conference

Anchorage, Alaska

challenges
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

ontario college of pharmacists
Ontario College of Pharmacists

Sandra Winkelbauer

CLEAR 2008 Annual Conference

Anchorage, Alaska

ocp program description
OCP Program Description

CLEAR 2008 Annual Conference

Anchorage, Alaska

ocp program description1
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

learning portfolio
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

self assessment tool
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

peer review
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

peer review1
Peer Review
  • Components assessed:
    • Clinical knowledge
    • Gathering information
    • Patient management and follow-up
    • Communication skills

CLEAR 2008 Annual Conference

Anchorage, Alaska

peer review validity
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

peer review remediation
Peer Review - Remediation
  • Professional Development Advisor
  • Peer Support Group
  • Professional Development Workshop

CLEAR 2008 Annual Conference

Anchorage, Alaska

outcomes
Outcomes
  • Quality Assurance program has been in place for 11 years
  • 10 year review conducted last year

CLEAR 2008 Annual Conference

Anchorage, Alaska

outcomes place of graduation
Outcomes – Place of Graduation

CLEAR 2008 Annual Conference

Anchorage, Alaska

outcomes place of practice
Outcomes – Place of Practice

CLEAR 2008 Annual Conference

Anchorage, Alaska

outcomes results
Outcomes - Results

CLEAR 2008 Annual Conference

Anchorage, Alaska

outcomes years since graduation
Outcomes – Years since Graduation

CLEAR 2008 Annual Conference

Anchorage, Alaska

outcomes place of graduation1
Outcomes – Place of Graduation

CLEAR 2008 Annual Conference

Anchorage, Alaska

challenges1
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

future directions
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

speaker contact information
Speaker Contact Information

Sandra Winkelbauer

Manager, Continuing Competency

Ontario College of Pharmacists

swinkelbauer@ocpinfo.com

416-847-8204

(insert OCP logo)

CLEAR 2008 Annual Conference

Anchorage, Alaska

quebec order of pharmacists
Quebec Order of Pharmacists

Danielle Fagnan

CLEAR 2008 Annual Conference

Anchorage, Alaska

mandatory statute of professional inspection in quebec
Mandatory statute of professional inspection in Quebec
  • Supervise professional practice
  • Inquire into the professional competence of any member of the Order

CLEAR 2008 Annual Conference

Anchorage, Alaska

pharmacy in quebec
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

professional inspection in quebec
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

evaluation in community pharmacies
Evaluation in community pharmacies
  • Professional practice (technical aspect)
    • Staff
    • Workload
    • Work organization
    • Hygiene
    • Equipment

CLEAR 2008 Annual Conference

Anchorage, Alaska

evaluation in community pharmacies1
Evaluation in community pharmacies
  • Respect of laws and regulations
    • Standards of practice
    • Labeling
    • Outdated products
    • Confidentiality
    • Ethics, etc.

CLEAR 2008 Annual Conference

Anchorage, Alaska

evaluation in community pharmacies2
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

evaluation in community pharmacies3
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

evaluation in health care facilities
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

evaluation in health care facilities1
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

assessment of individual competency
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)

CLEAR 2008 Annual Conference

Anchorage, Alaska

challenges2
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

challenges3
Challenges

Urgent need to rethink our processes and develop a strategic plan

CLEAR 2008 Annual Conference

Anchorage, Alaska

future
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

CLEAR 2008 Annual Conference

Anchorage, Alaska

speaker contact information1
Speaker Contact Information

Danielle Fagnan

Director of professional services

Quebec Order of pharmacists

dfagnan@opq.org

CLEAR 2008 Annual Conference

Anchorage, Alaska

slide54
QUESTIONS?

CLEAR 2008 Annual Conference

Anchorage, Alaska

slide55
Does anyone have any suggestions for improvement of these programs?

CLEAR 2008 Annual Conference

Anchorage, Alaska

slide56
Do you think public safety is protected by such a program?

CLEAR 2008 Annual Conference

Anchorage, Alaska

slide57
What are similar issues in your profession, and how have you approached quality assurance?

CLEAR 2008 Annual Conference

Anchorage, Alaska