Ethical Management of Self

Maureen Whittaker

and Mary Corcoran

18th September 2012

Acknowledgements: Celia Duff, HoS, East of England

Session objectives

Increase awareness of EMS Learning Outcomes Clarification of what counts as evidence, and

how to collate evidence in an efficient way Develop a shared understanding of sign off at

different phases of training and what to do when problems arise

Use of good PH practice as a framework for case based discussion eg for probity and health

Increase awareness of MSF tools available Increase understanding of metacompetence

Why EMS?

All doctors required to comply with codes of professional practice: GMC Good Medical Practice (2006)

Public health professionals bound by same requirement (in the context of their work) http://www.fph.org.uk/good_practice

Framework of professional behaviours and values underpinning practice regardless of professional background

This guidance : assists the public, public health professionals, colleagues and

employers to understand ‘good practice’ guides public health professionals when planning their CPD Supports preparation for appraisals or revalidation

EMS and the Curriculum

The curriculum provides a framework within which trainees and trainers can determine

and understand the knowledge, skills, attitudes and behaviours which will allow a registrar to achieve the level of competence

required of a specialist in the field

These link directly back to Good Public Health Practice providing principles of ethical and professional practice

Expectations of registrars

Guidance is not exhaustive nor covers all forms of professional practice or misconduct

Registrars must therefore be able to justify actions and decisions

Registrars must be able to ensure they are aware of, and adhere to, other professional codes of practice and conduct as set by other organisations and statutory regulatory bodies relevant to their work

Demonstration of Good Public Health Practice expected of all registrars at all phases of training.

Medically qualified registrars, especially those working in health protection, may undertake work of a clinical nature. This work will also be governed by Good Medical Practice

EMS Learning Outcomes

EMS 1 Recognise and work within the limits of professional competence including working within the limits of personal clinical competence when dealing with individual patients

CBD, DO, MSF

EMS 2 Be willing to consult colleagues DO, MSF

EMS 3 Keep clear, accurate and contemporaneous records including clinical records as necessary

DO, MSF

EMS 4 Keep colleagues well informed when working in partnership including referring appropriate clinical issues

DO, MSF

EMS 5 Establish and maintain trust by listening to and respecting others’ views including giving patients and others the information they need in a way they can understand

DO, reports, MSF

EMS 6 Treat others with courtesy DO, MSF

EMS 7 Respect the rights of the public and patients to be involved in choices DO, MSF

EMS 8 Treat information about patients as confidential. If in exceptional circumstances you feel you should pass on information without a patient or individual’s consent, or against their wishes, you should follow agreed guidance on confidentiality and be prepared to justify your decision

CBD, DO

EMS 9 Treat colleagues fairly and maintain the public’s trust through avoidance of unfounded criticism

DO, MSF

EMS learning Outcomes

EMS 10 Respect skills and contributions of colleagues and maintain professional relationships and effective communication in multi-disciplinary teams

DO, MSF

EMS 11 Be readily accessible to the public and colleagues when on duty including arranging suitable cover

DO, MSF

EMS 12 Pay regard to efficiency while not discriminating against individuals/populations

CBD, DO

EMS 13 Keep knowledge and skills up to date, including regular audit, appraisal and reflective learning

Reports, MSF

EMS 14 Practise safely including assuring professional indemnity, safeguarding the public from others’ unsafe practice, adhering to safe management practice through maintenance and development of an environment and culture that improves health, safety and security

DO, MSF

EMS 15 Deal with complaints fairly and co-operate with enquiries into practice DO, MSF

EMS 16 Demonstrate probity in professional and personal practice DO, MSF

EMS 17 Seek and follow advice where health concerns may affect practice DO, MSF

EMS 18 Work within a value system appropriate to public health advocacy DO, MSF

Other professional behaviours/attitudes in the LOF

8.8 Provide information needed and requested and in a way that can be understood

DO, reports, Part B

9.10 Work within the principles of good research governance where appropriate

DO, CBD

9.11 Help the public to be aware of and understand health issues DO, CBD

9.12 Contribute to the education and training of other staff, medical students and colleagues

DO, CBD

9.13 Develop skills and attitudes for teaching including appropriate supervision and assessment

DO, CBD

8.7 Treat information about patients as confidential DO, MSF

Sign off of EMS LOs

Normal principles of assessment apply:Activity summary sheet should describe the work and justify the claimThe assessment method should look specifically at that LO and challenge the claim sufficiently rigorouslyEvery LO should be evidenced twice through different pieces of work/in different waysYour registrar should collate the evidence they wish you to consider for sign off (remember WBA and sign off are different)You need to make a judgement about whether the standard is that you would expect of a PH professional (consider the ‘what if not’)Sign off expected for each phase of training

Probity and health

Probity is the cornerstone of good public health practice. Standards of practice should justify the public’s trust in your work, and the work of the

wider public health community

Probity in professional practiceSometimes the absence of a problem is sufficient evidenceAbstract conversation about ‘what if’ may not be helpfulWhat index of suspicion do you have over health matters

Elements of probity (honesty, integrity, objectivity, impartiality) Financial and commercial matters Research Conflicts of interest Convictions Writing reports, signing certificates and other documents Your CV Providing information about your services References for other colleagues Accepting and leaving posts

Group work

Each table work on one of the EMS learning outcomes below Discuss the kind of evidence you would require from your StR How would you expect that evidence to be presented on the eportfolio? Short feed back to the whole group on issues / solutions

EMS 16: Demonstrate probity in professional and personal practice EMS 17: Seek and follow advice where health concerns may affect

practice EMS 6: Treat others with courtesy EMS 12: Pay regard to efficiency while not discriminating against

individuals/populations EMS 1: Recognise and work within the limits of professional competence

MSF tools

No specificationInformal feedback from othersFormal feedback eg emails / reflective

notes by project supervisorsWest Midlands toolNHS LQFPersonalised

West Midlands tool

http://nhsleadershipframework.rightmanagement.co.

uk/

http://nhsleadershipframework.rightmanagement.co.uk/

Possible grouping of EMS LOs

Self awareness

1,17

Maintaining PH

principles7,12,18

Conduct2,4,5,6,8,9,10,11,14,15,

16

Record keeping

3

Communication skills3,4

Maintaining trust,

professional relationships,

attitudes, behaviours1,5,7,14,16

Technical3

Team working, multiagency partnership

skills2,6,9,10,18

Accessibility to others,

appropriate behaviour8,11,15

What quality of evidence is not…

Pantechnicon of evidenceMultiple LOs per Activity Summary SheetA reflection on your own practice/ability

Some tips Try to:

Scaffold/Triangulate Corroborate Reflect in ASS

Always: Read the ASS – does it make sense? Do the LOs claimed relate to the work

described? Temperature test the evidence Get your registrar to reflect on learning

Support for YOU: Training NetworkBuddiesMentoring/Shadowing

When it goes wrong, remediation

What is wrong, why is it wrong, what is the evidence?

Principles of early sign posting, feedback and good communication

Triangulate, evidence and record keepingTake adviceNB usually behaviours and attitudes, often

a sign of another underlying problemEarly intervention is important

Actually, it’s just good line management

Metacompetence Principle of spiral learning: demonstrate maintenance of

performance in increasingly varied, challenging and less controlled situations.

Demonstrate and assess LOs more than once to confirm progression.

At CCT the registrar will need to demonstrate a level of performance comparable with that of a consultant, not simply delivering a series of more clearly defined projects.

At CCT, knowledge, understanding, skills and competences need to be integrated, and the registrar needs to show that s/he can function in complex situations. Such performance should be robust under pressure and be able to withstand the demands of increasing responsibility

How do bricks make a building?

Metacompetence – 9 statements

Used to assess registrars’ progress:

Core knowledge; sub-specialty specific knowledge Core problem-identification and problem-solving skills Specific technical competencies Producing, assembling, and evaluating multiple evidence Ability to work/plan in complex multi-agency milieux High-order literacy & communication skills: including

educating, presenting, persuading Leadership & team-working skills Professional, Professional Development & Ethical Aspects;

Probity Vision Thing: guided by an overarching conception of Public

Health (attitude)

Metacompetence in Public Health Practice

Can select and use advanced public health knowledge and skills

appropriately for different tasks to deliver timely results

Can produce, integrate, and interpret complex evidence from multiple

sourcesCan identify and scope public health

problems, delivering effective solutions

Is acknowledged and recognised as a valuable source of applied public health expertise at a senior level within own organisation and by other partner organisations e.g. local authority or hospital

Consistently shows integrity, probity, and commitment to confidentiality, inspiring confidence in others

Can use a range of high order literacy and communication skills

Can deliver results in a complex environment using a range of ways of working.

Is proactive and innovative in identifying opportunities to improve public health and can set agendas

Can show flexibility and handle uncertainty, additional complexity and conflict, whilst still delivering effective results

Can plan and develop policy and strategy in complex, multi-agency environments

Shows consistent commitment to public health principles and continuing development of self and others

Expected standards

Public health expert

Can consistently apply a range of skills sets and knowledge to a reasonable range of problems, familiar or otherwise

Is flexible in applying different solutions to the same problem at different times (i.e. doesn’t always do things the same way)

Adapts work to context

Personal impact Acknowledged both within and outside the organisation as a credible and reliable source of public health input.

Well developed high level communication skills, and ability to deliver in a complex environment.

Takes independent responsibility as expected from a CPH.

Initiative and commitment

Generally shows initiative and is well motivated to succeed in work undertaken.

Proactive and Innovative in approach. Track record of delivery (i.e. not just “talk the talk”). Consistent use of public health principles in approach

How to assess metacompetence?