Since the conviction of UK specialist trainee, Dr Hadiza Bawa-Garba, for manslaughter on the grounds of gross negligence and her permanent removal from the medical register by the General Medical Council, many doctors have raised concerns regarding the court case and the role that Dr Bawa-Garba’s reflections played in the decision of the jury.
Reflective practice is a critical element of a practitioner’s professional development. The ability to critically self-appraise and identify areas for improvement form the foundation of the path to mastery. It is a practice that most undertake unconsciously, or at least, without formal documentation.
The Medical Board of Australia’s newly developed Professional Performance Framework (which was previously referred to as CPD or MOPS) has five pillars, one of which relates to fostering a positive culture of medicine and encourages doctors to: ‘Commit to reflective practice and lifelong learning’. As part of the new framework, doctors will be required to establish a Professional Development Plan (PDP) that will be based on the individual’s learning needs and scope of practice. Measurement of outcomes will be a requirement and this may be achieved through clinical audit, review of medical records and reflection of professional outcomes. It is likely that the Medical Council of New Zealand will introduce similar guidelines, as they are currently reviewing revalidation requirements and have been closely involved in the development of the Australian regulations.
For some, the Bawa-Garba case has raised significant concerns about the legal ramifications of reflective practice and provided a reason why this should not form part of a practitioner’s CPD or training. In the face of rising concerns and criticism, Dr Bawa-Garba’s defence body (MPS) confirmed that her e-portfolio did not form part of the evidence before the court and jury. In a statement on the 1 February 2018, they said:
‘The court was clear that reflections were irrelevant to the facts of the case and that no weight should be given to remarks documented after the event. The doctor’s e-portfolio is a vital part of their professional development. It allows open and honest recording of reflections on incidents and is a crucial tool in bringing about a shift to an open learning culture where lessons are learnt and there are continual improvements to patient care.’
In Australia, the Department of Health currently grants Commonwealth Qualified Privilege (QP) to evaluation activities such as practice review, multi-source feedback, morbidity and mortality reviews and patient surveys. In New Zealand, according to Section 54 of the Health Practitioners Competence Assurance Act 2003, the Minister of Health can grant protection of a quality assurance activity. This protection recognises the importance of engaging in regular and effective quality assurance activities. RANZCOG currently has QP for its practice visits, which individual practitioners can also apply for via the Department of Health website:
It is anticipated that the College will seek QP for activities such as multi-source feedback, as part of the College’s CPD program, once the new Professional Performance Framework is implemented.
Read the General Medical Council’s statement on Dr Bawa-Garba in this issue’s The Leg-Up.
As many of you are aware, the question of future accommodation needs for the College has been under discussion for some time. The Board has investigated a number of options and sought input from College members. We are now undertaking preliminary discussions to redevelop the current College site and potentially enter a joint venture arrangement with a property developer. Ideally, this would enable the College to retain the existing presence (including the heritage listed buildings facing Albert Street) and construct (for example) apartments or offices at the rear of the building. College House would retain a separate entrance and it would provide the opportunity to create meeting spaces, training rooms and additional offices while retaining the library, Council Room and other historic features. Although planning is still in the early stages, this option meets the need for increased accommodation while maintaining the desirable East Melbourne location. We will continue to provide updates as the project progresses.
Pearson Vue and online examinations
I was horrified to learn of significant issues associated with the recent RACP examination, where candidates were locked out of the examination due to technical issues. In addition, there were reports of poor or no invigilation, which left candidates frustrated, angry and distressed. As Pearson Vue is the current provider of RANZCOG’s online examination, we were anxious to meet with them to ensure these issues were not repeated during the next FRANZCOG written examination. Following this meeting, the College has decided to:
- Have paper copies available at the next examination as a back-up
- Reduce the number of sites at which the examinations is conducted
- Ensure there are RANZCOG staff present at each site
- Ensure non-RANZCOG invigilators are appropriately inducted and trained
While we cannot guarantee that an examination will be problem free, the College is satisfied that appropriate mitigation strategies have been put in place to alleviate any potential issues. An important underlying principle is that no candidate will be disadvantaged because of a system or College error. While this does not compensate for a disrupted examination, it hopefully provides reassurance to those who are planning to sit the examination in the near future.
Finally, we would like to offer our congratulations to Dr Vijay Roach on being voted President-Elect at the Council meeting in March. Vijay will take over as President following the Annual General Meeting in November.