ࡱ> j( F/ 0|DArialpe Sorts st0tDTimes New Roman st0t DVerdanaw Roman st0t"0DWingdingsRoman st0t@DMonotype Sorts st0t A .  @n?" dd@  @@`` 0%       "# 0AA@8ʚ;ʚ;g4NdNddQr0ppp@ <4ddddA10t s80___PPT10 ppeMaintaining Standards  Graham Newstead Chairman ICCP $  0Maintenance of& .. What? &(  6Standards: Activity within defined parameters  I behave as they want me to (and as I think appropriate) v. Competence: Quality and safety  Am I (still) good enough ? (i.e. safe) v. Certification: Examined and re-credentialed  Someone has actually checked me out again (?OK) " *1 Standards: LIFE STAGES mTRAINING: Learning EXAMINATION: Proof PRACTICE LIFE: Refinement RE-CREDENTIALING: Reassurance pV   m Components of Standards Medical knowledge Patient care (but compassionate!) Interpersonal & communication skills Professionalism (a profession, not an occupation!) *Skill & Skills Practice-based learning & improvement Audit, appraisal & assimilation of scientific evidence, Demonstrably improved patient care Systems-based practice Aware of, and responsive to, entire health system Able to call on system resources for optimal care\f4#5\d   F Maintenance requires Evidence of& $$(# lProfessional  standing Commitment to lifelong learning CME and (?)Self-Assessment and / or Cognitive expertise Closed book examination Evaluation of performance in practice ?How8&&9 '  AStandardising Criteria for: Training, Examination & CredentialingB(+A Minimum Standards: Developing CRS services Developing countries Best Practice: General Surgery Developed countries  (Gold) Standards : Colorectal surgeons Established specialty programs+("f$ff  ` Colorectal Surgeons : Who are we credentialing?0 6Academic Teaching Hospital District Hospital Dedicated purist General Surgeon  with an (strong) interest Trainee Fellows Surgeons in developing programmesP  &Credentialing for Colorectal Surgeons'$& Training Assessment or Exams? Re-credentialing: Many options! Knowledge v. Experience Case-load, Skills, Literature, Evolution Winding-down v. Retirement Solo v. Group Practice [+4  +    )Training & Credentialing around the world*( ) YABCRS/ASCRS CSSA/RACS ACP GBI EBSQ Other Role of International Council of Coloproctology0Z 6&K     ABCRS Proposal (current draft)$P0/Professional Standing submitted every 5 years Full unrestricted medical license Hospital privileges to practice CR surgery Recommendation from Chief of Staff at primary hospital Lifelong Learning & Self Assessment 3 year blocks 100 hours of CME CARSEP Acknowledgement: Jim Fleshman, ABCRS.%B#&6    ABCRS Proposal (current draft)$P09Cognitive Knowledge Every 10 years Recertification exam Operative procedure logs Assessment of Practice Performance Every 3 years Patient survey: 15 questions from each of 20 patients Document participation in a quality assessment & improvement program in a JCAHO Hospital (NSQIP, SCIPP, Choice)22f2"  &  M  +    When? 2006 (Assuming ABMS approves ABCRS proposal) Who? Diplomates re-certifying in 2006 will start cycle of M.O.C. and so on. (Uh! Oh!)* All residents certifying after 2006 will start the M.O.C. process immediately. (Oh boy!)* Diplomates with  non-time-limited certificates will be encouraged to participate and will be issued  additional certificates based on the M.O.C. process! (Phew!!)* *Emphases with gratitude to Jim Fleshman, ABCRS  *WB$*J fT f= _ 3Z>  "    ABCRS (Summary)$  Medical knowledge: Written exam every 10 years Every 5 years: Patient care: Outcome data & patient survey Interpersonal & communication skills: Patient survey Professionalism: Patient survey & reference letters *[Skills: No specific testing parameters planned] Practice-based learning & improvement: CME requirements, CARSEP, *Outcome data Systems-based practice: *Outcome data & patient survey/ZZZ)ZZ Z %#&'    United Kingdom 0ACPGBI  working with EBSQ towards an assessment in coloproctology Issues undergoing  fairly rapid change in the UK Biggest problem is gaining recognition from statutory bodies that  traditional general surgery has pretty much disappeared . Acknowledgement: Jim Hill, ACPGBI4$#B3   " United Kingdom Training( ( $ PBAs (Personal behaviour analyses: standardised criteria for management & surgery) developed with for JCHST ( with assistance of ACPGBI), but apply to general surgical trainees Surgical Advisory Committee of RCS accredits units and ACPGBI  recognises them (but ACPGBI  doesn t have infrastructure to visit units ) ACPGBI is introducing trainee assessment forms ACPGBI does not credential trainees Recommended Colorectal Curriculum based on ACPGBI syllabus (=ABCRS syllabus)  United Kingdom Examinations $ dCurrent Intercollegiate Examination in General surgery  considered inadequate for specialty (CRS) Existing Statutory Examination bodies are not keen/able to give ACPGBI examination rights Examinations have to meet PMETB standards An ACPGBI examination  will require eligibility criteria to be met (e.g. time in units, numbers of cases, etc) Examinations  Blueprint recently developed Collaborating with Division of CP, UEMS & ICCP  *United Kingdom Credentialing and Standards(+ $* Credentialing being introduced Quality standards for colonoscopy determined and trainees required to follow them (JAG guidelines) Credentialing will start to occur for colorectal & anal cancer via Cancer Networks (established last 3 years)dLR >United Kingdom Maintenance of Standards and Re-Credentialing?1$> Only being addressed for colonoscopy and via Cancer Networks, not yet looking at outcomes Will occur only after  feeling that training process is now right Recognised need for consistent standards throughout the world, using ASCRS as working model Europe( EBSQ: HG, De 7 years Gen Surgery 2 years CRS in >1 hospital and with >1 mentor 400 procedures required Most European countries have specialty Societies of CRS Lithuania: recognises Colorectal surgical specialisation Hungary: 6 months training in CRS Germany: one year in Proctology (3 Societies) Ireland: 2 years in CRS Sweden: LP, Sv 2nd monthly regional CR discussions Attend larger Units to ensure exposure 3 Years of theoretical exposure + operative skills Good standard of CR surgery Not formalisedZZZZZ Z .X    EUROPE EBSQ $  UEMS, Section of Surgery EBSQ Meets with ESCP (EACP / ECCP) Accreditation process: Submission of specified criteria and Exams: written, academic and clinical 85 CRS accredited throughout Europe over past 5 years Conflict between national regulations No accreditation process for units as yet Awaiting international guidelines Trying to: identify training units for accreditation develop standardised training criteria Acknowledgement: Lars Pahlman, EBSQ >P7PPP#P P}P1  2#O$ * &.   Asia and Latin-America( AFCP: 2nd yearly meetings FS-C China:  emerging rapidly India: one major Unit only; lots of  interest Japan & Korea: many Units; established Society Singapore: CRS not recognised as specialty (by Govt. or Med Council); excellent specialty Units ALACP: Most countries have Coloproctology Societies AH-G Brazil: 1400 members; 39 residency programs, 114 residents pa; Gen Surg 2 years, CRS 2 years, Fellowship 1 year: Certification (Also 1700 Digestive surgeons) Sao Paulo:  provide legal advice and reduce variability of results Litigation: 66% ano-rectal; >90% inadequate experience; 70% not Board certified Z9ZZ ZEZQZZ .6H    = Collaboration Examples(  ABCRS Syllabus Basis of ACP GBI Syllabus ASCRS Practice Adopted by CSSA Parameters etc& & & & .. B0ZZ@Z Wp -International Council of Coloproctology ICCP.. .   Develop standardised guidelines for Training programs Collaborate to share optimum maintenance standards 47 countries with National Societies of Coloproctology 4 International Federations of Coloproctology Develop universal minimum standards 154 countries without specialty Coloproctology Provide scholarships & Exchange training programmes Database: Societies, Training, Scholarships, Meetings Communication, Facilitation, and Outreach6ZZ3ZiZ$Z2ZlZZ*Z53e$.3 +*b  !  H   (NSW) Medical Board Code of Professional Conduct:  Good Medical Practice Standards: FX$$7 $W Clinical Competence & Performance 4:20 Professional & Ethical 11:61 Relationships with Colleagues 5:23 Probity 5:16 Totals 25:120 RACS Surgical Competence$ ATTRIBUTES: Medical expertise Technical expertise Judgement Communication Collaboration Management & Leadership Health Advocacy Scholar & Teacher Professionalism :    ODEMONSTRATED AS: Cognitive Integrative Psychomotor Relational Affective & Moral.??O RACS Code of Conduct$ (Good Patient Care Maintenance of Professional Standards Professional Relationships Responsibility in Teaching, Training & Supervision Research Business & Commercial responsibilities The Surgeon s responsibility to Society Sections: 7 Standards: 21 Musts & Shoulds: 19281/&   Australia CSSA / RACS: Politics   Section history Society development (11/88) Mark Killingback & Graham Newstead Training programme conjointly with Section Jack Mackay, Jim Sweeney, Andy McLeish Training Board within RACS structure: Phil Douglas MOU with RACS Mike Solomon, Ian Jones ?Board of Training & Standards:  Whole of Life Training + Integrated Training Programme Bruce Waxman Credentialing: Training Board assessments and Examinations Re-credentialing: CPD or Examination? FCSSA: Required criteria zP(P'PPPP9P/P{P#'   " ,.1   =Australia CSSA: Criteria to Maintain CR Fellowship Standards@>    = Membership Criteria: Commitment to CRS Majority of practice in CRS Recognised period of training in CRS Hospital Appointment as CRS Maintain RACS CPD National database participation Re-certification examination process Re-credentialing process 5 yearly (Details in preparation)`sW<rW<  Musings What happened to the Hippocratic Oath? ( not cutting unnecessarily for the stone ) What s wrong with the Golden Rule? ( do unto others ) Selection processes for: Students, Surgical Trainees and Colorectal Fellows: Do we have it right? Clearly not! Then how should we do it & who should we choose? [Difficult choice: Old school tie or Female, beautiful, 30] History of the Harvard selection process ( Getting In , Malcolm Gladwell, New Yorker, October 2005) Why should I have to be re-examined? Majority: No need to review us, we re just fine! Minority: The current system sorts them out, (doesn t it?) Some: Why penalise everyone just for those few? and& & ..  anyway, it s ridiculous; I m so experienced! [GLN certainly doesn t need to be re-assessed!!]V'P-P#PPP5PPhP%PPhP'f-f fff<%f: #  H !Conclusions (reality!!)  Nationally Accredited Training Programs in Colorectal Surgery exist only in the USA and Australia & New Zealand (thusfar!) 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What? Standards: LIFE STAGESComponents of Standards$Maintenance requires Evidence ofBStandardising Criteria for: Training, Examination & Credentialing1Colorectal Surgeons: Who are we credentialing?'Credentialing for Colorectal Surgeons*Training & Credentialing around the worldABCRS Proposal (current draft)ABCRS Proposal (current draft) Slide 12ABCRS (Summary)United KingdomUnited Kingdom TrainingUnited Kingdom Examinations+United Kingdom Credentialing and Standards?United Kingdom Maintenance of Standards and Re-CredentialingEurope EUROPE EBSQAsia and Latin-AmericaCollaboration Examples.International Council of Coloproctology ICCPX(NSW) Medical Board Code of Professional Conduct: Good Medical Practice Standards: RACS Surgical CompetenceRACS Code of Conduct Australia CSSA / RACS: Politics>Australia CSSA: Criteria to Maintain CR Fellowship StandardsMusingsConclusions (reality!!)  Fonts UsedDesign Template Slide Titles4 $, DocumentSummaryInformation8