Name: Effective frm / / t / / Initial privileges (initial appintment) Renewal f privileges (reappintment) All new applicants shuld meet the fllwing requirements as apprved by the gverning bdy, effective: December 11, 2014 Applicant: Check the Requested bx fr each privilege requested. Applicants are respnsible fr prducing required dcumentatin fr a prper evaluatin f current skill, current clinical activity, and ther qualificatins and fr reslving any dubts related t qualificatins fr requested privileges. Please prvide this supprting infrmatin separately. [Department/Prgram Head r Leaders/ Chief]: Check the apprpriate bx fr recmmendatin n the last page f this frm and include yur recmmendatin fr any required evaluatin. If recmmended with cnditins r nt recmmended, prvide the cnditin r explanatin n the last page f this frm. Current experience is an estimate f the level f activity belw which a cllegial discussin abut supprt shuld be triggered. It is nt a disqualifier. This discussin shuld be guided nt nly by the expectatins and standards utlined in the dictinary but als by the risks inherent in the privilege being discussed and by similar activities that cntribute t the skill under cnsideratin. This is an pprtunity t reflect with a respected clleague n ne's prfessinal practice and t deliberately plan an apprach t skills maintenance. Other requirements Nte that privileges granted may nly be exercised at the site(s) and/r setting(s) that have sufficient space, equipment, staffing, and ther resurces required t supprt the privilege. This dcument is fcused n defining qualificatins related t cmpetency t exercise clinical privileges. The applicant must als adhere t any additinal rganizatinal, regulatry, r accreditatin requirements that the rganizatin is bligated t meet. Nte: The dictinary will be peridically reviewed t ensure it is reflective f current practices, prcedures and technlgies. 1
Grandparenting: Practitiners hlding privileges prir t implementatin f the dictinary will cntinue t hld thse privileges as lng as they meet current experience and quality requirements. Definitin is the medical specialty primarily cncerned with the health f ppulatins. Its main purpse is disease preventin and cntrl, which is achieved thrugh health prtectin and health prmtin activities. A Public Health and Preventive Medicine specialist mnitrs and assesses the health needs f a ppulatin and develps, implements, and evaluates strategies fr imprving health and well-being thrugh inter-disciplinary and inter-sectral partnerships. Building n fundatinal cmpetencies in clinical medicine and the determinants f health, the specialist demnstrates cmpetencies in public health sciences (e.g. epidemilgy, bistatistics, and surveillance), planning, implementatin and evaluatin f prgrams and plicies, leadership, cllabratin, advcacy, and cmmunicatin. These cmpetencies are applied t a brad range f acute and chrnic health issues affecting a ppulatin, including thse that may be related t ccupatinal and envirnmental expsures. Qualificatins Initial privileges: T be eligible t apply fr privileges in Public Health and Preventive Medicine, the applicant shuld meet ne f the fllwing criteria: Current certificatin in r Cmmunity Medicine by the Ryal Cllege f Physicians and Surgens f Canada OR Recgnitin as a Specialist by the Cllege f Physicians and Surgens f British Clumbia by virtue f credentials earned in anther jurisdictin that are acceptable t bth the Cllege and the gverning bdy f the Health Authrity and its Affiliate(s). OR Designatin as a Medical Health Officer by the Prvincial Health Officer under sectin 71 (1) b in the Public Health Act OR 2
Current practice in, and trained as a family practitiner r specialist with a Master s degree r PhD relevant t public health and preventive medicine AND Required current experience: Practicing as a public health physician within the scpe f privileges requested fr a minimum f 4 mnths per year averaged ver the past 36 mnths, OR Successful cmpletin f a RCPSC (r equivalent) residency r traineeship within the past 12 mnths, OR Successful cmpletin f 6 mnths f supervised Public Health and Preventative Medicine practice. Renewal f privileges: T be eligible t renew privileges in Public Health and Preventive Medicine, the applicant shuld nrmally meet the fllwing criteria: Current demnstrated skill and an adequate vlume f experience (4 mnths per year) with acceptable results, reflective f the scpe f privileges requested, averaged ver the past 36 mnths based n results f nging prfessinal practice evaluatin and utcmes. Demnstrated cmpletin f PHSA s Indigenus Cultural Cmpetency (ICC) training. Return t practice: Thrugh an individualized evaluatin assessed in cnjunctin with UBC Pst-graduate Medical Educatin Training Prgram in PHPM. 3
Cre privileges: Cre privileges are ffered t ALL members in the discipline as lng as the facility can supprt thse activities. Requested Cre privileges reflect the set f skills expected f a recent fellw f specialty training in. While recgnizing that public health physicians may wrk in a variety f settings with emphasis n different privileged activities, the cre privileges shuld reflect the scpe f practice f a Medical Health Officer applying the full scpe f practice. The privileges are independent f prcesses under Sectin 68 f the Public Health Act fr Medical Health Officers. The privileges utline prcesses in the cntent areas f cmmunicable disease cntrl, chrnic disease and injury preventin, mental health, and child and family health; as well as the prcess areas f cnsultatin, mnitring surveillance and assessment, investigatin and mitigatin f risks t human health, plicy, planning and prgram develpment, cmmunicatin, leadership and management, and prfessinal practice. The cre privileges in this specialty include the prcedures n the attached prcedures list and such ther prcedures that are extensins f the same techniques and skills. Cre privileges: Admitting Privileges Requested: Full Admitting Cre prcedures list This is nt intended t be an all-encmpassing prcedures list. It defines the types f activities/prcedures/privileges that the majrity f practitiners in this specialty perfrm at this rganizatin and inherent activities/prcedures/privileges requiring similar skill sets and techniques. T the applicant: If there is a prcedure yu wish t NOT perfrm, then please type int the Cmments field. Ppulatin Health Assessment Cnduct health needs and status assessments Prepare reprts n health status 4
Reprt n the health f ppulatins Cnduct health impact assessments Advise n the health impact f plicy Apply infrmatin technlgy t mnitring and health assessment Undertake knwledge synthesis and translatin activities Health and Disease Surveillance Mnitr trends in health f individuals and families thrughut the lifecycle Mnitr disease and injury trends Mnitr trends in mental health and substance use Develp and mnitr surveillance systems Prvide supprt fr surveillance Interpret surveillance data Undertake public health related research Apply infrmatin technlgy t surveillance Disease and Injury Preventin and Cntrl Prvide clinical preventive medicine cnsultatin Prvide clinical management f sexually transmitted infectins Supprt management f persns with chrnic cmmunicable diseases Prvide cnsultatin and recmmendatins n immunizatin practices Assess and make recmmendatins n adverse events fllwing immunizatin Recmmend actin t reduce disease burden and inequity thrughut the lifecycle including: 5
Prenatal Perinatal and pstnatal Early childhd Schl age Yuth and yung adults Adult ppulatin Senirs Recmmend actin t reduce burden and inequity related t chrnic diseases and injury Recmmend actin t reduce burden f and inequity related t mental illness and harmful substance use Health Prtectin Prvide advice n preventin r management f cmmunicable diseases and infectin cntrl Manage persns at risk fr develpment f disease fllwing expsure t a knwn cmmunicable agent Apply the Public Health Act r ther interventins t prevent transmissin f cmmunicable agents Cntrl and manage health cncerns frm the envirnment r in ccupatinal settings Apply public health legislatin Health Prmtin Partner with Abriginal cmmunities n health and wellness Recmmend actin t prmte health, reduce disease burden and reduce inequities thrughut the lifecycle Recmmend actin in supprt f adptin f healthier behaviurs r reductin in risk Recmmend mental health prmtin activities 6
Prvide cnsultatin and advise n public and ppulatin health prblems and cncerns Develp public health plicy Recmmend healthy public plicies Use media t imprve public health Advcate fr health, reductin in health inequities, and fr marginalized ppulatins Disaster and Emergency Management Manage clusters and utbreaks f cmmunicable disease Undertake cluster investigatins Prvide supprt fr emergency and disaster situatins reflective f BCERMS r equivalent training Supprt planning fr emergency preparedness Leadership and Management Prepare public health plans Prvide public health leadership Apply public health ethics t public and ppulatin health issues Cnduct prgram evaluatin Prvide supprt fr evaluatin and research Represent health authrities n matters related t public health Manage human and financial resurces Prvide versight f delegated public health functins 7
Supervise and educate public health trainees Nn-cre Privileges (See Specific Criteria) Nn-cre privileges are permits fr activities that require further training, experience and demnstrated skill. Nn-cre privileges are requested individually in additin t requesting the cre. Each individual requesting nn-cre privileges shuld meet the specific threshld criteria as utlined. Nn-cre Privileges: Cmmunicable disease cntrl Clinical assessment and pharmaclgical/nn-pharmaclgical management f: Requested HIV Requested Hepatitis C (Hep C) Requested Hepatitis B (Hep B) Requested Tuberculsis (TB) Initial privileges: Physicians seeking privileges t manage a disease specific clinic shall demnstrate adequate training (such as disease specific training r experience apprved by the apprpriate department head). Required current experience: nging CPD relevant t the activity, and n-ging level f experience as determined by the apprpriate department head. Renewal f privileges: nging CPD relevant t the activity. Return t practice: demnstrated retraining cnsistent with initial training fr HIV and Hep C, individual assessment fr Hep B and TB Nn-cre privileges: Licensed prescribing Clinical assessment and pharmaclgical/nn-pharmaclgical management f substance use, bth fr initial treatment and fr maintenance. (e.g. Methadne management f chrnic piid misuse). Requested Methadne 8
Requested Buprenrphine/Nalxne Requested Other Initial privileges required: Exemptin frm Health Canada thrugh the CPSBC t prescribe the requested substance. Renewal f privileges: Exemptin t prescribe methadne and buprenrphine fr pid dependency frm the CPSBC t prescribe requested substance. Nn-cre Privileges: Travel medicine Initial privileges: ISTM CTH certificatin Renewal f privileges: Maintenance f ISTM CTH certificatin Return t practice: Renewal f ISTM CTH certificatin Cntext Specific Privileges Cntext refers t the capacity f a facility t supprt an activity. Cntext specific privileges: Administratin f prcedural sedatin Requested See Hspital Plicy fr Sedatin and Analgesia by Nn-anesthesilgists. 9
Prcess fr requesting privileges nt included in the dictinary Where a member f the medical staff requests a privilege nt included in the cre, nncre r cntext specific privileges fr a discipline, the fllwing prcess will be fllwed. 1. The practitiner will request a Change Request Frm frm the Medical Affairs Office. This will be submitted t the head f department r chief f staff as part f the electrnic applicatin prcess 2. The practitiner will cmplete the privileges sectin f the Change Request Frm and submit with the fllwing infrmatin; the privilege requested, the lcatin within the facility where the privilege wuld be exercised, and the relevant training and experience held by the practitiner in this area. 3. The department head r chief f staff, in cnsultatin with the senir medical administratr and medical administratr respnsible fr the facility, will determine if the requested privilege can be supprted at that site. 4. Where it is deemed apprpriate, the practitiner, the department head r chief f staff and the senir medical administratr will agree n any additinal training required, and a minimum level f activity required t maintain the privilege. The specific minimum number requirement indicating the level f experience needed t demnstrate skill t btain clinical privileges fr the requested prcedure must be evidence-based. Where n supprting literature exists fr a specific number, the criteria are established by the cnsensus f a multidisciplinary grup f practitiners wh d nt have self-interest in creating an artificially high vlume requirement. 5. Any additinal training will be dne in a facility that nrmally trains practitiners in this activity. Exceptins may be granted in circumstances where all that is required is training by a member f the medical staff wh hlds the privilege in questin. 6. On satisfactry cmpletin f training, the department head r chief f staff may recmmend t the gverning bdy thrugh the medical advisry cmmittee that the privilege be granted. The privileging dictinaries n this site (bcmqi.ca) are the fficial versins. They will be reviewed beginning in 2016. In the meantime if yu have any questins r cmments please cntact yur medical administratin ffice r the BC MQI Office by cmpleting the Prvincial Privileging Dictinary Feedback frm. 10
Acknwledgment f Practitiner I have requested nly thse privileges fr which by educatin, training, current experience, and demnstrated perfrmance I am qualified t perfrm and fr which I wish t exercise at the facility I am applying, and I understand that: a. In exercising any clinical privileges granted, I am cnstrained by hspital and medical staff plicies and rules applicable generally and any applicable t the particular situatin. b. Any restrictin n the clinical privileges granted t me is waived in an emergency situatin, and in such situatin my actins are gverned by the applicable sectin f the medical staff bylaws r related dcuments. Signed: Date: Department/Prgram Head r Leaders/Chief s Recmmendatin I have reviewed the requested clinical privileges and supprting dcumentatin fr the abve-named applicant and: Recmmend all requested privileges Recmmend privileges with the fllwing cnditins/mdificatins: D nt recmmend the fllwing requested privileges: Privilege Cnditin/mdificatin/explanatin Ntes: Name f Department / Divisin / Prgram: Name f Medical Leader: Title: Signature: Date: 11