2007 Annual Conference Continuing Competence: An Initiative to Measure and Inform Melanie Brim...

2007 Annual Conference

Continuing Competence: An Initiative to Measure and Inform

Melanie Brim

Michigan Bureau of Health Professions

Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference

PracticeSpecialty

Certification

Licensure

Becoming a Licensed Physician

Medical Education

Residency Training

USMLE Step 1/ COMLEX Level 1



State Medical BoardLCME, AOA, AAMC

ACGME, AOA

ABMS, BOS ACCME

CME

Patients, Payors, Insurers, JCAHO

LicenseRenewal

State Medical Board


Med

ical

Pro

fess

ion

Public/ C

onsumers/

Patients

Social Contract


Public/ C

onsumers/

Patients Social Contract

The

Med

ical

Pro

fess

ion


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


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?


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


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


Five Phases of Scenario Planning

• Gather data

• Assimilate and analyze

• Develop scenarios

• Discuss implications

• Develop action plan


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


Examples of Trends• 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


Summit 1 - Process• Significant events over the last 100 years

• Key factors/driving forces over next 15 years

• Generate scenarios to explore possible futures


Creating Scenarios• Use two most “uncertain” and most

“critical” trends to create scenario matrix

More government

Strong economy

Less government

Weak economy


Physician Accountability for Physician Competence Summits


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


Speaker Contact Information

Melanie BrimDirector, Bureau of Health Professions

Michigan Department of Community Health P.O. Box 30670

Lansing, MI 48909

[email protected]




Stephen G. Clyman, M.D.

National Board of Medical Examiners


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


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


GMP-USA

DocumentationOf Achievement

. .

AssessmentContinuous Improvement

V I R T U A L P O R T F O L I O


Continuous ImprovementAssessment

GMP-USA


. .V I R T U A L P O R T F O L I O


GMP-USA



Trusted Agent

DATA COMPILATION


GMP-USA



DATA COMPILATION

Practitioner

State Medical Board


GMP-USA



DATA COMPILATION


GMP-USA




Practice Audit

LongitudinalObservation

Competency-Format Mapping

ToolClass

GMP-USA





MSFChart Audit


ToolClass

Specific Tool

GMP-USA


Practice Audit



ToolClass

Specific Tool


MSFChart Audit

PracticeSpecificCustomization


GMP-USA


Practice Audit



Practice Audit


MSFChart Audit


Assessment

ToolClass

Specific Tool


GMP-USA




AssessmentContinuous Improvement

ToolClass

Specific Tool


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

GMP-USA





Stephen G. Clyman, M.D. Executive Director, Center for Innovation

National Board of Medical Examiners 3750 Market Street

Philadelphia, PA 19104

[email protected]




David Watt, M.D.

Federation of State Medical Boards


ParticipantsMedical LicensureFederation of State Medical BoardsIowa Board of Medical Examiners

Kentucky Board of Medical LicensureMichigan Bureau of Health Professions

North Carolina Medical Board Oregon Board of Medical Examiners

South Carolina Board of Medical ExaminersVirginia Board of Medicine

Medical EducationAmerican Medical Association – LCME

Association of Academic Health CentersAssociation of American Medical Colleges

Coalition for Physician EnhancementEast Tennessee State UniversityHarvard School of Public Health

Texas A&MUMDNJ School of Osteopathic Medicine

University of Medicine and Dentistry of New JerseyUniversity of Miami School of Medicine

Physician Membership OrganizationsAmerican Academy of Family Physicians

American Medical AssociationAmerican Osteopathic Association

College of Physicians and Surgeons of SaskatchewanCouncil of Medical Specialty Societies

The Medical Society of Virginia

Health Systems and PayorsAmerican Hospital Association

Blue Cross/Blue Shield AssociationBlue Cross/ Blue Shield of Illinois

Catholic Health InitiativesCrozer Keystone Health System

Specialty Certifying BoardsAmerican Board of Family MedicineAmerican Board of Internal Medicine

American Board of Internal Medicine FoundationAmerican Board of Medical Specialties

American Board of SurgeryAmerican Osteopathic Association

American Osteopathic Board of Emergency Medicine

Assessment/Accrediting OrganizationsAccreditation Council for Continuing Medical EducationAccreditation Council for Graduate Medical Education

Clinical Skills Evaluation CollaborationEducational Commission for Foreign Medical Graduates

The Joint CommissionMedical Council of Canada

National Board of Medical ExaminersNational Board of Osteopathic Medical Examiners

Foundations and PublicAARP

Agency for Healthcare Research and QualityBridgekeeper

Citizens Advocacy Center Commonwealth Fund

Consumers UnionMilbank Memorial Fund

National Committee for Quality AssuranceRobert Wood Johnson Foundation

OtherColumbia Law School

Physician Insurers Association of AmericaSanta Fe Institute, Los Alamos National Laboratory

Steege Thomson CommunicationVirginia House of Delegates


Intangible Outcomes• Growing sense of trust • Coalescing around core principles

– Periodic demonstration of competence, practice-based 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


Public/ C

onsumers/

Patients Social Contract

Med

ical

Pro

fess

ion


AM

AP

ublic/ Consum

ers/ P

atients

CMSS

AAMC

AC

GM

E

JCAHOAHA

NBMEEC

FM

G

ABMS

FSM

BA

CC

ME

AB

IM

ACS

SMBs

ACP

CMS

BC/BS

Social Contract


AM

AP

ublic/ Consum

ers/ P

atients

CMSS

AAMC

AC

GM

E

JCAHOAHA

NBMEEC

FM

G

ABMS

FSM

BA

CC

ME

AB

IM

ACS

SMBs

ACP

AARP

CU

PublicVoices

CMS

BC/BS

Social Contract


Public/ C

onsumers/

Patients

Nat

iona

l Alli

ance

for

Phy

sici

an C

ompe

tenc

e

Social Contract


Public/ C

onsumers/

Patients

Nat

iona

l Alli

ance

for

Phy

sici

an C

ompe

tenc

eSocial Contract

Social Contract


Nat

iona

l Alli

ance

for

Phy

sici

an C

ompe

tenc

e Public/ C

onsumers/

Patients

Social Contract

Definition of Competence – Good Medical Practice – USA

Training Level/Specialty Translators

Lifelong Learning Portfolio

Tools/Analyses/Measures


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


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


Next Steps• Summit V – December 6-7, 2007

– Good Medical Practice document– National Alliance– Technology/assessment tools

www.innovationlabs.com/summit



David Watt, M.D. Vice President, Professional Affairs Federation of State Medical Boards

P.O. Box 619850Dallas, TX 75261

[email protected]

2007 Annual Conference Continuing Competence: An Initiative to Measure and Inform Melanie Brim...

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