March 2022

• Chair’s message 
• Medical Board of Australia news
  • Update on changes to CPD
    • Extra time for doctors if they don’t have a CPD home by 1 January 2023
  • Acupuncture endorsement 
    • Minor changes coming in July 2022 for acupuncture endorsement
  • Lessons learned
    • From the Medical Board committee that deals with complaints about sexual boundaries – physical examinations
  • Accreditation
    • Providing high quality education and training
  • Consultation
    • Have your say: Independent cosmetic surgery review consulting now
• News and alerts
  • Temporary acceptance of additional English language tests effective 21 February 2022
  • On the pandemic response sub-register? You can extend your temporary registration now
  • Supervised practice framework now in place
  • New podcasts – eliminating family violence, and improving workplace culture for patient safety
  • Media statement – Doctor convicted for practising while suspended
• Medical regulation at work
  • Latest tribunal decisions published 
• Contacting the Board

Chair’s message 

There’s a great opportunity for anyone interested in the many challenging issues around cosmetic surgery to share their insights. Independent reviewer, former Queensland Health Ombudsman Andrew Brown, is calling for feedback in a public consultation open now. He’s keen to learn from people with lived experience on all sides of the sector, to understand issues and challenges and barriers to reporting when things go wrong. The Medical Board of Australia and Ahpra commissioned the review to make sure regulation keeps pace with this multimillion-dollar entrepreneurial industry. I encourage you to share your perspective.

Dr Anne Tonkin
Chair, Medical Board of Australia

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Medical Board of Australia news

Update on changes to CPD

Extra time for doctors if they don’t have a CPD home by 1 January 2023 

The new CPD registration standard 

The new CPD registration standard requires doctors to :

• complete a minimum of 50 hours of CPD per year relevant to their scope of practice, including:
  • at least 12.5 hours of educational activities
  • at least 25 hours of performance review and measuring outcomes activities (at least five hours of each)
  • the remaining 12.5 hours and any additional CPD above the minimum 50 hours distributed across any type of CPD
• have a CPD home and participate in its CPD program
• base their CPD on a personal professional development plan.

Changes to CPD are detailed in a revised Medical Board CPD registration standard, which takes effect on 1 January 2023. 

When do doctors have to meet the new standard? 

To meet the new standard, each doctor (other than those who are exempt) needs to have a CPD home. The CPD homes will be accredited by the AMC and approved by the Medical Board. The AMC will progressively accredit CPD homes throughout 2022 and 2023.

Specialist college CPD programs are well developed and already assessed by the AMC as part of their specialist education accreditation.

The AMC will work with specialist colleges to transition them from having accredited CPD programs to being accredited as a CPD home. This is expected to occur in 2022, in time for a 2023 start.

However, some CPD homes will be assessed in 2023. Therefore, not all doctors will be able to meet the standard from 1 January 2023.

If you have a CPD home on 1 January 2023 

Doctors who have a CPD home from 1 January 2023, such as a specialist college or another approved CPD home, will need to meet the requirements of the relevant CPD home.

Any practitioner holding specialist registration will need to meet the high-level requirements of the relevant specialist college. This applies whether or not the specialist college is their CPD home.

If you don’t have a CPD home on 1 January 2023 

Doctors are encouraged to join an approved CPD home relevant to their specialty or scope of practice and meet the new CPD standard as soon as possible. However, if they cannot join a CPD home in 2023, particularly if a relevant or appropriate CPD home has not been approved yet, they must meet the requirements of the 2016 CPD registration standard during 2023.

All doctors (except for those exempt) will need to participate in the CPD program of an approved CPD home from 1 January 2024.

What about interns and PGY2 doctors? 

Interns and PGY2 doctors in an approved program do not need to have a CPD home. In 2023, they will need to participate in the supervised training and education programs associated with their position.

Who is exempt from meeting the registration standard? 

• Medical students.
• Interns in accredited intern training programs and doctors in postgraduate year 2 positions who are participating in a structured program that leads to a certificate of completion.
• Medical practitioners who have limited registration in the public interest or limited registration for teaching or research (to demonstrate a procedure or participate in a workshop) and who have been granted registration for no more than four weeks.
• Medical practitioners who are granted an exemption or variation from this standard by their CPD home in relation to continuous absence from practice of at least six months and up to and including 12 months for parental or carer leave, serious illness or other approved circumstances.
• Medical practitioners with non-practising registration.

Consultation on the criteria for CPD homes

The AMC will progressively accredit CPD homes – both existing specialist colleges and new providers - throughout 2022 and 2023. The AMC will work with specialist colleges to transition them from having accredited CPD programs to being accredited as a CPD home.

The AMC will soon consult on draft criteria for accrediting CPD homes and invites feedback on the draft criteria. Consultation will begin in April 2022.

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Acupuncture endorsement

Minor changes coming in July 2022 for acupuncture endorsements 

If you have an approved acupuncture qualification, the Board’s revised registration standard for Endorsement of registration for acupuncture for registered medical practitioners is relevant to you. Minor changes to the registration standard apply from 1 July 2022. The changes make current requirements clearer and remove outdated information and include:

• alignment with the Board’s CPD registration standard
• removal of expired transitional arrangements
• a provision to grant endorsement to doctors who were previously endorsed under transitional arrangements, provided they meet recency of practice requirements.

Health Ministers approved the revised registration standard late last year, after public consultation. It’s published on the Registration standards page of the Board’s website.

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Lessons learned

From the Medical Board committee that deals with complaints about sexual boundaries – physical examinations

The Medical Board regularly receives complaints from patients about physical examinations. Patients often report that they felt uncomfortable about the way a physical examination was carried out and sometimes believe it was sexually motivated. We have noticed that this is often in the context of skin checks, respiratory examinations and breast examinations.

Skin checks

A common complaint in relation to skin checks is that practitioners touch and/or examine intimate areas without clearly communicating with patients.

Experienced practitioners or practitioners who work exclusively in this area can work quickly and methodically but may fail to inform the patient about what they are doing and why they are doing it. 

Respiratory examinations

Complaints about respiratory examinations are often from female patients who are asked to remove their shirt and/or bra so the doctor can listen to their lungs. If it is necessary for them to remove clothing, it is important to explain the reasons for this and gain their consent.

Breast examinations

We also receive complaints from patients who feel that they were touched or groped inappropriately during a breast examination.

These seemingly routine physical examinations can cause great distress to patients who may misunderstand the motivation for the examination. Such misunderstanding can undermine trust in the medical profession and can result in a notification to the Board.

Physical examinations

Physical examinations are an important part of the medical consultation. They can provide valuable information to assist in diagnosis. However, they must be clinically indicated and performed after obtaining the patient’s informed consent. A common complaint in these matters is practitioners touching and or examining intimate areas without clearly communicating with patients beforehand.

The Board’s Guidelines: Sexual boundaries in the doctor-patient relationship includes the following guidance.

Before conducting a physical examination, good medical practice involves:

• explaining to the patient why the examination is necessary, what it involves and providing an opportunity for them to ask questions or to refuse the examination
• obtaining the patient’s informed consent
• obtaining the patient’s permission if medical students or anyone else is to be present during an examination or consultation
• assessing whether a patient who is a child or young person or who is impaired is capable of giving informed consent and if they are not capable, seeking consent from their substitute decision-maker
• allowing the patient to undress and dress in private. A doctor should not assist a patient to undress or dress unless the patient is having difficulty and asks for assistance
• allowing a patient to bring a support person who may be a parent, carer, guardian, spouse, family member or friend.

When conducting a physical examination, good medical practice involves:

• being aware of any verbal or non-verbal sign that the patient has withdrawn consent
• not continuing with an examination when consent is uncertain, has been refused or has been withdrawn
• providing suitable covering during an examination so that the patient is covered as much as possible, to maintain their dignity
• using gloves when examining genitals or conducting internal examinations
  Note: Gloves may not be necessary when conducting external examinations of neonates, infants and young children. When conducting external examinations of these patients, doctors are expected to follow the accepted standards of practice described by accredited specialist medical colleges and expected by their peers. They must also follow accepted standards of hygiene and infection control.
• not allowing the patient to remain undressed for any longer than is needed for the examination.

There is also guidance in the Code of conduct on effective communication (section 4.3) and informed consent (section 4.5).

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Accreditation

Providing high quality education and training

The Medical Board of Australia has approved the following:

Specialist medical college program of study

Medical school program of study

Intern training accreditation authority

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Consultation

Have your say: Independent cosmetic surgery review consulting now

If you practise cosmetic surgery or you pick up the pieces when things go wrong, now is the time to share your ideas.

The public consultation for the Independent review of the regulation of health practitioners in cosmetic surgery is open.

Former Queensland Health Ombudsman Andrew Brown is leading the review, supported by an expert panel.

Ahpra and the Medical Board of Australia commissioned the review, which is keen to learn about any barriers to consumers, practitioners or their employees raising concerns about unsafe practice or unsatisfactory outcomes.

It is also examining how Ahpra and the Medical Board can best manage concerns when they are raised, and what information would help consumers make informed decisions.

The consultation paper, including consultation questions, is available on the Independent review page on the Ahpra website.

You can email your submission, marked 'Submission to the independent review on cosmetic surgery', to CSReview@ahpra.gov.au.

There is also an anonymous survey for consumers to easily share their cosmetic surgery experiences.

The consultation ends on 14 April 2022. The Independent Reviewer expects to report his findings by mid-2022.

More information, including FAQs, is on the review website.

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News and alerts

Temporary acceptance of additional English language tests effective 21 February 2022

COVID-19 pandemic lockdowns have disrupted many English language tests and made it difficult for some applicants to use the English language test pathway to meet the Medical Board’s English language skills registration standard.

In response, the Medical Board and other National Boards have adopted a temporary policy. From 21 February 2022, the following English language tests are being accepted:

• the OET computer-based test and the OET@home test for applications received until 21 February 2023, and
• the TOEFL iBT® Home Edition for applications received until 1 June 2022.

All other requirements set out in the Board’s English language skills registration standard still apply. There are no changes to any other requirements in the standard, including minimum test scores.

All National Boards are currently reviewing their English language registration standards and will consult widely on any proposed changes.

The use of remote proctoring for English language tests for registration is relatively new, even though this is widely used in education settings. Boards will consider these additional test modes in their review and will look at the approaches of other similar regulators, available evidence, and the details of the security arrangements in place.

The Medical Board’s English language skills registration standard is on the Registration standards webpage.

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On the pandemic response sub-register? You can extend your temporary registration now

If you’re on the 2020 pandemic response sub-register, you can opt in to extend your temporary registration before it expires.

We recognise that our health system still needs help dealing with increased healthcare demands and workforce challenges from the COVID-19 pandemic.

We are contacting medical practitioners on the 2020 sub-register before their temporary registration expires on 5 April 2022. There are options to stay registered, which will take effect from 6 April 2022.

5 April deadline

To stay on the sub-register, you must tell Ahpra by midnight on 5 April 2022 if you want to:

• opt in so your temporary registration is extended to expire at midnight on 21 September 2022, or
• formally apply for registration on the main register using a transition pathway.

Look out for an email from Ahpra explaining what to do to stay registered on the pandemic response sub-register or apply to transition to the main register.

Or you can do nothing and let your registration expire. Your name will be removed from the 2020 sub-register on 6 April 2022 and you will no longer be able to practise.

If you opt in

If you choose to opt in to extend your temporary registration on the pandemic response sub-register, you will be registered to practise to the full scope of your registration from 6 April 2022.

If you choose the transition pathway

If you choose to transition from the temporary 2020 sub-register to the main register you can keep practising from 6 April 2022, but only if you formally apply using the transition pathway, before midnight on 5 April.

Your registration will continue to be limited to practise for the COVID-19 response until you are advised about the outcome of your application. When your registration has transitioned to the main register and your registration details have been updated, you can practise to the full scope of your registration (subject to any notations).

If you do nothing

From 6 April 2022 you will no longer be registered to practise and will need to apply for registration on the main register through the standard process.

If you had non-practising registration before you were on the 2020 pandemic response sub-register, you will automatically return to non-practising registration on the main register on 6 April 2022.

Need more information?

More information is included in a news item on the Board’s website.

If you are on the 2020 pandemic response sub-register and did not receive an email from Ahpra, contact pandemicregister@ahpra.gov.au.

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Supervised practice framework now in place

Reminder: The Supervised practice framework (the framework) is now in place – but it doesn’t apply to all medical practitioners who require supervision.

The framework does not apply to:

• international medical graduates with limited or provisional registration
• interns with provisional registration, or
• vocational (specialist) trainees.

Supervision requirements for these medical practitioners have not changed.

The framework applies to medical practitioners when supervision relates to eligibility or suitability for registration. For example, when doctors are returning to practice after a prolonged absence or when a doctor is required to complete a period of supervised practice after a complaint.

The framework and additional information can be found on the Board’s Supervised practice framework page and in the news item.

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New podcasts – eliminating family violence, and improving workplace culture for patient safety

Ahpra releases fortnightly episodes of the Taking care podcast, discussing current topics and the latest issues affecting safe healthcare in Australia. You can access these on the Ahpra website or listen and subscribe on Spotify, Apple Podcasts and by searching ‘Taking care’ in your podcast player. New episodes include:

Health practitioners’ role in eliminating family violence – a survivor’s story

The first episode of Taking care for 2022 is a powerful and honest conversation about family violence and the role of health practitioners in helping survivors. It features survivor Emma*; Professor Kelsey Hegarty, an academic GP who helps train practitioners in responding to family violence; and Dr Anne Tonkin, Chair of the Medical Board of Australia.

*not her real name

Tackling the blame culture to improve patient safety – is it possible?

In this episode we explore workplace culture in healthcare through a safety lens. What is the best approach to support a practitioner’s professional practice to ensure patient safety? How do we regulate when honest errors occur in a workplace environment? It features Adjunct Professor Debora Picone, CEO of the Australian Commission on Safety and Quality in Health Care; Andrea Sutcliffe CBE, CEO and Registrar of the Nursing and Midwifery Council (UK); and Martin Fletcher, CEO of Ahpra.

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Media statement – Doctor convicted for practising while suspended

Ahpra published this media statement this month:

Doctor convicted for practising while suspended – A magistrate convicted a Melbourne doctor who practised while suspended and obstructed an Ahpra investigation, after Ahpra laid charges.

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Medical regulation at work

Latest tribunal decisions published 

There are important lessons in tribunal decisions about registered medical practitioners. The Medical Board of Australia refers the most serious concerns about medical practitioners to tribunals in each state and territory. These decisions were published recently:

• inappropriate practice under the Health Insurance Act 1973 (Cth), failing to keep adequate clinical records and providing substandard patient care led the Victorian Civil and Administrative Tribunal to reprimand a GP and put conditions on his registration (Medical Board of Australia v Jigua)
• exploiting vulnerable patients by prescribing them drugs of dependence for his own use led the Victorian Civil and Administrative Tribunal to reprimand a GP and disqualify him from applying for registration until 2026 (Medical Board of Australia v Miller)
• breaching supervision conditions, practising without professional indemnity insurance and providing false information led the State Administrative Tribunal in Western Australia to reprimand and suspend a GP (Medical Board of Australia v Pepulani).

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Publication of panel, court and tribunal decisions 

Ahpra, on behalf of the 15 National Boards, publishes a record of panel, court and tribunal decisions about registered health practitioners. 

When investigating a notification, the Board may refer a medical practitioner to a health panel hearing, or a performance and professional standards panel hearing. Under the National Law, panel hearings are not open to the public. Ahpra publishes a record of panel hearing decisions made since July 2010. Practitioners’ names are not published, consistent with the National Law. 

Summaries of tribunal and court cases are published on the Court and tribunal decisions page of the Ahpra website. The Board and Ahpra sometimes choose not to publish summaries, for example about cases involving practitioners with impairment.

In New South Wales and Queensland, different arrangements are in place. More information is available on Ahpra’s website on the Concerned about a health practitioner? page.

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Contacting the Board

• The Medical Board of Australia and Ahpra can be contacted by phone on 1300 419 495.
• For more information, see the Medical Board of Australia website and the Ahpra website.
• Lodge an enquiry form through the website under Contact us at the bottom of every web page.
• Mail correspondence can be addressed to: Dr Anne Tonkin, Chair, Medical Board of Australia, GPO Box 9958, Melbourne, VIC 3001.

More information

Please note: Practitioners are responsible for keeping up to date with the Board’s expectations about their professional obligations. The Board publishes standards, codes and guidelines as well as alerts in its newsletter. If you unsubscribe from this newsletter you are still required to keep up to date with information published on the Board’s website.

Comment on the Board newsletter is welcome and should be sent to newsletters@ahpra.gov.au.

For registration enquiries or contact detail changes, call the Ahpra customer service team on 1300 419 495 (from within Australia).

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