Procedures such as epidural injections, radiofrequency neurotomy and implantation of neuromodulation devices have been part of the pain management repertoire of many practitioners since the 1960s, but defining the appropriate standards for performing them, and articulating how such biomedical interventions sit within a whole-person approach to persistent pain has been a challenging process.
The Faculty of Pain Medicine of ANZCA commenced an ambitious project in 2018 to meet the needs of specialist doctors, patients and healthcare organisations. This year, the FPM Clinical Care Standard (CCS) for Procedures in Pain Medicine was endorsed and released and represents the first such detailed standard of its type that has been produced by a specialty medical college. The CCS details 10 ‘quality statements’ with supporting explanations highlighting what each statement means for consumers, doctors and healthcare organisations.
The next development arising from the CCS is to endorse FPM fellows who conduct their practices to the technical and governance standards set out within it. This can be done by either the Practice Assessment Pathway(PAP) for practitioners who already have training and experience at the standard, or via the Supervised Clinical Experience Pathway (SCEP) for those who have not yet received training up to the required standard.
The SCEP is a novel training pathway that is based on the time-honoured medical apprenticeship model whereby an experienced supervisor passes on knowledge and experience in a workplace setting without assessments such as examinations or assignments. The SCEP is scheduled to commence its pilot phase in early 2021, and the PAP has begun assessing applications for endorsement for the fellows who will be leading the pilot phase. A critical part of the endorsement process is peer assessment and on-site verification of adherence to the CCS which will give the endorsement process the rigor and transparency needed to make it worthy of the trust placed in it by the community and by hospitals.
The core of the SCEP is the curriculum of 21 endorsed procedures which fellows or trainees can select to cover the scope of practice in procedures that they wish to have. The curriculum and assessment is competency-based, so when the supervisor is satisfied that their endorsee has met the required standard for independent practice, this is notified to FPM and endorsement can be provided. A program of continuous assessment against an expected progression trajectory is done using an app-based system that enables dozens of assessment episodes per week to form a comprehensive picture of the journey towards independent practice in procedures. Trainees and fellows of FPM will be able to commence their SCEP at any phase of their career, as the training is workplace-based and runs independently of the FPM Fellowship Training Program. Membership of FPM, whether as a trainee or a fellow, is required for endorsement. By the time the pilot phase is completed the SCEP will be able to be run in sites in Australia, New Zealand, Hong Kong, and Singapore in line with the goal of developing a world-leading standard of training in procedures.
Once endorsed, the continuing professional development (CPD) required to maintain it will reflect sound practice. Endorsed fellows will be expected to maintain regular clinical audits and peer review activities in order to maintain their status. Medical regulators require that CPD be self-directed so the activities available to document ongoing adherence to the CCS are being designed and will be as wide-ranging and flexible as possible.
The forthcoming rollout of the PEP is the next step in FPM meeting its mission of setting standards in training and professionalism in pain medicine. Reducing variation between proceduralists will give consumers peace of mind, and FPM endorsement in due course will provide a visible reassurance that your specialist pain medicine physician is practicing at the highest standard.