The Royal Australian College of General Practitioners (RACGP) was disappointed to read an article published in Fairfax publications (‘Discredited vaccination claims injected into GP training’ Saturday 25 May) that failed to report key aspects of information provided by the RACGP on this matter.
The provision of education to GPs that uses discredited research and promotes views not in accordance with the latest immunisation guidelines is of great concern to the College, and a quality review of the activity referred to in the article will be conducted.
The College has robust processes in place to ensure all continuous professional development activities provided by accredited providers are in line with the latest evidence-based research.
In the period from 2011 to 2013, there have been 250,000 GP attendances at accredited activities for continuing professional development. During this period, audits have demonstrated extremely high compliance with RACGP standards with breaches being rare.
The RACGP accredits providers that must commit to providing education that is in line with latest evidence based research. Individual providers are responsible for ensuring that their activities meet this standard.
Quality Assurance Assessment is fundamental to the integrity of the QI&CPD Program. Any breaches of the College’s education standards are taken very seriously and acted on immediately. In addition to random audits, if the RACGP receives a complaint or question about any accredited education program, a quality review is automatically triggered, which has occurred in this case.
Dr Liz Marles, RACGP President said "The RACGP’s Quality Improvement and Continuing Professional Development framework delivers a high quality educational program meeting the broad and diverse learning needs of GPs. GPs are involved in both directed and self-directed learning during the three year triennium."
"It is obviously a great concern if an accredited provider uses discredited evidence as part of its course. However the article is misleading in suggesting that this course is mandated education. It is one activity out of an estimated 250,000 GP attendances at accredited activities between 2011-2013."
The RACGP endorses the systematic and effective immunisation of all children and adults against vaccine preventable diseases as recommended by the National Health and Medical Research Council (NHMRC) Australia. The RACGP’s Guidelines for preventive activities in general practice (8th edition) provides immunisation recommendations across the lifespan in line with the Australian Government Department of Health and Ageing's Australian Immunisation Handbook 10thedition.
“We trust medical staff can refer to the above immunisation resource material to guide practice and inform patient choice,” Dr Marles said.
The College’s official statement originally provided to Fairfax media upon being requested to comment is outlined below:
Q1: Does the RACGP believe that this course in particular meets accreditation standards?
The RACGP is undertaking a quality review of the activity at the moment and is unable to comment publicly until the outcome of the review.
Q2: This course www.acnem.info/printing/Primary-final.pdf contains a paediatriccase study of 'temper tantrums', page 167-169, in which part of the management plan for this child includes "delay next immunisations". Does the RACGP consider that this is acceptable training to be provided to GPs?
The RACGP is not commenting in relation to this particular case until the outcome of the review but will state the following.
In general, the RACGP endorses and actively supports immunisation as detailed in the Australian Government, Department of Health and Ageing Australian Immunisation Handbook including the appropriate reasons for delaying immunisation. Temper tantrums are not a recognised reason for delay of immunisations.
Q3: Other concerning claims in the course handbook include: claims to a correlation between thimerosal and autism (page 390), claims to a correlation between the MMR vaccine and autism (page 393-396), claims to a correlation between the MMR vaccine and gastrointestinal disturbances that directly cites Wakefield's discredited and retracted 1998 Lancet article (without mentioning that the article has been discredited and retracted) on page 393. Does the RACGP believe this is acceptable?
The RACGP is not commenting in relating to this particular provider until the outcome of the review.
In general, the RACGP reiterates that there is no demonstrated evidence of any relationship of measles-mumps-rubella vaccine immunisation and autism spectrum disorder. The RACGP acknowledges the issues around the withdrawal of the 1998 Wakefield article in 2010 and states that the use of such an article as supporting evidence subsequent to this date would constitute serious academic misconduct. The RACGP also reiterates there is no evidence supporting any relationship between thiomersal and autism and the MMR vaccine and gastrointestinal disturbances.
Q4: Your statement says that all courses can be audited – will you now be auditing this program?
Yes. When the RACGP receives any complaint or question about any accredited education program, a quality review is automatically immediately initiated. This involves content review and delivery process with respect to RACGP educational standards. As the RACGP has been alerted to this issue, the RACGP is undertaking a quality review of this program.
Q5: It's all well and good to audit programs based on complaints, but how did this program of study ever get accepted in the first place?
There are standards that RACGP accredited providers are expected to maintain and these are regularly randomly audited. Any breaches of these standards are taken very seriously. Random auditing of educational activities is a standard educational industry approach and has been demonstrated as being an effective means of maintaining standards. There have been an estimated 250,000 GP attendances at accredited activities between 2011-2013. During this period audits have demonstrate extremely high compliance with RACGP standards with breaches being rare.
Q6: What specific measures are in place to ensure programs of study certified by the RACGP meet basic levels of evidence-based medicine?
All accredited providers are required to demonstrate the evidence base for all claims in all educational activities. These processes are reviewed during auditing processes.
Q7: Will the RACGP continue to accredit courses from the Australasian College of Nutritional and Environmental Medicine?
The RACGP will make this decision at the end of the review.
In general, if an accredited provide has been found to breach the RACGP standards, educational provider accreditation status can be revoked.