Enhance under attack

The Pharmaceutical Society’s professional development programme, Enhance, has become the subject of a heated debate with several pharmacists calling for its immediate review.

Terming the system “onerous” and “flawed”, pharmacists say the documentation process for claiming continuing professional development (CPD) credits is extremely bureaucratic as it focuses more on the process rather than the purpose.

The single most contentious aspect of Enhance is its insistence topics will not count for a CPD credit, unless what the pharmacist has learnt is used in practice.

“A lot of what we learn, or know, is not used daily but when the occasion arises,” Motueka pharmacist David Ross says.

“For example, I have just updated my first aid certificate. This takes many hours of my personal time, and am now current for cardiopulmonary resuscitation. However, in 30 years of practice, I have never had to provide CPR to anyone – thus this is not CPD by definition because I have not achieved an outcome,” Mr Ross says.

“Should I lurk in an alleyway, waiting for a mugging, so I can prove what I’ve learnt?”

Whangarei pharmacist Benjamin Oldfield, who provoked the debate by openly raising the issue during the society’s Auckland regional symposium on 13 June, says knowledge gained at a lecture may not be immediately implemented, but may be used at an opportune moment at a later date. Under the current system, he says, such undocumented learning would receive no outcome credit.

“Pharmacists pay good money and give up a Sunday to come here, and it is entirely possible that some will go home today without any credits toward Enhance. This is wrong and any continuing education-related effort should count, and the use of the knowledge should be reconciled through peer review with a colleague.”

Veteran pharmacist Harvey Lockie agrees, saying a major part of being a competent professional in any field is the ability to gracefully handle unexpected and rare events.

“I’m familiar with the pilot licence renewal system, where unlikely events, such as engine failure or an in-flight fire, are considered and the procedures demonstrated. It is not necessary to have suffered a real occurrence of one of these events to be credited with the ability to handle it.”

Auckland pharmacist John Savory cites his own example. A while ago, he says, he submitted a plan “to write a presentation on Parkinson’s for rest-home care staff” which was rejected because that title is not an object but an outcome.

“The proper wording for an object is ‘To learn enough about Parkinson’s to be able to write a presentation ...’ When I queried the semantics, I was accused of being rude and unprofessional. I haven’t submitted anything since and flagged my MUR accreditation.”

Mr Savory thinks yearly review of pharmacist practice is “nonsense”.

“No one can predict what demands are going to be made on our practice in the next 12 months. Who knows what new drugs are going to come into common use?” he asks.

Quoting anecdotes, Mr Savory says most CPD logs are written up retrospectively and more than 50% are rejected at first attempt.

The pharmacists believe Enhance should work around the presumption a pharmacist is competent unless proven otherwise and use a peer review system similar to the Medical Council’s CPD requirements.

“The medical council system involves a single line of documentation for each learning activity, a colleague’s sign-off and evidence such as a certificate of attendance or similar,” Mr Oldfield says.

Enhance manager Elizabeth Johnstone says Enhance is internationally recognised as one of the best and the Australian CPD programme is modelled on it.

However, the Pharmacy Council has begun a review of the current Annual Practice Certificate recertification framework, which means the requirements for the Enhance recertification programme are likely to change. (The Pharmacy Council says, as a result of this the 2010 APC recertification audit will now be held over July and August, rather than in April, as originally scheduled.)

“The review is in response to submissions and advice from the society and the college, plus feedback from the sector to the council. Much of what Ben said is on the work table now,” Ms Johnstone says.

She adds, the society will continue to work with the council to provide a recertification programme that meets both the requirements of the Health Practitioners Competence Assurance Act and pharmacists’ responsibilities under law for CPD documentation.

“In addition, we are mindful  the programme must enable all pharmacists to demonstrate learning and competence in a realistic, practical manner and with a more straightforward and less time-consuming documentation process.”

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