2. ïĄ Timeline of Scope Reform
ïĄ Current Scope of Practice Schema
ïĄ Amending qualifications for the existing vocational
scopes of practice: (1) pain management (2)
gerontology
ïĄ Additional Vocational Scope in Rehabilitation
ïĄ Consultation on amendments to the general
osteopathic scope of practice
ïĄ Extended scope of practice for internal techniques
3. ïĄ Determine scopes of practice
ïĄ Prescribe qualifications / accredit institutions
ïĄ Determine Competency / Recertification Frameworks
ïĄ Assess international osteopathic graduates
ïĄ Complaints â HPDT / HDC
ïĄ Competence reviews
ïĄ Fitness to practice reviews
ïĄ Professional conduct
4. ïĄ Scope of Practice Consultation 2007 â 12
ïĄ Osteopathic Capabilities Framework 2007-09
ïĄ WMA Scope Gazetted Sept 2009
ïĄ Clear SkiesThinkingWorkshop December 2009
ïĄ Scope ReformWhite Paper June & Conference 2010
ïĄ Three Cycles of OCNZ Regional Conferences
ïĄ Revised General SoP Schema January 2013
ïĄ Proposed Amendments to the SoP Schema
5. (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.
6. ïĄ Broad Based & Inclusive General SoP
ïĄ Aligned to the strategic direction of NZ
Healthcare Policy
ïĄ Vocational Scopes for particular areas of
practice expressly included in General SoP
(Pain Management & Gerontology)
ïĄ Extended Scopes for techniques expressly
excluded from the GeneralOsteopathic SoP
ïĄ Western Medical Acupuncture & Related
NeedlingTechniques
7. ïĄ Osteopaths are primary healthcare practitioners
ïĄ Osteopathy is a person-centred form of manual medicine
ïĄ Osteopaths conceptualise health and disease within a broad holistic
bio-psycho-social and environmental context
ïĄ Osteopathic practice may be situated within the continuum of
healthcare - wellness
ïĄ The competent practice of osteopathy requires broad diagnostic
competencies
ïĄ Osteopaths work with patients from across the lifespan
8. 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.
9. 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.
10. 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.
11. (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.
12. (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
13. Post Graduate Diploma in Pain Management or Older PeoplesWellness
(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 inVocational Rehab (PG
Cert)
Council proposing that for Unitec Grads or other registrants with a Clinically
relevant Masters degree acquired post registrationVocSoP qual reduced to
a PG Cert
Original SoP Consultation Document proposed Rehab SoP â Aligned to ACC
14. 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.
ï§ Gerontology
ï§ Pain management
ï§ Rehabilitation
ï§ Child health / Paediatrics
ï§ Sports injuries
ï§ Occupational Health
17. 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 SoP
for adults & creating an extended SoP
18. 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.
19. 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.
20. Issue of âsensitive areasâ 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.
21. 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 âexpertâ
practitioners in internal techniques from osteopathy and
other clinical disciplines such as midwifery, nursing,
physiotherapy or medicine.
22. 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.
23. 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
24. 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.
25. 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 âchildâ in the ChildrenYoung Persons and
Their Families Act 1989).
Whilst the risk and reward ratios are unknown for HVLA
techniques this is not a straightforward matter.
26. 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.
27.
28.
29.
30. 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
31. ï§ Resource constraints
ï§ Conventional thinking amongst administrative staff.
ï§ Focus on the added value of reflection on practice over the
growing pains of different working practices.
ï§ Reluctance of osteopaths to be assessed.
ï§ Osteopathic Exceptionalism - the ultra-positivists & the insider /
outsider problem.
ï§ 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.
32. ïĄ A form of assessment that aligns learning and
assessment was required allowing the practitioner to
identify and develop a reflective approach.
ïĄ 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.
ïĄ Creating an understanding of reflective practice and a
commitment to lifelong/lifewide learning - training
and dialogue with the profession.
33. Reflective practice: âthe capacity to reflect
on action so as to engage in a process of
continuous learningâ (Donald Schön 1930 â
1997).
One of the defining characteristics of
professional practice.
34.
35.
36. An understanding of the nature of âPracticeâ is central to
designing an assessment process which is capable of
capturing evidence of an individualâs ability to practice.
ïĄ The first step in designing the assessment process was
accepting a conceptual model for osteopathic
practice.
ïĄ Then developing an analysis / deconstruction of practice
from the perspective of process - rather focussed on
academic knowledge â Osteopathic Capabilities
Framework.
ïĄ Identifying assessment tools to assess the various
components of practice. K S A
37. ïĄ Three year cycle of regional conferences to raise awareness
amongst the profession.
ïĄ Problematising current approaches and sharing an understanding
of the theoretical framework supporting the use of PebblePad
ïĄ Migrating from a p-portfolio to an e-portfolio:
ïĄ Encouraging practitioners to creatively develop and use
PebblePad as a personal learning space.
ïĄ Creating allies and project champions. Identifying potential pilot
sites for trialling professional development/recertification
processes.
38. ïĄ Conventional wisdom of evidence based practice applies
theoretical knowledge to practice.
ïĄ In reflective practice theory and practice are seen as
being reciprocally inter-related.
ïĄ Professional identity / knowledge is complex and is not
merely assembled from discreet knowledge base.
ïĄ Professional knowledge / identity arises from a
synthesis of natural and social sciences
39. 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
40. ï§ OCNZ needs to be realistic
ï§ Broad church
ï§ Freshen up - maintain interest in practise
ï§ Skills acquisition: Cognitive - Associative - Autonomous
- "OK" Plateau - Fitts & Posner
ï§ Honesty & Openness to change / development
41. ïĄ Millerâs pyramid of competence indicates that assessment of âdoesâ
reflects professional authenticity.
ïĄ Whatever one âdoesâ in the assessment must reflect practice in order for
that assessment to be authentic.
ïĄ The portfolioâs purpose is to guide learning and capture evidence
ïĄ Portfolio was the Hoorah word of â90s
ïĄ Evidenced Based Practice âoos
ïĄ e-Portfolio is current Hoorah!
ïĄ Trial the e-Portfolio for the overseas assessment processes
ïĄ Reference Group to look at applications for CPD / Recertification
Processes
42. ïĄ Learning NeedsAnalysis
ïĄ Personal Development Plan
ïĄ Learning Outcome Reports
ïĄ Case based Discussion
ïĄ Critical Incident Report
ïĄ Critiquing journal articles
ïĄ Literature reviews
ïĄ Reflective statements from training courses
43. ïĄ Scope of Practice Reform 2007 - 12
ïĄ Osteopathic Capabilities Framework 2007-09
ïĄ Development of work-based competence assessment
2010
ïĄ PebblePad PreceptorTraining Nov 2013
ïĄ Unitec â Clinical Practicum 2013
ïĄ Trialled for overseas assessment 2013
ïĄ Overseas Assessment Process from Aug 2014
ïĄ Peer GroupTraining Aug / Nov 2014
ïĄ Recertification -Voluntary adoption by registrants 2015
ïĄ Recertification Mandatory 2016