Governance of Physicians in a Globalized World Developing a transnational research program for medical regulation

Beginning to build a research-based, global framework for medical regulation Howard Adelman, Griffith U, Brisbane Daniel Klass, CPSO Ontario (David Stern, U Michigan) Who regulates the regulator? Regulation and system safety Entry to PG test Accreditation Entry to practice test ?Accreditation? Accreditation Training component Med school Post grad training Entry training Monitoring, revalidation, CPD, complaints, suits, discipline Public outcomes Accountability of regulatory process • Historical accountability – Notion of retrospective accountability; legislative, due process and appeal based • Context of current accountability crisis – Enron, Shipman, Bristol, CH Winnipeg, Swango, malpractice) • Are there other routes to accountability? – Is it enough just to “do current processes better”? Alternative routes to accountability • External audits or control? Severe threat to principle of professional self regulation • Accreditation model • Evidence based regulation? Measurement and transparent reporting of outcomes of regulatory processes with comparative models. Evidence Based Regulation • Until recently, little measurement of outcomes of regulation by regulatory agencies, criteria of success are adherence to legal procedure; • In parallel, little research to speak of, either locally or internationally. What needs to be known? • Three major dimensions of medical regulation; entry to practice, maintaining quality once in practice, removal from practice. • Each worthy of research, each with measurable outcomes that until now have been left implicit, • proposal is to foster a culture of research to make the outcomes of regulation explicit Some examples • MCC, CPSO, CMQ, McGill University • IPAC/NCAS Study of MD assessment and enhancement programs ( Rosemary Field and Charlotte Humphrey) Does a National Clinical Skills Examination Predict Complaints to Licensing Authorities? • Large scale educational research team, results submitted for publication; (report is not ready for attribution) • McGill U, R Tamblyn • MCC, Dale Dauphinee, David Blackmore • CPSO , Elizabeth Wenghofer, Daniel Klass • CMQ, Andre Jacques Assembling the Study Population and Measuring Predictors Study Population and National Exam Scores National OSCE Exam (1993-1996) 6,677 physicians Practice: Ontario 2,415 physicians Overall Mean Score 523.9 (80.1) Practice: Quebec 1,161 physicians Practice: Other Province 3,101 Overall Mean Score 527.3 (80.6) Overall Mean Score 496.0 (92.4) Communication Score 502.8 (97.8) Communication Score 511.2 (91.9) Communication Score 511.0 (89.5) The Rate of Complaints to the College of Physicians in Ontario and Quebec in Relationship to Communication Score Quartile All Complaints Retained Complaints 7 Number Complaints/ 100 Practice Years 6 5 4 3 2 1 0 Communication Score Study Conclusions • Communication skill scores on the MCC QE2 SP licensure test of clinical ability are strong predictors of patient complaints in subsequent practice Salient Features of Studies • Multiple, complex, cross jurisdictional sources of data • Experienced, devoted researchers and teams • Committed involvement of regulatory or quasi regulatory organizations (data sources) • A funding source Question? • Can regulators adopt a new culture of research and evidence based activity? • Can collaborations of appropriate researchers, regulators and other data sources be organized? • Can sufficient targeted funding be found to support this complex research?