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
USMLE Step 2/ COMLEX Level 2
USMLE Step 3/ COMLEX Level 3
State Medical BoardLCME, AOA, AAMC
ACGME, AOA
ABMS, BOS ACCME
CME
Patients, Payors, Insurers, JCAHO
LicenseRenewal
State Medical Board
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Med
ical
Pro
fess
ion
Public/ C
onsumers/
Patients
Social Contract
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Med
ical
Pro
fess
ion
Public/ C
onsumers/
Patients
Social Contract
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Med
ical
Pro
fess
ion
Public/ C
onsumers/
Patients
Social Contract
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Public/ C
onsumers/
Patients Social Contract
The
Med
ical
Pro
fess
ion
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
Five Phases of Scenario Planning
• Gather data
• Assimilate and analyze
• Develop scenarios
• Discuss implications
• Develop action plan
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
Creating Scenarios• Use two most “uncertain” and most
“critical” trends to create scenario matrix
More government
Strong economy
Less government
Weak economy
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Physician Accountability for Physician Competence Summits
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
Speaker Contact Information
Melanie BrimDirector, Bureau of Health Professions
Michigan Department of Community Health P.O. Box 30670
Lansing, MI 48909
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
GMP-USA
DocumentationOf Achievement
. .
AssessmentContinuous Improvement
V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Continuous ImprovementAssessment
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Trusted Agent
DATA COMPILATION
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
DATA COMPILATION
Practitioner
State Medical Board
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
DATA COMPILATION
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Practice Audit
LongitudinalObservation
Competency-Format Mapping
ToolClass
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
LongitudinalObservation
MSFChart Audit
Competency-Format Mapping
ToolClass
Specific Tool
GMP-USA
DocumentationOf Achievement
Practice Audit
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
ToolClass
Specific Tool
LongitudinalObservation
MSFChart Audit
PracticeSpecificCustomization
Competency-Format Mapping
GMP-USA
DocumentationOf Achievement
Practice Audit
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Practice Audit
LongitudinalObservation
MSFChart Audit
Competency-Format Mapping
Assessment
ToolClass
Specific Tool
PracticeSpecificCustomization
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
AssessmentContinuous Improvement
ToolClass
Specific Tool
PracticeSpecificCustomization
GMP-USA
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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
DocumentationOf Achievement
. .V I R T U A L P O R T F O L I O
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Speaker Contact Information
Stephen G. Clyman, M.D. Executive Director, Center for Innovation
National Board of Medical Examiners 3750 Market Street
Philadelphia, PA 19104
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Public/ C
onsumers/
Patients Social Contract
Med
ical
Pro
fess
ion
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Public/ C
onsumers/
Patients
Nat
iona
l Alli
ance
for
Phy
sici
an C
ompe
tenc
e
Social Contract
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
Public/ C
onsumers/
Patients
Nat
iona
l Alli
ance
for
Phy
sici
an C
ompe
tenc
eSocial Contract
Social Contract
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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
Council on Licensure, Enforcement and RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
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 RegulationAtlanta, Georgia2007 Annual Conference
Speaker Contact Information
David Watt, M.D. Vice President, Professional Affairs Federation of State Medical Boards
P.O. Box 619850Dallas, TX 75261