Stiofán Mac Suibhne

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Timeline of Scope Reform

Current Scope of Practice Schema

Amending qualifications for the existing vocational scopes of practice: (1) pain management (2) gerontology

Additional Vocational Scope in Rehabilitation

Consultation on amendments to the general osteopathic scope of practice

Extended scope of practice for internal techniques

Determine scopes of practice

Prescribe qualifications / accredit institutions

Determine Competency / Recertification Frameworks

Assess international osteopathic graduates

Complaints – HPDT / HDC

Competence reviews

Fitness to practice reviews

Professional conduct

Scope of Practice Consultation 2007 – 12

Osteopathic Capabilities Framework 2007-09

WMA Scope Gazetted Sept 2009

Clear Skies Thinking Workshop December 2009

Scope Reform White Paper June & Conference 2010

Three Cycles of OCNZ Regional Conferences

Revised General SoP Schema January 2013

Proposed Amendments to the SoP Schema

(1) The principal purpose of this Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.

Broad Based & Inclusive General SoP Aligned to the strategic direction of NZ

Healthcare Policy Vocational Scopes for particular areas of

practice expressly included in General SoP(Pain Management & Gerontology)

Extended Scopes for techniques expressly excluded from the General Osteopathic SoP

Western Medical Acupuncture & Related Needling Techniques

Osteopaths are primary healthcare practitioners

Osteopathy is a person-centred form of manual medicine

Osteopaths conceptualise health and disease within a broad holistic bio-psycho-social and environmental context

Osteopathic practice may be situated within the continuum of healthcare - wellness

The competent practice of osteopathy requires broad diagnostic competencies

Osteopaths work with patients from across the lifespan

Osteopaths are primary healthcare practitioners. Central to the competent practice of osteopathy is an understanding of the role of the primary care team and referral routes within primary care and to hospital based service.

Rogers, F., D'Alonzo, J., GE. , Glover, J., Korr, I., Osborn, G., Patterson, M., et al.

(2002). Proposed tenets of osteopathic medicine and principles for patient care.J Am Osteopath Assoc, 102, 63-65.

Osteopaths are primary healthcare practitioners. Central to the competent practice of osteopathy is an understanding of the role of the primary care team and referral routes within primary care and to hospital based service.

Rogers, F., D'Alonzo, J., GE. , Glover, J., Korr, I., Osborn, G., Patterson, M., et al.

(2002). Proposed tenets of osteopathic medicine and principles for patient care.J Am Osteopath Assoc, 102, 63-65.

Osteopathy is a person-centred form of manual medicine informed by osteopathic principles. Osteopathic medicine is not confined to historical osteopathic knowledge; rather osteopathic philosophies and concepts inform the interpretation and application of interdisciplinary knowledge and the basic medical sciences.

Osteopathic medicine is an evolving field of knowledge and incorporates new concepts as our understanding of health and disease progresses.

(1) Each authority appointed in respect of a profession must, by notice published in the Gazette, describe the contents of the profession in terms of 1 or more scopes of practice.

(2) A scope of practice may be described in any way the authority thinks fit, including, without limitation, in any 1 or more of the following ways:

(a) by reference to a name or form of words that is commonly understood by persons who work in the health sector:

(b) by reference to an area of science or learning:(c) by reference to tasks commonly performed:(d) by reference to illnesses or conditions to be diagnosed,

treated, or managed

Post Graduate Diploma in Pain Management or Older Peoples Wellness (Gerontology). NZQF Level 9

The diploma level qualification aims to equip registrants with evidenced based practice approaches and critical appraisal skills

Unitec Grads have Level 9 Qual with 90 Units Research Component

ACC requiring 50% providers have PG Qualification in Vocational Rehab (PG Cert)

Council proposing that for Unitec Grads or other registrants with a Clinically relevant Masters degree acquired post registration Voc SoP qual reduced to a PG Cert

Original SoP Consultation Document proposed Rehab SoP – Aligned to ACC

Advanced standing and post graduate study / specialisation in areas of practice that remain within the general scope of practice.

There is a continuum of skills / knowledge from novice to expert. Pre-professional training prepares osteopaths to commence practice.

Gerontology Pain management Rehabilitation Child health / Paediatrics Sports injuries Occupational Health

InterprofessionalRelationships

Primary Healthcare

Responsibilities

Osteopathic Care &Scope of

Practice

Person Orientated Care & Commuication

Professional & Business Activities

Clinical Analysis

Council is undertaking research to determine capabilities for osteopathic practice with children.

Discussion with the profession and other stakeholders on refining the boundaries of the general osteopathic scope with regard to two specific areas of paediatric practice:

Internal techniques Manual techniques applied to the spine

And removing Internal techniques from the General SoPfor adults & creating an extended SoP

In August 2013 the Council issued interim guidelines

Legitimately part of the repertoire of osteopathic techniques (PV & PR).

Adequate information about proposed examination and treatment to allow patents to make informed decisions.

A chaperone or support person is offered.

Universal precautions are used for infection control purposes.

The Council is considering removing internal techniques from the General SoP for under 18s.

Potential psychological harm to a child or adolescent from such a procedure out ways the potential benefits

From a regulatory perspective children and young people are particularly vulnerable.

It is rarely the case in osteopathic practice for any given presentation that a single technique would be the only approach that may be of value.

Issue of ‘sensitive areas’ and opportunity for general up-skilling in consent.

Council does not currently accredit any training pathways that cover internal techniques.

No formal instruction on internal techniques as part of the curriculum on the Unitec osteopathic programme.

Council has no data on the educational biographies of individual osteopaths relating to their pre-registration training with regard to internal techniques.

Determining an extended scope of practice and mandating a qualification for prospective registrants.

Pathway of study, blending e-learning with in-attendance practical sessions - medico-legal consideration, differential diagnosis and conduction examination and treatment.

Interdisciplinary focus with input from ‘expert’ practitioners in internal techniques from osteopathy and other clinical disciplines such as midwifery, nursing, physiotherapy or medicine.

Number of potential benefits not only in terms of public protection but developing expertise in the profession.

Patients interested in these treatment approaches would be reassured that the osteopath is competent in this area of practice.

In order to ensure those registered in the general osteopathic scope were not bearing the costs the course would be run on a cost recovery basis.

A range of osteopathic manual techniques (OMT) are applied to the spine.

HVLA techniques applied to the cervical spine are often considered the procedures that carry the greatest risk.

The literature reveals very few studies concerned with such techniques in osteopathic practice.

Dearth of published studies relating to the use of such techniques in children in any professional discipline

The Council is aware of a number of cases internationally where manual techniques applied to spines of young children have purportedly resulted in severe damaged or death of a child.

Incomplete details of these cases are in the public domain, the Council is minded to apply the precautionary principle and consider the risks of manual procedures applied to children.

Research conducted by Council in 2011 was reassuring as no respondents reported using HVLA on patients younger than 8 years of age.

Council thinking at present would be to seek to restrict HVLA in children under the age of 14 (consistent with the definition of a ‘child’ in the Children Young Persons and Their Families Act 1989).

Whilst the risk and reward ratios are unknown for HVLA techniques this is not a straightforward matter.

Cervical spine?

All regions of the spine?

+/- peripheral joints?

The forces used in motion testing or techniques other than HVLA may also need to be considered.

Move the focus of what the profession understands constitutes competence beyond the boundaries and artificial subject areas of traditional pre-registration training courses to professional practice.

Progress not perfection

Resource constraints

Conventional thinking amongst administrative staff.

Focus on the added value of reflection on practice over the growing pains of different working practices.

Reluctance of osteopaths to be assessed.

Osteopathic Exceptionalism - the ultra-positivists & the insider / outsider problem.

An advantage of the slow burn approach with the profession has been time for the conceptual framework to be understood and producing practitioners that are keen to push forward with innovation.

A form of assessment that aligns learning and assessment was required allowing the practitioner to identify and develop a reflective approach.

Defensible mechanism that allows evidence to be assembled and, notwithstanding the diversity of approaches to practice, allows competencies to be identified within a flexible capabilities framework.

Creating an understanding of reflective practice and a commitment to lifelong/lifewide learning - training and dialogue with the profession.

Reflective practice: ‘the capacity to reflect on action so as to engage in a process of continuous learning’ (Donald Schön 1930 –1997).

One of the defining characteristics of professional practice.

An understanding of the nature of ‘Practice’ is central to designing an assessment process which is capable of capturing evidence of an individual’s ability to practice.

The first step in designing the assessment process was accepting a conceptual model for osteopathic practice.

Then developing an analysis / deconstruction of practice from the perspective of process - rather focussed on academic knowledge – Osteopathic Capabilities Framework.

Identifying assessment tools to assess the various components of practice. K S A

Three year cycle of regional conferences to raise awareness amongst the profession.

Problematising current approaches and sharing an understanding of the theoretical framework supporting the use of PebblePad

Migrating from a p-portfolio to an e-portfolio:

Encouraging practitioners to creatively develop and use PebblePad as a personal learning space.

Creating allies and project champions. Identifying potential pilot sites for trialling professional development/recertification processes.

Conventional wisdom of evidence based practice applies theoretical knowledge to practice.

In reflective practice theory and practice are seen as being reciprocally inter-related.

Professional identity / knowledge is complex and is not merely assembled from discreet knowledge base.

Professional knowledge / identity arises from a synthesis of natural and social sciences

Reflection-in-Action: as we work identifying learning needs / opportunities

Reflection-on-Action: After the fact seeking theoretical perspectives and integrating them into our thinking

Reflection-for Action: Applying knowledge to practice

Creating Personal reflective space / Organisational Context. Thinking>Analysis>Self>Awareness

OCNZ needs to be realistic

Broad church

Freshen up - maintain interest in practise

Skills acquisition: Cognitive - Associative - Autonomous - "OK" Plateau - Fitts & Posner

Honesty & Openness to change / development

Miller’s pyramid of competence indicates that assessment of ‘does’ reflects professional authenticity.

Whatever one ‘does’ in the assessment must reflect practice in order for that assessment to be authentic.

The portfolio’s purpose is to guide learning and capture evidence

Portfolio was the Hoorah word of ‘90s

Evidenced Based Practice ’oos

e-Portfolio is current Hoorah!

Trial the e-Portfolio for the overseas assessment processes

Reference Group to look at applications for CPD / Recertification Processes

Learning Needs Analysis

Personal Development Plan

Learning Outcome Reports

Case based Discussion

Critical Incident Report

Critiquing journal articles

Literature reviews

Reflective statements from training courses

Scope of Practice Reform 2007 - 12 Osteopathic Capabilities Framework 2007-09 Development of work-based competence assessment

2010 PebblePad Preceptor Training Nov 2013 Unitec – Clinical Practicum 2013 Trialled for overseas assessment 2013 Overseas Assessment Process from Aug 2014 Peer Group Training Aug / Nov 2014 Recertification - Voluntary adoption by registrants 2015 Recertification Mandatory 2016