Minutes from Meeting One of the Plastic Surgery Expert Panel on Clinical Privileges

Meeting held WednesdayApril 3, 2013 at the College of Physicians and Surgeons

In attendance: Stan Valnicek, Chris Taylor, Mark Hill, Doug Courtemanche, Adrian Lee, Chris Vuksic, Emma Bloch-Hansen

Regrets:KristianMalpass, Richard Warren, Nick Carr,

The meeting was called to order at 0900 hours.

  1. Welcome, Introductions, Review of Agenda
  1. Terms of Reference, Meeting Norms, Check In

The Panel reviewed the Expert Panel Terms of Reference and agreed to meeting norms.

During the check-in the following surfaced:

  • Value in province wide standards
  • Hope this will align with community needs
  • Fear what this will mean in terms of call and for those focusing in cosmetics who haven’t done hand in years
  • A privileging is about getting something and giving something
  • What is a plastic surgeon
  • Nervous about the HA expansion of scope, sensitive to need of physicians, has to be balance
  • Overlap with other disciplines will have to be addressed
  • Fear this will add another layer of bureaucracy, realize this is necessary but need to keep it simple and practical
  • Fear this will tell physicians to do what they are not comfortable doing or let they them get out of doing what they can’t or don’t want to do
  • Current system does not add value, not sure how we will use, monitor and implement a new system
  • Concern surgeons will cross activities off which could create an issue for the community
  • Competencies for training will change by 2020
  • Concerns for limiting practice vs. doing things one is not competent doing
  • Concerns for licensing practices and private practice in non-hospital settings
  1. Project Overview

A video recording of the project lead, Jon Slater, providing an overview of the project with reference to the Cochrane Report was viewed.

The Panel was provided with a document covering key information which was discussed.Reference was made to Project Blog which will be used to share information and capture feedback

  1. Privileging Dictionary –Example Nephrology

The privileging dictionary developed by the Expert Panel for Nephrology was presented so the panel could ‘see’ the task ahead.

The work breakdown structure was reviewed to highlight the goals of each meeting and the expectation for panel members to engage the broader community of Plastic Surgeons in the province.

  1. HCPRO Dictionary

The Panel then started workon the dictionary for Plastic Surgery with the following direction:

  • Perfect will be the enemy of good
  • Working diagnosis not final
  • Think of collegial conversation regarding what is required

Description:

  • Royal College revising to evolve. Rick Warren has updated vision in draft that we can use.
  • Five paragraphs long, decided to be brief, and include more detail in core privilege section
  • Removed second sentence re Greek terminology

Next paragraph change from training to practice; highlights collaborative relationships.

Qualifications

  • Discussed and adapted from Nephrology then added to draft
  • Questions arose regarding organization name arose
  • At what level
  • Name impartial and informed
  • Who is involved in decision, does it include department, division head who is a plastic surgeon

Core Privileges

  • Decided paragraph fine as is
  • Unintentional consequences seem not to pose risk

Core Privilege List

The following points were discussed:

  • Neoplasms to be discussed with colleagues
  • Add diagnostic and labraratoy test
  • Mastectomy for benign disease including gynecomastia
  • Cleft – context
  • Craniofacial surgery, Skull base surgery – Not core
  • Clarification for tumours of the head and neck too much grey zone removed will move to non-core
  • After discussion leave as surgery or the hand, and extremities
  • Remove hand wounds
  • Tendon injuries on par not category
  • Remove carpal tunnel, add peripheral nerve surgery
  • Remove grafts, flaps to non-core, - leave microvascular tissue transfer
  • Replantation and revascularization
  • Add skeletal reconstruction
  • Remove to non-core
  • Replant necessary in residency program, only done in four sites, review in context
  • Reconstruction of peripheral nerve injury - delayed brachial plexus included in non-core
  • Gender reassignment to non-core – phsyco-social element
  • Decubitus ulcers added
  • Add complex soft tissue defects
  • Treatment of soft tissue infections
  • Add autologous fat grafting alloplastic implants of tissue fillers – not common
  • Tissues expanders
  • Body contouring instead of body and facial
  • Change heading from cosmetic to aesthetic
  • Liposuction remove laser, UAL, Pal, resident coming out of residency could not do Laser
  • Endoscopic plastic surgery
  • Add surgical pigmentation done in residency
  • Concern raised for locums or others in call programs who cross off privilege lists which could create gaps and pressure on others
  • If hand fracture core astric non-core
  1. Check Out
  • Demystified process
  • Done with not to
  1. Next Steps
  • Chris and Emma to forward dictionary and minutes to Panel and Jon
  • Jon will post to blog
  • Panel members to discuss with colleagues.

Meeting adjourned at 1250 hours