July 2019

Issue 22

Chair’s message
News from the Board
Registration
- Latest registration statistics released
National Scheme news
Keep in touch with the Board

Chair’s message

Welcome to our Winter 2019 newsletter.

It’s been a very busy few months for the Board. I attended the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) conference in Adelaide in March and the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) conference in April, both in Adelaide. The conferences were very energising and it was great to see so many practitioners keeping their knowledge up to date and hearing about future technology and its effect on practice.

The future of practice was a recurring theme and talking of the future, recently the public consultation on revised Professional capabilities for medical radiation practice closed. The Board is working through the feedback, but meanwhile I would like to acknowledge and thank all of those who made a submission to the consultation. My experience is that the result is always better when the minds of many are working on the task.

In other news, there have been changes in Queensland that allow nuclear medicine technologists limited use of scheduled medicines and we hear about the great work that the facilitators are doing with the supervisor training.

We also look at some issues that arise in practice around communication and consent.

Happy reading.

Mark Marcenko
Chair, Medical Radiation Practice Board of Australia

News from the Board

Teaching on the Run – supervisor training

The Board has been offering the Teaching on the Run (TOTR) workshops to help supervisors since 2014. This year we started with our first two training days in Brisbane, and we have followed up with sessions in Sydney and very recently in Melbourne.

The program is presented by registered practitioners who have completed the TOTR facilitation course and have an interest in clinical teaching. We asked Glenn Trainor, one of the senior facilitators, his thoughts about the supervisor training program.

‘The training days are lots of fun. We challenge the participants and take them out of their comfort zone, but after two days all the participants seem ready to get back to their workplaces and start applying the principles of teaching, learning and clinical assessment,’ he said.

Glenn said, ‘The module on microlearning seems to have really hit a chord with most supervisors as they can see just how useful small learning sessions can be in helping a student or supervised practitioner to make progress.’

The aim of the training program is to support supervisors in their workplace clinical teaching roles. The program uses an innovative blended-learning approach that combines face-to-face workshops and eLearning, and covers the following modules:

Clinical supervision
Planning learning
Assessment
Supporting learners
Clinical teaching
Skills teaching
Effective group teaching.

If you would like to find out more or join in the training sessions please visit the Board’s website and go to the Supervisor training section.

Board workshop Brisbane

Board workshop Sydney

Brisbane (top) and Sydney supervisor training workshops

Revised Professional capabilities for medical radiation practice – update

The public consultation on the revised Professional capabilities for medical radiation practice (the professional capabilities) closed on 26 April 2019. Thank you to those who attended the information sessions in Brisbane and Melbourne and to those who joined our webinar.

The Board received a great deal of feedback from the profession, community members and community organisations and organisations representing other health professions and other regulatory bodies.

We will take time to carefully review and balance the feedback to ensure that the revised professional capabilities:

provide a clear and contemporary structure
describe capabilities for the safe use of ultrasound and magnetic resonance imaging
describe capabilities for safe and effective practice in CT for all medical radiation practitioners
provide a complete description for recognising and responding to deteriorating patients, and
highlight the importance of conveying information when urgent or unexpected findings are identified.

We will publish further updates on the Board’s work to finalise the professional capabilities. The updates will include implementation arrangements, proposed information sessions and other material to help practitioners, education providers, employers and the public to understand what the capabilities mean in practice.

Use of scheduled medicines by nuclear medicine technologists in Queensland

In late 2018, the Queensland Health (Drugs and Poisons) Regulation 1996 was amended to provide new authorities for nuclear medicine technologists in relation to the use of scheduled drugs and poisons.

The changes authorise nuclear medicine technologists to:

administer under a clinical protocol schedule 2 and 3 poisons and specified schedule 4 restricted drugs including a histamine H2 receptor antagonist, an angiotensin-converting enzyme inhibitor either alone or in combination with a diuretic, and
administer adrenalin of a strength not more than 0.1%, if administered by a pre-loaded device for the management of anaphylaxis if the nuclear medicine technologist has completed a certified course of training relating to the first aid management of anaphylaxis.

Important note: these changes only apply to nuclear medicine technologists in Queensland. The authorisation does not extend to nuclear medicine technologists in other states and territories at this time. Also, the authorisation only applies to medical radiation practitioners registered in the division of nuclear medicine technologist.

For more information see the fact sheet or visit the Queensland Health website.

Broadening a scope of practice

While the Queensland regulations authorise the use of medicines under protocol, registered practitioners also have professional obligations to meet.

The current Professional capabilities statement requires that practitioners working with medicines ‘apply knowledge of pharmaceuticals relevant to the division of registration’.

If you are using medicines in practice you must:

be aware of the laws that apply to medicines and their use
understand the risks, precautions and contraindications for use, and
follow procedures for checking medications, labelling, dosage and route.

As required by the authorisation, and consistent with the professional capabilities, you must be able to recognise and respond to the deteriorating patient.

The Code of conduct also outlines expectations for practitioners, as follows.

Maintaining a high level of professional competence and conduct is essential for good care. Good practice involves:

recognising and working within the limits of your competence and scope of practice, which may change over time
ensuring that you maintain adequate knowledge and skills to provide safe and effective care, and
when moving into a new area of practice, ensuring that you have sufficient training, and/or qualifications to achieve competency in that area.

Professional indemnity insurance (PII)

If your scope of practice changes, you must consider how this will affect your professional indemnity insurance (PII) arrangements. Regardless of where you work, you need to confirm that your current PII arrangements cover the change in practice. The professional capabilities ensure that the use of medications in practice is part of a medical radiation practitioner’s scope of practice, but it is important that any indemnity policies reflect the use of medications as part of your practice.

Communicating effectively – listening to be heard

In some of the recent complaints the Board has received about registered practitioners, communication between the medical radiation practitioner and the patient was identified as one of the major influences on outcomes.

Most often the complaints described circumstances where the patient was not explicitly aware of the examination or treatment that they were agreeing to undergo. Often the patient had little understanding of what the examination entailed or what they could expect. While in many cases there was evidence that practitioners had attempted to provide relevant information, what the practitioner provided and what the patient comprehended were not always the same.

Medical radiation practitioners, indeed most health professionals, are tremendously busy. They are often trying to do many tasks at once. Unfortunately, one of the things that commonly gives way to the constant pressure of practice is active listening; actually hearing what the patient is saying and then taking the opportunity to address the patient’s questions or concerns.

As most of us know, communication takes a number of different forms. It can be verbal (express or implied) or non-verbal, which can include gestures and facial expressions (body language).

The professional capabilities specify that the medical radiation practitioner must be aware of the patient’s capacity to understand, which may be influenced by their English language skills, health literacy, age, health status or culture. Equally, the practitioner must be aware of the ways in which their own culture and experience affect their interpersonal style.

Communication to gain consent – setting aside the time

Communication in healthcare must flow both ways between practitioner and patient. One of the ethical principles in healthcare is that of autonomy – a person (patient) has the right to determine what is done to their body. It is this principle that gives rise to the obligation on health practitioners to obtain informed consent from the patient. Where an issue arises in terms of consent by a patient, most commonly it’s because the communication between practitioner and patient has not been able to align their respective expectations.

The professional capabilities require medical radiation practitioners to ‘provide relevant information to patient/client and demonstrate appropriate methods to obtain informed consent.’ They also describe what informed consent means. Consent in this setting must be given expressly or explicitly, and while informed consent can be verbal, where there is a higher risk to the patient, the better approach is to record the consent in writing.

In some cases, it may not be possible to obtain consent, or timely consent, due to an emergency or incapacity of the patient. In this case you will need to collaborate with other health practitioners to understand the nature of an implied consent.

We know you are often extremely busy, so it’s important to make time to go through the details of an examination or a procedure with the patient. Setting aside this time allows you to build rapport and trust and to obtain informed consent.

Registration

Latest registration statistics released

The Board has analysed its registration data and produced a number of breakdowns about the registrant community to share with the profession and public. These cover registration statistics by type, place of practice, area of division, age and gender.

The latest report covers the period 1 January-31 March 2019. Some takeaways include:

There are 16,589 registered medical radiation practitioners in Australia, of whom 15,926 have general registration.
There are 428 practitioners with provisional registration, two with limited registration and 223 with non-practising registration.
The registered workforce by gender is 68.1 per cent female and 31.9 per cent male. By division, there are 12,917 diagnostic radiographers, 1,194 nuclear medicine technologists and 2,461 radiation therapists.
Of those with dual registration, 15 are diagnostic radiographers and nuclear medicine technologists and two are diagnostic radiographers and radiation therapists.

For more information, visit our Statistics page.

National Scheme news

Practitioners’ responsibility to support public health programs

Australia’s health regulators have reminded health practitioners about their responsibility to support public health programs, including vaccination.

Regulators have spoken out to support public safety, given mounting concerns about a five-year high in measles cases and an early spike in flu cases this year.

AHPRA and the National Boards for 16 professions have urged more than 740,000 registered health practitioners to take seriously their responsibilities for public health, including by helping patients to be protected from preventable illnesses. AHPRA CEO Martin Fletcher reminded practitioners that supporting public health programs, including vaccination and immunisation, and not promoting anti-vaccination views were regulatory responsibilities.

‘Registered health practitioners have a regulatory responsibility to support patients to understand the evidence-based information available,’ Mr Fletcher said.

National Boards set codes, standards and guidelines, including about protecting and promoting the health of individuals and the community, which they expect registered health practitioners to meet.

‘Practitioners are of course entitled to hold personal beliefs, but they must ensure that they do not contradict or counter public health campaigns, including about the efficacy or safety of public health initiatives,’ he said.

If practitioners do not comply and meet the professional standards set by their National Board, regulators can and do take action.

National Boards and AHPRA have acted to manage risk to the public, in response to a number of concerns raised about practitioners (including medical practitioners, nurses and chiropractors) who have advocated against evidence-based vaccination programs. This has included restricting practitioners’ practice pending further investigation, when there was a serious risk to the public.

Read the media release on the AHPRA website.

WHO launch banner

AHPRA launches WHO Collaborating Centre for Health Workforce Regulation

In April, AHPRA officially launched as a designated World Health Organization (WHO) Collaborating Centre for Health Workforce Regulation in the Western Pacific Region.

AHPRA, working in partnership with the National Boards, joins a list of over 800 institutions in more than 80 countries supporting WHO programs in areas such as nursing development, communicable diseases, mental health, chronic diseases and health technologies.

Strengthening the regulation of the health workforce is an important part of the WHO’s global strategy to build the human resources needed for access to safe and quality healthcare across the world.

AHPRA and National Boards are excited by the opportunity to share expertise and promote dialogue that collectively improves the standard of regulatory practice within the WHO Western Pacific Region.

The global health workforce crosses country borders and is mobile, including in Australia where thousands of overseas-qualified practitioners are registered and take up practice here. It’s important that regulators from different countries work together to set the standards for practitioner education, competence and conduct necessary for the global health workforce to deliver safe and reliable healthcare.

As a WHO collaborating centre AHPRA will:

help the WHO in providing technical support to strengthen health workforce regulatory systems in member states
support the WHO in promoting the adoption of contemporary regulatory approaches to health workforce regulation, and
strengthen the capacity, skills and knowledge of regulators in member states under the WHO’s guidance.

Read more about the collaboration on the AHPRA website.

Tackling the fear of notifications – one practitioner’s experience

Earlier this year, AHPRA launched a series of videos to support the public and registered health practitioners as they go through the notification process.

The video series, called ‘Let’s talk about it’, explains what happens when concerns are raised with the regulator, gives easy-to-follow information about the notifications process and addresses common questions, so consumers and health practitioners know what to expect when they interact with AHPRA and National Boards.

A new video has just been added to the series, to help tackle the fear of notifications: A notification was made about me: A practitioner’s experience.

This unscripted video is an honest, first-hand account of a health practitioner’s experience of what it is like to be the subject of a notification to AHPRA. The medical practitioner featured agreed to participate to share her experience and reflections with other practitioners in her situation. In particular, she reflects that she wishes she had reached out for help sooner.

Getting support early is important for any practitioner going through the notifications process, as many practitioners tell us that the notification process is very stressful. A good support network is essential.

There are now four videos:

A notification has been made about me features five health practitioners who work within the National Scheme and is directed at health practitioners who have had a notification made about them.
A notification was made about me: A practitioner’s experience is a first-person account from a practitioner who had a notification made about her.
I have a concern, am I in the right place? is targeted at members of the public who have a concern but aren’t yet sure whether AHPRA is the right place in which to raise it.
I have raised a concern with AHPRA provides information for people who have just raised a concern with AHPRA.

The videos sit alongside other written resources available on our website, including information about understanding the notifications experience. See: www.ahpra.gov.au/Notifications.

You can view the videos on the AHPRA and National Board websites or from our YouTube and Vimeo channel, and join the conversation by following AHPRA on Facebook, Twitter or LinkedIn, use the hashtag #letstalkaboutit and tag @AHPRA.

Notifications video series Practitioner notification video

Fake practitioners face jail and hefty fines as new regulatory powers come into force

From 1 July, the law is getting tougher on people who pretend to be a registered health practitioner. The penalties for anyone prosecuted by AHPRA under the National Law for these offences now include bigger fines and the prospect of prison time.

AHPRA CEO Martin Fletcher said the strengthened sanctions better protect the public.

‘All health ministers recognise that penalties need to be tougher for serious cases. When someone pretends to be a registered health practitioner, they pose a significant risk to the public.

‘We don’t hesitate to act when someone is pretending to be a registered practitioner. If you claim to be registered when you’re not, you will face serious consequences when you are caught,’ said Mr Fletcher.

Since 2014, AHPRA has successfully prosecuted more than 50 cases where people were falsely claiming to be registered practitioners.

Mr Raffaele Di Paolo was successfully prosecuted in two state courts (Victoria and Queensland) for offences under the National Law, including holding himself out as a medical practitioner and specialist health practitioner, when he was in fact a homeopath. He was fined more than $28,000 in Queensland and in Victoria he was sentenced to nine years and six months in jail.

Another high-profile case involved the successful 2017 prosecution of Mr Shyam Acharya, who claimed to be UK-based doctor Dr Sarang Chitale. Mr Acharya was convicted in a NSW Local Court and fined $30,000, and was ordered to pay AHPRA’s legal costs of $22,000.

Other prosecutions have included people pretending to be nurses, physiotherapists, psychologists, dentists and pharmacists.

Fake practitioners betray the trust that patients place in them. The amendments mean that offenders will face the possibility of a maximum term of three years’ imprisonment per offence. They also face an increase in the maximum fines from $30,000 to $60,000 per offence for an individual and from $60,000 to $120,000 per offence for a corporate entity.

The public can check the online register of practitioners to make sure they are seeing a registered practitioner. The register assures patients that the practitioner is qualified and must meet national standards.

Summary of the new laws

The amendments were passed in February 2019 by the Queensland Parliament under the Health Practitioner Regulation National Law and Other Legislation Amendment Act 2019 (Qld) (the Act).
The new offence provisions will apply in all states and territories, except Western Australia. The amendments to offence provisions do not apply to advertising offences under the National Law.
Under the National Law, anyone who calls themselves any of the ‘protected titles’, such as ‘chiropractor’, ‘medical practitioner’ or ‘psychologist’, must be registered with the corresponding National Board.
It is an offence to use one of the protected titles, and it is also an offence to knowingly or recklessly claim to be a registered practitioner when you’re not or use symbols or language that may lead a reasonable person to believe that an individual is a registered health practitioner or is qualified to practise in a health profession. These offences are known as ‘holding out’.

Keep in touch with the Board

Visit www.medicalradiationpracticeboard.gov.au for the mandatory registration standards, codes, guidelines and FAQ.
Visiting the website regularly is the best way to stay in touch with news and updates from the Board.
Lodge an enquiry form via the website by following the Enquiries link on every web page under Contact us.
For registration enquiries, call 1300 419 495 (from within Australia) or +61 3 9275 9009 (for overseas callers).
To update your contact details for important registration renewal emails and other Board updates, go to the AHPRA website: Update contact details.
Address mail correspondence to: Mark Marcenko, Chair, Medical Radiation Practice Board of Australia, GPO Box 9958, Melbourne, VIC 3001.