Continuing Competence leads to Quality Practice – The College Supports You Through the Practice Support Program
By Brad Matthews, Dr.TCM
The Health Professions Act (HPA) requires health regulators to develop and implement Quality Assurance (QA) programs. Specifically, the Act states that regulators are required to ensure the “continuing competence” of their registrants throughout their careers. Continuing competence through a QA program will ensure “safe, ethical, quality” healthcare for the public.
On the surface, this sounds like a good idea: make sure registrants maintain a level of competence that will uphold the primary mandate of the regulator to provide safe, ethical, quality care. But it is somewhat simplistic; defining just what constitutes continuing competence is not easy in a profession as complex as TCM.
The notion underlying QA programs has been that undertaking a certain number of continuing education hours per reporting cycle means that registrants are maintaining continuing competence. However, learning derived from taking a course is only a small part of the total learning that leads to competence. Health professionals have many learning opportunities in their practices: they can learn from their experiences, from the peers, and from their clients or patients. Continuing competence becomes tricky to assess because it’s somewhat of a moving target: over the course of a health professional’s life, some competencies will naturally erode, and others will become very much more proficient.
For example, in my own practice I don’t treat children, and as a result, my entry to practice competencies related to pediatrics have eroded. However, I do treat a very large number of orthopedic cases so my competencies in these areas have been enhanced. The fact that my pediatrics skills have eroded in no way makes me less competent given my patient profile. Another example would be fertility. Some practitioners have a very singular practice focus on fertility and perhaps, as a result, their geriatric competencies have declined. However, they too are by no means less competent, given their professional focus.
One of the real problems with QA programs being rooted in accumulating continuing education hours is that it becomes nothing more than a regulatory hoop to jump through. Invariably there are registrants who, when renewal time approaches, scramble to ‘get hours’ without much thought as to what might actually help them in their practice setting. So, in addition to feeling like it’s just a hoop, there is no assurance that the courses are making them more competent practitioners.
There is another area of shortcoming when fulfilling a CE credit requirement alone is the marker of continuing competence. That is, what about the overall idea of professionalism? Does taking a few hours of courses improve professionalism to be a good doctor? Amazingly, surveys have shown that 70% of patients are more concerned with their relationship with their doctor than they are with treatment outcomes! Let’s think about that: as many as 70% of patients feel that the ability as practitioners to communicate, to empathize, to be relatable (in other words our bedside manner and personality) are more important than if the treatment ultimately works. Only 30% rate treatment efficacy as the most important trait of a doctor!
The above issues were among those practitioners and consultants contemplated in the early days of developing the PSP: How do one assess competence when career span is a moving target? Is there a set of very broadly stated competencies that could better describe what continuing competence really is?
Ultimately, 14 Career Span Competencies (CSCs) of the PSP were developed to describe continuing competence. It’s important to mention that the CSCs were not pulled out of the air. In fact, they flow directly from the Entry to Practice competency profiles of a number of health regulators, including CTCMA.
Having a brand-new framework that better describes career span competence, what if a QA program, could be more than just another hoop to jump through, that is, a fixed quantity of CE hours to count? What if the program could serve as a means to support career span development and competence leading to high-quality professional practice? What if we could stimulate registrants’ professional development – give them a practice-building tool, much like a business plan, that could help guide them as professionals as they progress through their careers? After all, it’s in nobody’s best interest to remain the novice practitioner we all are on day one of our careers. That doesn’t serve the individual practitioner. It doesn’t serve the profession as a whole and it most certainly doesn’t serve the public interest.
The PSP is a program developed for YOU – the CTCMA registrants. The CTCMA wants to support your career development and to give registrants a valuable practice-building tool. The PSP satisfies the requirements of the HPA to provide a quality assurance program to ensure the continuing competence of registrants. The PSP is about helping registrants be the best they can be.
 Health Professions Act: Part 3 s 26.1
 College Bylaws: s 20(3)