Transcript Continuing Competence: An Initiative to Measure and Inform

2007 Annual Conference
Continuing Competence: An
Initiative to Measure and Inform
Melanie Brim
Michigan Bureau of Health Professions
Becoming a Licensed Physician
USMLE
Step 1/
COMLEX
Level 1
USMLE
Step 2/
COMLEX
Level 2
Medical
Education
LCME, AOA,
AAMC
Specialty
Certification
ABMS, BOS
USMLE
Step 3/
COMLEX
Level 3
Residency
Training
Licensure
ACGME, AOA
State Medical Board
Practice
Patients, Payors,
Insurers, JCAHO
CME
ACCME
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
License
Renewal
State Medical
Board
Atlanta, Georgia
Social Contract
Medical Profession
Public/ Consumers/
Patients
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Social Contract
Medical Profession
Public/ Consumers/
Patients
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Social Contract
Medical Profession
Public/ Consumers/
Patients
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
The Medical Profession
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Public/ Consumers/
Patients
Social Contract
Atlanta, Georgia
Plan for First Summit
• Position meeting as discussion about how
the “system” will be organized to ensure
physician competence
• Goals
– Get people to “own” problem and take
responsibility
– Begin to break down barriers, biases, hidden
agendas
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
March 2005 Summit
• Scenario planning selected as format
• Invited guests: stakeholders with vested
interest in ensuring physician competence
• Question: How does the healthcare
community evaluate and measure the
ongoing competence of a physician?
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Why Scenario-based Planning?
• Adam Kahane’s Solving Tough Problems
– Future is influenced, not predicted
– Focus on identifying different possible futures
– Move participants beyond individual interests
towards common ground
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Value of Using Scenarios
• Scenarios are useful tools to
– Test assumptions
– Recognize uncertainty
– Widen perspectives
– Allow better understanding about current
dilemmas and conflicts
– Explore strategic questions
– Challenge mental models and develop new
ones
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Five Phases of Scenario Planning
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Gather data
Assimilate and analyze
Develop scenarios
Discuss implications
Develop action plan
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Pre-summit Activities
• Sponsor group selected to shape program
• Attendees interviewed for input on trends
and drivers influencing
– Environment and society
– Healthcare and medicine
– Medical regulation
– Physician competence
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Examples of Trends
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Growing sophistication of patients/public
Globalization of economy/healthcare
Role of government in healthcare
Rapid changes in technology and science
Aging population
Rising costs of healthcare
Spread of internet
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Summit 1 - Process
• Significant events over the last 100 years
• Key factors/driving forces over next 15
years
• Generate scenarios to explore possible
futures
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Creating Scenarios
• Use two most “uncertain” and most
“critical” trends to create scenario matrix
Strong economy
More
government
Less
government
Weak economy
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Physician Accountability for Physician Competence Summits
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
March 2005 Summit -- Outcomes
• Five scenarios describing the US
healthcare system in the year 2020
• Consensus that
– Status quo not acceptable
– Collaboration will be critical
• Agreement to
– Meet again, continue dialogue
– Begin to involve parent organizations
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Speaker Contact Information
Melanie Brim
Director, Bureau of Health Professions
Michigan Department of Community Health
P.O. Box 30670
Lansing, MI 48909
[email protected]
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
2007 Annual Conference
Continuing Competence: An
Initiative to Measure and Inform
Stephen G. Clyman, M.D.
National Board of Medical Examiners
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Evolution of Process
• Three additional summits held to date
• Examined implications of scenarios on
five stakeholder groups
• Explored ways physician competence
could be measured within each scenario
• Considered how regulatory system might
look if critical components were “taken
away”
• Probed how future system “ought” to look
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Tangible Outcomes
• Definition of competence
• Good Medical Practice-USA document
• Preliminary drafts of possible “regulatory
system” of the future
• Proposal for National Alliance for Physician
Competence
• Discussions between licensing and certifying
boards
• Organizational commitments for staff and
financial support
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
GMP-USA
Continuous Improvement
Documentation
Of Achievement
Assessment
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
Assessment
Continuous
Improvement
Documentation
Of Achievement
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
DATA COMPILATION
Trusted Agent
Documentation
Of Achievement
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
Practitioner
DATA COMPILATION
State Medical Board
Documentation
Of Achievement
V Council
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
DATA COMPILATION
Documentation
Of Achievement
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
Documentation
Of Achievement
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
Practice
Audit
Longitudinal
Observation
Competency-Format Mapping
Tool
Class
Documentation
Of Achievement
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
Practice
Audit
Longitudinal
Observation
Competency-Format Mapping
Tool
Class
Specific
Tool
Chart Audit
Documentation
Of Achievement
MSF
V Council
I R Ton U
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Licensure, Enforcement and Regulation
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2007 Annual Conference
.
Atlanta, Georgia
GMP-USA
Practice
Audit
Longitudinal
Observation
Competency-Format Mapping
Tool
Class
Specific
Tool
Chart Audit
MSF
Practice
Specific
Customization
Documentation
Of Achievement
V Council
I R Ton U
A
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Licensure, Enforcement and Regulation
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2007 Annual Conference
.
Atlanta, Georgia
GMP-USA
Competency-Format Mapping
Practice
Audit
Longitudinal
Observation
Chart Audit
Assessment
Tool
Class
Specific
Tool
MSF
Practice
Specific
Customization
Documentation
Of Achievement
V Council
I R Ton U
A
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P
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F
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Licensure, Enforcement and Regulation
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2007 Annual Conference
.
Atlanta, Georgia
GMP-USA
Tool
Class
Specific
Tool
Continuous
Improvement
Assessment
Practice
Specific
Customization
Documentation
Of Achievement
V Council
I R Ton U
A
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
GMP-USA
Attributes of Continuous Improvement/Assessment System
Clarity of purpose - Data for defined purposes, under physician’s control
Cultural readiness-
Non-punitive, culture of trust; transparency
Learner-centricity -
Self actualization, self assessment with mentored guidance
Continuous quality improvement – defined by public health and patient benefit
Communication/coordination - Assessment that reinforces practice improvement
and public accountability
Documentation
Of Achievement
V Council
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Licensure, Enforcement and Regulation
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2007 Annual Conference
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Atlanta, Georgia
Speaker Contact Information
Stephen G. Clyman, M.D.
Executive Director, Center for Innovation
National Board of Medical Examiners
3750 Market Street
Philadelphia, PA 19104
[email protected]
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
2007 Annual Conference
Continuing Competence: An
Initiative to Measure and Inform
David Watt, M.D.
Federation of State Medical Boards
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Medical Licensure
Participants
Federation of State Medical Boards
Iowa Board of Medical Examiners
Kentucky Board of Medical Licensure
Michigan Bureau of Health Professions
North Carolina Medical Board
Oregon Board of Medical Examiners
South Carolina Board of Medical Examiners
Virginia Board of Medicine
Medical Education
American Medical Association – LCME
Association of Academic Health Centers
Association of American Medical Colleges
Coalition for Physician Enhancement
East Tennessee State University
Harvard School of Public Health
Texas A&M
UMDNJ School of Osteopathic Medicine
University of Medicine and Dentistry of New Jersey
University of Miami School of Medicine
Specialty Certifying Boards
American Board of Family Medicine
American Board of Internal Medicine
American Board of Internal Medicine Foundation
American Board of Medical Specialties
American Board of Surgery
American Osteopathic Association
American Osteopathic Board of Emergency Medicine
Assessment/Accrediting Organizations
Accreditation Council for Continuing Medical Education
Accreditation Council for Graduate Medical Education
Clinical Skills Evaluation Collaboration
Educational Commission for Foreign Medical Graduates
The Joint Commission
Medical Council of Canada
National Board of Medical Examiners
National Board of Osteopathic Medical Examiners
Foundations and Public
American Academy of Family Physicians
American Medical Association
American Osteopathic Association
College of Physicians and Surgeons of Saskatchewan
Council of Medical Specialty Societies
The Medical Society of Virginia
AARP
Agency for Healthcare Research and Quality
Bridgekeeper
Citizens Advocacy Center
Commonwealth Fund
Consumers Union
Milbank Memorial Fund
National Committee for Quality Assurance
Robert Wood Johnson Foundation
Health Systems and Payors
Other
American Hospital Association
Blue Cross/Blue Shield Association
Blue Cross/ Blue Shield of Illinois
Catholic Health Initiatives
Crozer Keystone Health System
Columbia Law School
Physician Insurers Association of America
Santa Fe Institute, Los Alamos National Laboratory
Steege Thomson Communication
Virginia House of Delegates
Physician Membership Organizations
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Intangible Outcomes
• Growing sense of trust
• Coalescing around core principles
– Periodic demonstration of competence, practicebased assessment, quality improvement
• Willingness to discuss “taboo” issues
– National licensure, specialty based licensure
• Agreement to “own” initiative
• Agreement that collaboration is critical
• Excitement about the opportunity to shape
future of health care
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Medical Profession
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Public/ Consumers/
Patients
Social Contract
Atlanta, Georgia
AMA
Public/ Consumers/
Patients
Social Contract
ABMS
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
AARP
AMA
Social Contract
Public
Voices
Public/ Consumers/
Patients
CU
ABMS
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
National Alliance for
Physician Competence
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Public/ Consumers/
Patients
Social Contract
Atlanta, Georgia
Social Contract
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Public/ Consumers/
Patients
National Alliance for
Physician Competence
Social Contract
Atlanta, Georgia
Definition of Competence –
Good Medical Practice – USA
Training Level/Specialty
Translators
Public/ Consumers/
Patients
National Alliance for
Physician Competence
Social Contract
Lifelong Learning Portfolio
Tools/Analyses/Measures
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Challenges
• Engaging broader audience
– Practicing physicians
– Public
• Understanding real-life implications to practicing
physicians
• Transparency – public right to information vs.
confidentiality of data collected
• Turf issues
– Organizational
– Practitioners (scope of practice)
• Licensing authorities (state medical boards)
must take the lead
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Future Discussion Topics
• Assessing competence of teams
• Handling of incompetent physicians
• Identifying and addressing gaps and
barriers in the continuum of education,
training and licensure
• Tracking of quality, pay for performance
and measurement initiatives underway
• Outline plan for applying measures to
the GMP-USA document
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Next Steps
• Summit V – December 6-7, 2007
– Good Medical Practice document
– National Alliance
– Technology/assessment tools
www.innovationlabs.com/summit
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia
Speaker Contact Information
David Watt, M.D.
Vice President, Professional Affairs
Federation of State Medical Boards
P.O. Box 619850
Dallas, TX 75261
[email protected]
Council on Licensure, Enforcement and Regulation
2007 Annual Conference
Atlanta, Georgia