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This topic has been split off from the Political Developments thread as they are valuable enough for a new thread and were off the topic of the valuable original posts of that thread

Hi Davidh

Yes we will always disagree on the methods used to bring about change all the time ,in my opinion, it remains in a devisive format.

I have read of your departure from the SCP in other threads and have to say my comments were not meant in a present tense more that you were a former member and would therefore have more of an insight into the reasoning that I .

Time will tell on the eventual outcome but all I can say is I hope reason and reality rather than denigration ( by that I mean putting practioners livlihoods at risk) and ideals win the day .

We have now as of July compusory CPD which is being geared to improving patient care and practice rather than simply attending for a set number of hours or collecting points .

I have always been an advocate of "continual assessment" rather than the "exam culture" as I believe the former is acurate marker of an ability rather that the later which is simply a memory test.

Perhaps the new age of cpd will reflect that theory and evolution will in time unite us in the most painless way.

My ideal ? pehaps , but not confrontational and I DO believe it WILL work.

Derek

Works well in primary school education, huh?

Primary school eductation is an extremely good model for CPD etc - even for UG education.

Think about it - the kid has got a problem --- what does he do? ... goes to the teacher.... what does the teacher do? ---- "Hey Johnny - how do you think we/you can solve this problem?"... (they don't give them the answer)

Best model is continuous improvment vs the pass an exam mentality. How do you continously improve -- self identify a problem or knowledge or skill deficit and find a way to solve it (eg books, conference, peers, etc) - evidence is this is how people learn best ---- the primary schools have got it right.

Its the old story of the big difference between 10 years of experience and 1 year of experience 10 times ---- exams noly encourage people to keep on repeating the one year of expereince. Self idenifying deficits and doing someting about it, that leads to growth, accumulation of experience, etc --- rather than just repeating the one year... (I am sure we can all identify those in the profession who just keep on repeating the one year )

My $0.02

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Hi Mark

I Think Craig has put it better than I ever could thank you Craig .

I think a proven record that is assessed for content and performance is a more accurate indicator of competence than any singular examination .It also gives the opportunity of correction and positive direction.

The academics amongst us may disagree with me but ..... just my opinion .

Derek

I think the point I tried to make above is what would you rather have:

1) a model where everyone has to pass a minimum standard exam every year
2) a model where everyone has to show continuous improvement and development every year (ie best facilitated by the primary school model of learning)

Another way of looking a it:
Consider everyones competence to be a bell shaped curve. Having a competency exam is an exclusionary model in which its aimed to get rid of those who are > 2 standard deviations below the mean.

Rather then this exclusion model, why not have an inclusion model? - ie rather than chop of those who are 2SD's below the mean --- why not just move the whole bell shaped curve to the right? Accept that there will always be people >2SD's below the mean, but if the curve keeps moving to the right, who cares??

The best way to move the curve to the right, is not by exam, but by self identification of deficits etc etc (see above) --> continuous improvement for everyone, as opposed of bringing everyone to a minimum standard (ie the 10 years of experience vs the 1 year 10 times) .... guess which model we adopted in Australia?

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Why can't you adopt a model that does both? Continual assesment sounds fine in theory but in practice it depends heavily on the educators objectivity and experience. Great if you have established institutions whose educators also undergo continual assesment by their peers, but when you have private institutions, whose syllabus and teaching methodology has not been exposed to inspection or outside scrutiny, how can you ensure the educators' standards are valid and robust?

I agree with the thrust of your points regarding self progression in education, but not everyone shares the same motivation. Having a yearly examination to ensure minimum standards have been met often provides the incentive that some folks lack. Are you seriously suggesting that all examinations should be dropped in favour of a system of ongoing assesment?

Exams tell you nothing more than how well someone can memorise things (and then forget them after the exam). They don't encourage the kinds of things that are needed to be good clinicians. They encourage superficial fact memorisation as opposed to deep learning and understanding. They encourage the repeating of the 1 year of experience as opposed to continual development and learning. They encourage people to achieve the minimal standard, rather than go beyond it.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Craig

That's not what I asked. I'm familiar with the arguments for continual assessment -v- examination, but I get the impression you are advocating a system of education that has no examinations whatsoever. Is that your position?

Surely you mean some people, Craig? If you're reasonably self motivated, you'll drive your own standards, irrespective of whatever learning programme you graduate from. If your statement was all-encompassing, how do we have exceptional people in podiatry today? Would you think the profession is best served by constructing an undergraduate programme that is completely geared towards continual assesment without examination, or one that has both?

Mark Russell

It is a sad fact of teaching and learning that we wrestle with often ---- for the student, learning is driven by the nature of the assessment.

Exams encourage the wrong kind of learning for continual professional development.

eg mutli choice exams encourage the lower order superficial commision of facts to memory ---

We are conintually trying to adapt our UG teaching and learning towards the higher order learning ---- but all that counts for nought if the assessment does not reflect it as students will still focus their learning based on the nature of the assessment.

The same applies to continuing professional development and learning. Any form of assessment has to encourage/reflect the kind of learning/development expected at that level and has actually been shown to be related to patient outcomes.

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

[quote=Mark Russell] Great if you have established institutions whose educators also undergo continual assesment by their peers, but when you have private institutions, whose syllabus and teaching methodology has not been exposed to inspection or outside scrutiny, how can you ensure the educators' standards are valid and robust?

Perhaps you should ask Davidh or Bill Liggins to answer that one Mark ???

Derek

[quote=Mark Russell]Craig


Surely you mean some people, Craig? If you're reasonably self motivated, you'll drive your own standards, irrespective of whatever learning programme you graduate from.

Mark

Perhaps you could cite one successful businessman that is Not self motivated ?? = IPP's

Derek

Could be. But I still think there has to be some examination at the end of a course. Are you advocating all year-end examinations be abolished in favour of continual assessment?

Not quite. We just have to move on from the "terminal exam" mentality and move towards forms of assessment that reflects what is important (ie what is related to patient outcomes).

In the subjects I teach, most students actually know what is in the exam --- but that does not mean that they do any good with knowing that. The questions are just not testing the memory, but other deeper things --> I tell them that (so the assessment should drive the learning --- as much as I hate that happening) ... despite knowing whats coming up in the exam, they generally do surpisingly badly, as they are so hung up on the "commit all the material to memory" due to the nature assessment in the first couple of years before I see them that is based on committing all these facts to memory.

I am taking a risk saying this .... But hopefully no one from Australia reads this in the UK forum , BUT, my wife is a podiatrist in private practice who needed to employ a new grad.... so I approached a couple ---- the one I specifically sort out that accepted the position (and is now doing really well) was approached based on how well I thought that person would go - it had nothing to do with the marks that person got (ie the exams were assessing something that the employer was not really interested in) .... (actually, I am not really taking a risk as I just rung her to tell her about this message :) )

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

Craig,

Thanks for directing me to this line of discussion (I wasn't sure if it was because of my quals in Primary and Secondary teaching, or because my other half is a demented Highland Piper).

I totally endorse Craigs beliefs and sentiments re the nature of learning - change can only happen when we reflect on and challenge our knowledge and practice. Summative assessment - the dreaded 'final exams' are too often seen as the single hurdle to practice. I confess I have a colleague who brags that in over 23 years of practice she has not bothered to follow up on any developments on our profession. "What she knows is enough".

But I do question whether our professional community offers the environment required for successful individual constructive growth. In a classroom the teacher's role is to gently support the student as they leave their comfort zone of knowledge/practice and challenge and reconstruct their understandings for themselves. Do we offer the mentors, the guides and the support structures to provide this to our professional community?

Just as students are assessment driven, they place equal importance on modeling - one of the issues behind the problems we are encountering in converting the more vocationally oriented programs to off-campus e-format. Can we provide models to enable inividuals to seek to improve their practice? It is little wonder that the old Royal Colleges of Insert-Your-Medical-Specialty-Here have stayed the way they are. The Guild Apprenticeship model of training has some real advantages (although it is not PC to say so).

Now, what was I saying? Damn, it was probably profound. Never mind, I will check your spelling and make sure you haven't gone over the lines when you are colouring in later.

Yours in Podiatric Fellowship

Felicity

In other words you chose your associate based on your gut feeling, which at the end of the day is often more reliable than any other method. But the point is this, Craig - your two candidates graduated after completing some studies in podiatry. You didn't approach two individuals in a bar and said, "Hey, I'm looking to employ someone to work with my wife who is a podiatrist. You gotta do some studies as you go along, but it doesn't really matter if you haven't done any to date because there's such a shortage of podiatrists nowadays that the government are allowing anyone to come into the profession for the next three years. You don't have to prove nothing!"

I suspected we might end up on the same track as the excellent Undergraduate Education thread (hello Felicity) and seek to re-examine the whole issue of UG learning and how this profession approaches new blood, but before we do I would just like to make clear that the issue of examination raised in this thread relates to measuring the competence of people who have applied to join a register of professionals, where they have taken a route of training that falls out-with the standard programme - if indeed they have taken any training in the first instance.

I'm sure your comments have validity in the educational programmes and I respect your views entirely, but how do you measure suitability to practice and clinical competency in a body of individuals who have varied and diverse backgrounds in training and education, without setting some examinations?

Gotta agree with Mark there Craig, although you did not select the successful grad on their 'marks', you had a highly developed (and internalised) system of assessment by which you measured the potential Pod's competence and capacity for growth.

I guess the point that you are making along the way here Craig is that while the final exams might measure competence (or a dull variant thereof) - do they in any way measure potential for growth? I actually believe that the use of lower order assessment techniques in the tertiary sector (ie the rote-learned superficial stuff) is a function of the lack of resources to do anything more searching and meaningful, and the (dare I say it) lack of pedagogical training offered to/undertaken by academic staff members.

Having said all that, the point, as Mark makes, is that when you have a disparate and heterogenous group of applicants for registration, how to assessment baseline standards? By crikey if we could discover a method of assessment which:
is deep and searching
encompasses diversity and individual differences
addresses the theory-research-praxis intersection
is non-threatening and formative
is diagnostic of capacity for growth as a reflective practitioner
can be administered easily
is cost and resource neutral (or better yet - lets make some money for our poor Governments....)
...well then, I think I would never have to see another toe-nail again.

Anyway, how about they write in 25 words or less "I would like to be a Podiatrist because..." and include the inners of at least one expensive running shoe bearing the imprints of some orthotic devices?

cheers,

Felicity

PS For the sake of personal publicity, I would like to point out that the avatar is of Weird Al Yankovic, not a recent picture of me after intensive testosterone treatment

Hi Felicity

At the (severe) risk of diving headlong into an academic discussion that is frankly above me after an opinion I raised (but what the heck here goes anyway)

Firstly thank You and Craig for making me THINK !!

I am not an academic so please bear with me.

The situation we have in this country as I see it is :

The division of the profession in two main sectors:-

Graduate

Non Graduate (diploma level)

The The Health Professions Council has decreed " Anyone that has been in practice for five years in SAFE EFFECTIVE PRACTICE" ( a form of continual assessment ??) will be admitted to the register.


Then after, cpd will be required to show "effect on patient outcomes" within your scope of practice.

Now as a private practioner that has completed EVERY diploma course my teaching institution offers and is being blocked from advancing my knowledge by Mark and the like within the profession.

I now have to look to other disciplines to advance my knowledge in new patient care techniques .

The need for me is, any learning at this stage MUST relate to my practice situation and the assumed benift to my patients, ie , I don't particularly care HOW it works , prove to me ( as researchers /academics) it DOES work and will improve my patients quality of life and take their pain away I will be the first in line to learn everything about it and the intigrate it within my practice

This situation is not of my making yet I am being threatened (if Mark has his way) with yes the ultimate exam!!

The effect will be( if approved) of exclusion rather than inclusion thereby depriving thousands of patients of patient choice and treatment.

I believe , given time , a level playing field will be set and a structure made based on levels of ability/education , self aspiration and scope of practice.

But my opinion still is ,ANY ongoing apraisal MUST be based on a continual assessment basis to encourage improvement in educational growth standards .

Thanks for indulging me

Be lucky

Derek

ps . your Atavar was looking quite atractive till you told me it was a BLOKE Jeeeeze these damn glasses :)

A line I use often when discussing some new ideas is something like - "I don't care if I am wrong - if you go away thinking, then my job is done"

We did publish a paper on critical thinking and critical reflection and teaching:
CB Payne and AR Bird: J Am Podiatr Med Assoc 1999 89: 525-530 Teaching clinical biomechanics in the context of uncertainty in which we outlined one model in which developent from the lower order to the higher order level of thinking can happen.

Here is an eg I use often, that summarise my views on CPD:
Take a clinician who decides their clinical biomechanics and orthoses prescribing skills are not where they should be (first step to learning well is this self identification of a learning need or deficit). Next step is to plan what to do about it...

Under traditional models (eg the USA's CME points) - you find a course and go on it and get your points. But how often have you been on a course (you have fun, it was interesting, you caught up with collegues, you got drunk at the dinner).....but come Monday morning, how much better off are your patients? (assuming you weren't hung over ) (...also, how many of those weekend biomechanics/foot orthoses courses are still teaching what we gave up teaching ~10 years ago)

Under the reflective/critical thinker/self directed type approach, what can you do?... perhaps spend the day seeing patients with a collegue who does a lot of biomechanics and orthoses; find a mentor who is willing to 'debrief' with you after each biomechanics patient ("what could I have done better?); buy a couple of books; read the Biomechanics forum here; organise a 'journal club' type mtg with collegues; spend an afternoon at an orthotic lab; maybe do a course, but its a small part of the plan ---- BUT, most importantly spend time reflecting on these activities, making notes etc on what was learned and how it can be applied.

Guess, under which method the patient outcomes are better? Guess which method leads to continuous improvement (ie shifting the bell shaped curve to the right; inclusion vs exclusion) - all I am arguing is that what ever form of assessment is in place it needs to encourage this kind of activity (ie learning is driven by the nature of the assessment)

Under the CPD in Australia, you self declare and can claim points for these kinds of activities - there are random audits (on her latest annual points return, my wife even claimed points for being married to me - she runs a lot of patient problems past me, that she learns from and patient outcomes improve, so why not? )

__________________
Craig Payne
Department of Podiatry
La Trobe University
Melbourne, Australia
http://www.latrobe.edu.au/podiatry
__________________________________________________ ___________________________________
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
The views expressed above are those of the author and not that of La Trobe University
This is where I am, where are you?

'Now as a private practioner that has completed EVERY diploma course my teaching institution offers and is being blocked from advancing my knowledge by Mark and the like within the profession.'

What is being blocked and how, sorry i've missed something here.

Exams, in my opinion and it is only an opinion, prove that an individual can pass or fail them, agreed in the first few years of training they probably are an accurate way of ruling out plagerism, should it be suspected with regards to an individuals performance in the class room and the submission of assignments. However trying to introduce a five yearly examinable test of competence would leave the vast majority of people out in the cold regardless of training, and thats not taking into account the financial implications and the inevitable appeals and remarks that occur. Should we differentiate between an individual who passes with 90% and one who passes with 40%.....do some know 50% more or less than the others.

Like Dereck I have done everything my institution has to offer, and have also studied beyond both at diploma and degree level so my opinion is valid, continual assesment streatches my skills as an individual, a student and a practitioner, exams when I have to take them, locks me a way in a small room cramming information in, making me hope that the right questions appear.

I for one would not in any way shape or form agree to a five yearly examinable test of competence, it would be frought with distrust and the allegations of favouratism would be rife.

A variation of the CPD which involed constructive and active participation would be a way that I think most people, however reluctantly, would agree to, but thankfully I don't have to make those descions.

Imagine turning to a consultant orthopedic surgeon or nerosurgeon, sitting them down for a two hour exam and say to them, I don't care how good you are, if you don't pass this test...your'e out! (and don't you dare say that's different, because it ain't!)

Cheers

David D :)

PS

I see now I am a senior member.....does that mean I get paid for coming on here?

Cheers

David

Unfortunatly no :( ---- we just now respect your opinion even more :)

Thanks

Derek,
I don't think there are many CPD courses you can't access in the UK.
You can certainly attend any I run!
Cheers,
David

How does the HPC measure safe & effective practice? It doesn’t. It relies on the applicant making true and honest statements in relation to their prior activities. The process is deeply flawed and wholly unreliable.

With such a fertile imagination, I appear to have taken on the mantle of the Devil-Reincarnate with you Derek. But I can assure you that my satanic powers do not extend to course blocking for grand-parented registrants.

I hate to tell you this Derek, but the colleagues you seek to join, have all had to undergo examinations before they were allowed to practice. Can you tell me why you should be treated any different?

Only if you don’t make the grade and if that is the case then that is most certainly in the best interests of the patient.

That is precisely what will happen with revalidation and this process has already been adopted by both the General Medical Council and the General Dental Council.

Mark Russell

Thank you for the invitation :)

I know via the SMAE I can attend cpd which Mark by the way is questioning the quality and dare I say the qualification of the educators , ( see earlier in this thread) I really would like your comments on that one

I will agree it is getting easier to access cpd run by or involving SCP members but lets be fair until very recently we were treated like leppers in that respect.

I am not going to persue that tack any further as I think it is going away from the subject under discussion but suffice to make the point.

Cheers

Derek

Hi Mark]

[quote=Mark Russell]

How does the HPC measure safe & effective practice? It doesn’t. It relies on the applicant making true and honest statements in relation to their prior activities. The process is deeply flawed and wholly unreliable.

Mark pleeeeeeeeeeze can we restore some sense or reality !!
Are we now all liars cheats scallywags and incapable of giving a true declaration ???
If that is trully what you believe then I am genuinly saddend because if that is so there will never be a true resolution to our differences

"With such a fertile imagination, I appear to have taken on the mantle of the Devil-Reincarnate with you Derek. But I can assure you that my satanic powers do not extend to course blocking for grand-parented registrants."

You are only "devil incarnate" to me Mark as you apper to head and perpetuate the anti Smae lobby. I'm sure your a very nice chap really

"I hate to tell you this Derek, but the colleagues you seek to join, have all had to undergo examinations before they were allowed to practice. Can you tell me why you should be treated any different?"

I have not been treated any different ,I have also completed exams that were expected of me to obtain the qualifications I have

"Only if you don’t make the grade and if that is the case then that is most certainly in the best interests of the patient".

I'm afraid I'm firmly in total agreement with Craig on the question of Exam culture vs continual assessmet as a much more accurate conclusion can be arrived at on patient care standards.

"That is precisely what will happen with revalidation and this process has already been adopted by both the General Medical Council and the General Dental Council."

And have you sat down with any of the above and asked how they feel about that ??
I have and a lot aint happy about it.

Cheers

Derek

I guess that's the passage that's hacked you off, Derek. What's the problem? The mainstream colleges have to undergo external scrutiny for their syllabus as well as HPC validation for their course programme. I would have thought any teaching institution would be bound by the same regulation, but in the private sector, in the UK at least, that is not the case. Ask yourself this: Why haven't SMAE and the West Midlands School et al. applied to join the register of approved institutions with the HPC for chiropodists and podiatrists? Who are these institutions training nowadays - Foot Health Practitioners who fall out-with the regulatory legislation or chiropodists/podiatrists, who are covered by the Order.

I suspect Craig, Felicity, Cameron and other educators all have a recognised podiatry qualification plus a supplementary teaching certificate; are exposed to regular inspections and are bound by some form of regulatory control. The same principles cannot be applied to the private establishments to which you refer.

Please don't take this as another slagging-off for private establishments and their protégés but you often make a great play of level playing fields and I am simply pointing out to you the duplicity of your statements. Graduate podiatrists underwent three or four years of full-time study and training plus an interminable number of examinations before being allowed onto the register - you didn't. Podiatry colleges are bound by strict guidelines and regulations that govern their activities and staff - the private colleges have no such regulatory environment. Level playing field? Send on the Jambos!

I have no idea, but I have it on very good authority that someone has registered a stuffed gorilla as a HPC podiatrist and that said gorilla now has the same legal status as you and I and all the other UK pods who contribute to this forum. Maybe he can type? Certainly he was able to dupe the system - I wonder how many others have too?

Mark Russell

Mark

"Originally Posted by Mark Russell
Great if you have established institutions whose educators also undergo continual assessment by their peers, but when you have private institutions, whose syllabus and teaching methodology has not been exposed to inspection or outside scrutiny, how can you ensure the educators' standards are valid and robust"

I believe David h & Bill Liggins are now educators for Smae ?? Are we to assume from your comments they are in some way deficiant ???

I cannot speak for or against other establishments because I don't know the details.

I believe wheels are in motion to dot the i's and cross the t's to make the Smae a teaching establishment recognised by the HPC.

One last thing ,

If as you say the Smae does not get inspections etc how do you know so much about what supposedly goes on there ??

Have you had first hand experience of the teaching methods or are your comments ( as I suspect)based on supposition ??

But please Mark dont lets get into them and us on this thread .

Out of interest should your exam proposal be accepted , who would set the exam and at what educational level ??

Cheers

Derek

Mark

"I have no idea, but I have it on very good authority that someone has registered a stuffed gorilla as a HPC podiatrist and that said gorilla now has the same legal status as you and I and all the other UK pods who contribute to this forum. Maybe he can type? Certainly he was able to dupe the system - I wonder how many others have too?"



As we have said before every system is open to abuse and or stupidity

Examination and regulation will never stop that

Cheers

Derek

Derek,
One point, although I have been an educator for SMAE in the past, this is not the case now. However I believe the one Workshop I did run for them was at least up to the standard of undergrad podiatry teaching in the UK, as were the two CDRoms I wrote.
Cheers,
David

Then David why is Mark so insistant the standards of educators/education at the Smae fall short ???

Cheers
Derek