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Kennedy G, Jacobs N, Freemark L, Madan S, Chan N, Tran Y, Miller PA. Remediation Programs for Regulated Health Care Professionals: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2022; 42:36-46. [PMID: 34581709 DOI: 10.1097/ceh.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE Clinical competence is essential for providing safe, competent care and is regularly assessed to ensure health care practitioners maintain competence. When deficiencies in competence are identified, practitioners may undergo remediation. However, there is limited evidence regarding the effectiveness of remediation programs. The purpose of this review is to examine the purpose, format, and outcomes of remediation programs for regulated health care practitioners. METHODS All six stages of the scoping review process as recommended by Levac et al were undertaken. A search was conducted within MEDLINE, Embase, CINAHL, ERIC, gray literature databases, and websites of Canadian provincial regulatory bodies. Emails were sent to Registrars of Canadian regulatory bodies to supplement data gathered from their websites. RESULTS A total of 14 programs were identified, primarily for physicians (n = 8). Reasons for remediation varied widely, with some programs identifying multiple reasons for referral such as deficiencies in recordkeeping (n = 7) and clinical skills (n = 6). Most programs (n = 9) were individualized to address specific deficiencies in competence. The process of remediation followed three stages: (1) assessment, (2) active remediation, and (3) reassessment. Most programs (n = 12) reported that remediation was effective in improving competence. CONCLUSIONS Regulatory bodies should consider implementing individualized remediation programs to ensure that clinicians' deficiencies in competence are addressed effectively. Further research is indicated, using reliable and valid outcome measures to assess competence immediately after remediation programs and beyond.
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Affiliation(s)
- Geneva Kennedy
- MSc Physiotherapy Program, School of Rehabilitation Science, McMaster University, Hamilton, Canada
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Mills LM, Boscardin C, Joyce EA, Ten Cate O, O'Sullivan PS. Emotion in remediation: A scoping review of the medical education literature. MEDICAL EDUCATION 2021; 55:1350-1362. [PMID: 34355413 DOI: 10.1111/medu.14605] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Remediation can be crucial and high stakes for medical learners, and experts agree it is often not optimally conducted. Research from other fields indicates that explicit incorporation of emotion improves education because of emotion's documented impacts on learning. Because this could present an important opportunity for improving remediation, we aimed to investigate how the literature on remediation interventions in medical education discusses emotion. METHODS The authors used Arksey and O'Malley's framework to conduct a scoping literature review of records describing remediation interventions in medical education, using PubMed, CINAHL Complete, ERIC, Web of Science and APA PsycInfo databases, including all English-language publications through 1 May 2020 meeting search criteria. They included publications discussing remediation interventions either empirically or theoretically, pertaining to physicians or physician trainees of any level. Two independent reviewers used a standardised data extraction form to report descriptive information; they reviewed included records for the presence of mentions of emotion, described the mentions and analysed results thematically. RESULTS Of 1644 records, 199 met inclusion criteria and were reviewed in full. Of those, 112 (56%) mentioned emotion in some way; others focused solely on cognitive aspects of remediation. The mentions of emotion fell into three themes based on when the emotion was cited as present: during regular coursework or practice, upon referral for remediation and during remediation. One-quarter of records (50) indicated potential intentional incorporation of emotion into remediation programme design, but they were non-specific as to how emotions related to the learning process itself. CONCLUSION Even though emotion is omnipresent in remediation, medical educators frequently do not factor emotion into the design of remediation approaches and rarely explicitly utilise emotion to improve the learning process. Applications from other fields may help medical educators leverage emotion to improve learning in remediation, including strategies to frame and design remediation.
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Affiliation(s)
- Lynnea M Mills
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Christy Boscardin
- Department of Anaesthesia and Perioperative Care and Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Elizabeth A Joyce
- Department of Microbiology and Immunology, University of California, San Francisco, San Francisco, CA, USA
| | - Olle Ten Cate
- Center for Research and Development of Education, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia S O'Sullivan
- Departments of Medicine and Surgery, University of California, San Francisco, San Francisco, CA, USA
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Price T, Wong G, Withers L, Wanner A, Cleland J, Gale T, Prescott-Clements L, Archer J, Bryce M, Brennan N. Optimising the delivery of remediation programmes for doctors: A realist review. MEDICAL EDUCATION 2021; 55:995-1010. [PMID: 33772829 DOI: 10.1111/medu.14528] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 05/15/2023]
Abstract
CONTEXT Medical underperformance puts patient safety at risk. Remediation, the process that seeks to 'remedy' underperformance and return a doctor to safe practice, is therefore a crucially important area of medical education. However, although remediation is used in health care systems globally, there is limited evidence for the particular models or strategies employed. The purpose of this study was to conduct a realist review to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety. METHOD We conducted a realist literature review consistent with RAMESES standards. We developed a programme theory of remediation by carrying out a systematic search of the literature and through regular engagement with a stakeholder group. We searched bibliographic databases (MEDLINE, EMBASE, PsycINFO, HMIC, CINAHL, ERIC, ASSIA and DARE) and conducted purposive supplementary searches. Relevant sections of text relating to the programme theory were extracted and synthesised using a realist logic of analysis to identify context-mechanism-outcome configurations (CMOcs). RESULTS A 141 records were included. The majority of the studies were from North America (64%). 29 CMOcs were identified. Remediation programmes are effective when a doctor's insight and motivation are developed and behaviour change reinforced. Insight can be developed by providing safe spaces, using advocacy to promote trust and framing feedback sensitively. Motivation can be enhanced by involving the doctor in remediation planning, correcting causal attribution, goal setting and destigmatising remediation. Sustained change can be achieved by practising new behaviours and skills, and through guided reflection. CONCLUSION Remediation can work when it creates environments that trigger behaviour change mechanisms. Our evidence synthesis provides detailed recommendations on tailoring implementation and design strategies to improve remediation interventions for doctors.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care, Health Sciences, University of Oxford, Oxford, UK
| | | | - Amanda Wanner
- NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula (PenCLAHRC), Community and Primary Care Research Group, University of Plymouth, Plymouth, UK
| | - Jennifer Cleland
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore City, Singapore
| | - Tom Gale
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Faculty of Medicine, Nursing and Healthcare, Monash University, Melbourne, Vic., Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment, Faculty of Health, University of Plymouth, Plymouth, UK
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Price T, Brennan N, Wong G, Withers L, Cleland J, Wanner A, Gale T, Prescott-Clements L, Archer J, Bryce M. Remediation programmes for practising doctors to restore patient safety: the RESTORE realist review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
An underperforming doctor puts patient safety at risk. Remediation is an intervention intended to address underperformance and return a doctor to safe practice. Used in health-care systems all over the world, it has clear implications for both patient safety and doctor retention in the workforce. However, there is limited evidence underpinning remediation programmes, particularly a lack of knowledge as to why and how a remedial intervention may work to change a doctor’s practice.
Objectives
To (1) conduct a realist review of the literature to ascertain why, how, in what contexts, for whom and to what extent remediation programmes for practising doctors work to restore patient safety; and (2) provide recommendations on tailoring, implementation and design strategies to improve remediation interventions for doctors.
Design
A realist review of the literature underpinned by the Realist And MEta-narrative Evidence Syntheses: Evolving Standards quality and reporting standards.
Data sources
Searches of bibliographic databases were conducted in June 2018 using the following databases: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Education Resources Information Center, Database of Abstracts of Reviews of Effects, Applied Social Sciences Index and Abstracts, and Health Management Information Consortium. Grey literature searches were conducted in June 2019 using the following: Google Scholar (Google Inc., Mountain View, CA, USA), OpenGrey, NHS England, North Grey Literature Collection, National Institute for Health and Care Excellence Evidence, Electronic Theses Online Service, Health Systems Evidence and Turning Research into Practice. Further relevant studies were identified via backward citation searching, searching the libraries of the core research team and through a stakeholder group.
Review methods
Realist review is a theory-orientated and explanatory approach to the synthesis of evidence that seeks to develop programme theories about how an intervention produces its effects. We developed a programme theory of remediation by convening a stakeholder group and undertaking a systematic search of the literature. We included all studies in the English language on the remediation of practising doctors, all study designs, all health-care settings and all outcome measures. We extracted relevant sections of text relating to the programme theory. Extracted data were then synthesised using a realist logic of analysis to identify context–mechanism–outcome configurations.
Results
A total of 141 records were included. Of the 141 studies included in the review, 64% related to North America and 14% were from the UK. The majority of studies (72%) were published between 2008 and 2018. A total of 33% of articles were commentaries, 30% were research papers, 25% were case studies and 12% were other types of articles. Among the research papers, 64% were quantitative, 19% were literature reviews, 14% were qualitative and 3% were mixed methods. A total of 40% of the articles were about junior doctors/residents, 31% were about practicing physicians, 17% were about a mixture of both (with some including medical students) and 12% were not applicable. A total of 40% of studies focused on remediating all areas of clinical practice, including medical knowledge, clinical skills and professionalism. A total of 27% of studies focused on professionalism only, 19% focused on knowledge and/or clinical skills and 14% did not specify. A total of 32% of studies described a remediation intervention, 16% outlined strategies for designing remediation programmes, 11% outlined remediation models and 41% were not applicable. Twenty-nine context–mechanism–outcome configurations were identified. Remediation programmes work when they develop doctors’ insight and motivation, and reinforce behaviour change. Strategies such as providing safe spaces, using advocacy to develop trust in the remediation process and carefully framing feedback create contexts in which psychological safety and professional dissonance lead to the development of insight. Involving the remediating doctor in remediation planning can provide a perceived sense of control in the process and this, alongside correcting causal attribution, goal-setting, destigmatising remediation and clarity of consequences, helps motivate doctors to change. Sustained change may be facilitated by practising new behaviours and skills and through guided reflection.
Limitations
Limitations were the low quality of included literature and limited number of UK-based studies.
Future work
Future work should use the recommendations to optimise the delivery of existing remediation programmes for doctors in the NHS.
Study registration
This study is registered as PROSPERO CRD42018088779.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 11. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tristan Price
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Nicola Brennan
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Jennifer Cleland
- Medical Education Research and Scholarship Unit (MERSU), Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Amanda Wanner
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | - Thomas Gale
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Julian Archer
- Medicine, Nursing and Health Sciences Education Portfolio, Monash University, Melbourne, VIC, Australia
| | - Marie Bryce
- Collaboration for the Advancement of Medical Education Research and Assessment (CAMERA), Faculty of Health, University of Plymouth, Plymouth, UK
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LaDonna KA, Ginsburg S, Watling C. Shifting and Sharing: Academic Physicians' Strategies for Navigating Underperformance and Failure. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1713-1718. [PMID: 29794519 DOI: 10.1097/acm.0000000000002292] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Medical practice is uncertain and complex. Consequently, even outstanding performers will inevitably experience moments of underperformance and failure. Coping relies on insight and resilience. However, how physicians develop and use these skills to navigate struggle remains underexplored. A better understanding may reveal strategies to support both struggling learners and stressed practitioners. METHOD In 2015, 28 academic physicians were interviewed about their experiences with underperformance or failure. Constructivist grounded theory informed data collection and analysis. RESULTS Participants' experiences with struggle ranged from patient errors and academic failures to frequent, smaller moments of interpersonal conflict and work-life imbalance. To buffer impact, participants sometimes shifted their focus to an aspect of their identity where they felt successful. Additionally, although participants perceived that insight develops by acknowledging and reflecting on error, they sometimes deflected blame for performance gaps. More often, participants seemed to accept personal responsibility while simultaneously sharing accountability for underperformance or failure with external forces. Paradoxically, participants perceived learners who used these strategies as lacking in insight. CONCLUSIONS Participants demonstrated the protective and functional value of distributing responsibility for underperformance and failure. Shifting and sharing may be an element of reflection and resilience; recognizing external factors may provide a way to gain perspective and to preserve the self. However, this strategy challenges educators' assumptions that learners who deflect are avoiding personal responsibility. The authors' findings raise questions about what it means to be resilient, and how assumptions about learners' responses to failure may affect strategies to support underperforming learners.
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Affiliation(s)
- Kori A LaDonna
- K.A. LaDonna is assistant professor, Department of Innovation in Medical Education and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada. S. Ginsburg is professor, Department of Medicine, and scientist, Wilson Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada. C. Watling is professor, Department of Clinical Neurological Sciences, scientist, Centre for Education Research and Innovation, and associate dean of postgraduate medical education, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Prescott-Clements L, Voller V, Bell M, Nestors N, van der Vleuten CPM. Rethinking Remediation: A Model to Support the Detailed Diagnosis of Clinicians' Performance Problems and the Development of Effective Remediation Plans. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2018; 37:245-254. [PMID: 29189494 DOI: 10.1097/ceh.0000000000000173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The successful remediation of clinicians demonstrating poor performance in the workplace is essential to ensure the provision of safe patient care. Clinicians may develop performance problems for numerous reasons, including health, personal factors, the workplace environment, or outdated knowledge/skills. Performance problems are often complex involving multifactorial issues, encompassing knowledge, skills, and professional behaviors. It is important that (where possible and appropriate) clinicians are supported through effective remediation to return them to safe clinical practice. A review of the literature demonstrated that research into remediation is in its infancy, with little known about the effectiveness of remediation programs currently. Current strategies for the development of remediation programs are mostly "intuitive"; a few draw upon established theories to inform their approach. Similarly, although it has been established that identification of the nature/scope of performance problems through assessment is an essential first step within remediation, the need for a more widespread "diagnosis" of why the problems exist is emerging. These reasons for poor performance, particularly in the context of experienced practicing clinicians, are likely to have an impact on the potential success of remediation and should be considered within the "diagnosis." A new model for diagnosing the performance problems of the clinicians has been developed, using behavioral change theories to explore known barriers to successful remediation, such as insight, motivation, attitude, self-efficacy, and the working environment, in addition to addressing known deficits regarding knowledge and skills. This novel approach is described in this article. An initial feasibility study has demonstrated the acceptability and practical implementation of our model.
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Affiliation(s)
- Linda Prescott-Clements
- Dr. Prescott-Clements: Lead Assessment and Intervention Adviser, National Clinical Assessment Service, NHS Resolution, London, United Kingdom. Ms. Voller: Director of NCAS, National Clinical Assessment Service, NHS Resolution, London, United Kingdom. Mr. Bell: Professional Support and Remediation Lead, National Clinical Assessment Service, NHS Resolution, London, United Kingdom. Ms. Nestors: Professional Support and Remediation Manager, National Clinical Assessment Service, NHS Resolution, London, United Kingdom. Prof. van der Vleuten: Professor of Education and Scientific Director of the School of Health Professions Education, Department of Educational Research and Development, Maastricht University, Maastricht, The Netherlands
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Williams BW, Flanders P, Grace ES, Korinek E, Welindt D, Williams MV. Assessment of fitness for duty of underperforming physicians: The importance of using appropriate norms. PLoS One 2017; 12:e0186902. [PMID: 29053736 PMCID: PMC5650180 DOI: 10.1371/journal.pone.0186902] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 10/10/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To determine whether population-specific normative data should be employed when screening neurocognitive functioning as part of physician fitness for duty evaluations. If so, to provide such norms based on the evidence currently available. Methods A comparison of published data from four sources was analyzed. Data from the two physician samples were then entered into a meta-analysis to obtain full information estimates and generate provisional norms for physicians. Results Two-way analysis of variance (Study x Index) revealed a significant main effect and an interaction. Results indicate differences in mean levels of performance and standard deviation for physicians. Conclusions Reliance on general population normative data results in under-identification of potential neuropsychological difficulties. Population specific normative data are needed to effectively evaluate practicing physicians.
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Affiliation(s)
- Betsy White Williams
- Department of Psychiatry School of Medicine, University of Kansas, Clinical Program, Kansas City, Kansas, United States of America
- Professional Renewal Center® (PRC®), Lawrence, Kansas, United States of America
- * E-mail:
| | - Philip Flanders
- Professional Renewal Center® (PRC®), Lawrence, Kansas, United States of America
| | - Elizabeth S. Grace
- Center for Personalized Education for Physicians (CPEP), Denver, Colorado, United States of America
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Elizabeth Korinek
- Center for Personalized Education for Physicians (CPEP), Denver, Colorado, United States of America
| | - Dillon Welindt
- Wales Behavioral Assessment (WBA), Lawrence, Kansas, United States of America
| | - Michael V. Williams
- Wales Behavioral Assessment (WBA), Lawrence, Kansas, United States of America
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Goulet F, Thiffault J, Ladouceur R. Remediation and rehabilitation programmes for health professionals: challenges for the future. BMJ Qual Saf 2017; 26:941-943. [DOI: 10.1136/bmjqs-2017-007187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2017] [Indexed: 11/04/2022]
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Weenink JW, Kool RB, Bartels RH, Westert GP. Getting back on track: a systematic review of the outcomes of remediation and rehabilitation programmes for healthcare professionals with performance concerns. BMJ Qual Saf 2017; 26:1004-1014. [DOI: 10.1136/bmjqs-2017-006710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 06/19/2017] [Accepted: 07/18/2017] [Indexed: 11/04/2022]
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Williams BW, Flanders P. Physician health and wellbeing provide challenges to patient safety and outcome quality across the careerspan. Australas Psychiatry 2016; 24:144-7. [PMID: 26906436 DOI: 10.1177/1039856215626652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Age correlated changes in mental and physical capacity have contributed to increasing concerns about older physicians' clinical competence. This paper explores the relationship between age and health in a clinical population referred for fitness for duty evaluations. METHODS Fifty cases from an evaluation center performing fitness for duty evaluations were randomly selected. Cases were reviewed for referral reason, demographic information, diagnosis, and recommendations. RESULTS Age ranged from 28-70 (median age of 51, mode of 45).Eighty-eight percent of cases had a diagnosed medical condition with potential cognitive sequellae. CONCLUSION While the literature supports performance concerns in aging practitioners, health independent of age, appears to be an important contributing factor. A screening process considering biopsychosocial reserve and professional load while applicable to older clinicians would optimally be implemented for physicians across their careerspan.
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Affiliation(s)
- Betsy White Williams
- Clinical Associate Professor, Department of Psychiatry, School of Medicine, University of Kansas and Clinical Program Director, Professional Renewal Center, Lawrence, KS, USA
| | - Philip Flanders
- Director of Psychological Services, Professional Renewal Center, Lawrence, KS, USA
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Hawkins RE, Welcher CM, Stagg Elliott V, Pieters RS, Puscas L, Wick PH. Ensuring Competent Care by Senior Physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2016; 36:226-231. [PMID: 27584000 DOI: 10.1097/ceh.0000000000000080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The increasing number of senior physicians and calls for increased accountability of the medical profession by the public have led regulators and policymakers to consider implementing age-based competency screening. Some hospitals and health systems have initiated age-based screening, but there is no agreed upon assessment process. Licensing and certifying organizations generally do not require that senior physicians pass additional assessments of health, competency, or quality performance. Studies suggest that physician performance, on average, declines with increasing years in medical practice, but the effect of age on an individual physician's competence is highly variable. Many senior physicians practice effectively and should be allowed to remain in practice as long as quality and safety are not endangered. Stakeholders in the medical profession should consider the need to develop guidelines and methods for monitoring and/or screening to ensure that senior physicians provide safe and effective care for patients. Any screening process needs to achieve a balance between protecting patients from harm due to substandard practice, while at the same time ensuring fairness to physicians and avoiding unnecessary reductions in workforce.
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Affiliation(s)
- Richard E Hawkins
- Dr. Hawkins: Vice President, Medical Education Outcomes, American Medical Association, Chicago, IL. Ms. Welcher: Senior Policy Analyst, Medical Education Outcomes, American Medical Association, Chicago, IL. Ms. Stagg Elliott: Technical Writer, Medical Education Outcomes, American Medical Association, Chicago, IL. Dr. Pieters: Professor of Radiation Oncology and Pediatrics, University of Massachusetts Medical School, Worcester, MA. Dr. Puscas: Associate Professor of Surgery, Duke University School of Medicine, Durham, NC. Dr. Wick: Assistant Professor, Psychiatry Department, Senior Behavioral Health Outpatient Services, University of Texas Health Northeast, Tyler, TX
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Lillis S, Takai N, Francis S. Long-term outcomes of a remedial education program for doctors with clinical performance deficits. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2014; 34:96-101. [PMID: 24939351 DOI: 10.1002/chp.21227] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Medical regulatory authorities need reliable methods of assessing and remediating doctors where there are concerns over competence. There's a small but growing literature describing remediation programs and documenting their effectiveness. This article adds to that literature by describing a program associated with the Medical Council of New Zealand (MCNZ) and reporting outcomes for 24 consecutive doctors required to undergo remediation. METHODS Over the 18-month period covered in this study, 24 doctors were required by the MCNZ to enter remediation after a performance assessment. The data set used in this study was drawn from these 24 consecutive cases and included the nature of concerns, severity of concerns, results of remediation and outcome of a second assessment when such an assessment was ordered. RESULTS Of 24 doctors who underwent initial assessment, 5 failed to engage with remediation and withdrew from clinical work. A 12-month education remediation program was completed by all remaining 19 doctors. Of these, 13 were considered to be practicing at an acceptable standard at the end of remediation on the basis of sequential supervisor reports. Six doctors were required to have a second performance assessment. Of these, only 1 was considered to be functioning at an acceptable standard. Concurrent health concerns were common among this cohort of doctors. DISCUSSION Seventy-five percent of doctors who entered remedial education were considered to be practicing at an acceptable standard at the end of remediation. This accords well with international data. A small number of doctors appear to be unresponsive to remediation.
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Humphrey C. Assessment and remediation for physicians with suspected performance problems: an international survey. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2010; 30:26-36. [PMID: 20222039 DOI: 10.1002/chp.20053] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Little is known about the overall appropriateness and value of the various programs available internationally for assessment and remediation for individual physicians whose performance in their clinical practice has been identified as giving cause for concern. METHOD A questionnaire was e-mailed to members of the International Physicians Assessment Coalition and/or the Coalition for Physician Enhancement--organizations that were thought to provide this type of assessment (n = 20). Questions covered the aims, organization, methods, and outcomes of assessment programs and associated remediation. RESULTS Responses came from 15 regulatory bodies, universities, not-for-profits, and health service organizations in 5 countries. The assessment programs and remediation activities identified were small in scale. Their focus ranged from a narrow concern with identifying and repairing specific knowledge and skills deficits to a wider interest in the biopsychosocial functioning of the physician as a whole. Both "diagnosis" and "treatment" of problems focused on the individual physician. Less attention was given to broader systems or contextual factors that might impact performance. Although progress through remediation was carefully monitored, none of the programs undertook regular systematic follow-up to ascertain the success of their interventions in the longer term. DISCUSSION This field of activity is characterized by the use of sophisticated methods for measuring performance/competence, but provision of remediation is more patchy and variable. The small scale of these programs raises questions about the relationship between scale of provision and potential need for remediation. Gaps in information about impact and outcomes mean that the overall impact and value of this type of assessment and remediation is hard to determine.
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Affiliation(s)
- Charlotte Humphrey
- Division of Health and Social Care Research, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8HA, United Kingdom.
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van Luijk SJ, Gorter RC, van Mook WNKA. Promoting professional behaviour in undergraduate medical, dental and veterinary curricula in the Netherlands: evaluation of a joint effort. MEDICAL TEACHER 2010; 32:733-739. [PMID: 20795803 DOI: 10.3109/0142159x.2010.505972] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND From 2002 onwards, a nationwide working group of representatives from all medical (8), dental (3) and veterinary medicine (1) schools collaborated in order to develop and implement recommendations for teaching and assessing professional behaviour. AIM The aim of this article is to describe the outcomes of this process, including hurdles encountered and challenges to be met. METHOD By a qualitative survey, information was requested on teaching professional behaviour, assessment, instruments used, consequences of unprofessional behaviour and faculty training. RESULTS All schools have adopted at least parts of the 2002 recommendations. Differences exist mainly in the organisational structure of teaching and assessment as well as in the assessment instruments used. In all schools a longitudinal assessment of professional behaviour was accomplished. CONCLUSION All schools involved have made progress since 2002 with regard to teaching and assessment of professional behaviour, resulting in a shift from an instrumental to a cultural change for some schools. A stimulating factor was society's call to focus on patient safety and therefore on assessment of unprofessional behaviour. Hurdles yet to be taken are the involvement of students in the assessment process, teacher confidence in personal assessment capacities, remediation programmes and logistic and administrative support.
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Affiliation(s)
- Scheltus J van Luijk
- Free University Medical Centre, Institute for Education and Training, Amsterdam, The Netherlands.
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Korinek LL, Thompson LL, McRae C, Korinek E. Do physicians referred for competency evaluations have underlying cognitive problems? ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:1015-1021. [PMID: 19638765 DOI: 10.1097/acm.0b013e3181ad00a2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Research suggests that there are concerns about the neuropsychological functioning of physicians who undergo physician competency evaluation. Academic health center faculty often participate in the evaluation and remediation of these physicians. The purpose of this study was to compare the cognitive abilities between a group of physicians referred for competency evaluations and a control group. METHOD Using the MicroCog, a computerized neuropsychological screen originally designed for physicians, the authors compared the cognitive performance of 267 physicians referred for competency evaluations with a control group of 68 recruited physicians. Physicians referred for competency evaluations took the MicroCog as a part of their evaluation at CPEP, the national Center for Personalized Education for Physicians, from January 1997 to January 2004. The control group comprised practicing physicians whose competency was not in question. RESULTS Compared with the control group, the competency evaluation group had a greater proportion of physicians with scores suggesting possible cognitive impairment and performed significantly lower on scores of processing speed, processing accuracy, and cognitive proficiency. The control group of physicians performed significantly better than the age- and education-corrected normative sample. CONCLUSIONS Because there were significant neuropsychological differences between physicians referred for competency evaluations and physicians whose competency was not in question, it is important that neuropsychological screening be included as part of physicians' competency evaluations.
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Affiliation(s)
- Lauri L Korinek
- Neuropsychological Services, Colorado Mental Health Institute at Fort Logan, Denver, Colorado, USA.
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The aging physician with cognitive impairment: approaches to oversight, prevention, and remediation. Am J Geriatr Psychiatry 2009; 17:445-54. [PMID: 19461256 DOI: 10.1097/jgp.0b013e31819e2d7e] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are many important unanswered issues regarding the occurrence of cognitive impairment in physicians, such as detection of deficits, remediation efforts, policy implications for safe medical practice, and the need to safeguard quality patient care. The authors review existing literature on these complex issues and derive heuristic formulations regarding how to help manage the professional needs of the aging physician with dementia. To ensure safe standards of medical care while also protecting the needs of physicians and their families, state regulatory or licensing agencies in collaboration with state medical associations and academic medical centers should generate evaluation guidelines to assure continued high levels of functioning. The authors also raise the question of whether age should be considered as a risk factor that merits special screening for adequate functioning. Either age-related screening for cognitive impairment should be initiated or rigorous evaluation after lapses in standard of care should be the norm regardless of age. Ultimately, competence rather than mandatory retirement due to age per se should be the deciding factor regarding whether physicians should be able to continue their practice. Finally, the authors issue a call for an expert consensus panel to convene to make recommendations concerning aging physicians with cognitive impairment who are at risk for medical errors.
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May W, Park JH, Lee JP. A ten-year review of the literature on the use of standardized patients in teaching and learning: 1996-2005. MEDICAL TEACHER 2009; 31:487-92. [PMID: 19811163 DOI: 10.1080/01421590802530898] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
BACKGROUND Although there is a growing body of literature on the educational use of standardized patients (SP) in teaching and learning, there have been no reviews on their value. OBJECTIVE To determine whether the educational use of SPs has an effect on the knowledge, skills, and behaviour of learners in the health professions. METHODS English-language articles covering the period 1996-2005 were reviewed to address the issue of to what extent has the use of SPs affected the knowledge, skills and performance of learners. Out of 797 abstracts, 69 articles, which met the review criteria, were selected. An adaptation of Kirkpatrick's model was used to classify and analyse the articles. RESULTS Most of the learners were students in medicine and nursing. SPs were used mostly to teach communication skills and clinical skills. The study designs were case-control (29%), pre-test/post-test (24.6%), post-test only (26.1%) and qualitative studies (20.3%). METHODOLOGICAL ISSUES: Most of the studies had weak research designs. More rigorous designs with control or comparison groups should be used in future research. CONCLUSIONS Most studies reported that the educational use of SPs was valuable. More rigorous studies would support the evidence-based use of SPs in teaching and learning.
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Affiliation(s)
- Win May
- Division of Medical Education, Keck School of Medicine, KAM 211B, Los Angeles, CA 90033, USA.
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Bond W, Kuhn G, Binstadt E, Quirk M, Wu T, Tews M, Dev P, Ericsson KA. The use of simulation in the development of individual cognitive expertise in emergency medicine. Acad Emerg Med 2008; 15:1037-45. [PMID: 18785938 DOI: 10.1111/j.1553-2712.2008.00229.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This consensus group from the 2008 Academic Emergency Medicine Consensus Conference, "The Science of Simulation in Healthcare: Defining and Developing Clinical Expertise," held in Washington, DC, May 28, 2008, focused on the use of simulation for the development of individual expertise in emergency medicine (EM). Methodologically sound qualitative and quantitative research will be needed to illuminate, refine, and test hypotheses in this area. The discussion focused around six primary topics: the use of simulation to study the behavior of experts, improving the overall competence of clinicians in the shortest time possible, optimizing teaching strategies within the simulation environment, using simulation to diagnose and remediate performance problems, and transferring learning to the real-world environment. Continued collaboration between academic communities that include medicine, cognitive psychology, and education will be required to answer these questions.
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Affiliation(s)
- William Bond
- Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, USA.
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Goulet F, Gagnon R, Gingras ME. Influence of remedial professional development programs for poorly performing physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2007; 27:42-8. [PMID: 17385737 DOI: 10.1002/chp.93] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
INTRODUCTION The Collège des Médecins du Québec (CMQ) offers an individualized remedial professional development program to help physicians overcome selected clinical shortcomings. To measure the influence of the remedial professional development program, physicians who completed the program between 1993 and 2004 and who were assessed by peer review during a 2-year period preceding or following the remedial activities were tracked. METHODS For each physician, 30 to 50 patient records were selected randomly for review. Ratings were assigned for the quality of record keeping and for 3 elements pertaining to the quality of care: the clinical investigation plan, diagnostic accuracy, and patient treatment and follow-up. The impact of the program was measured by comparing the proportion of physicians with satisfactory ratings assigned by peer review before and after the remedial professional development program. RESULTS Statistically significant improvements (p < .05) were observed for a proportion of physicians (n = 51) with satisfactory ratings with regard to record keeping (20% before and 54% after remediation), the clinical investigation plan (13% before and 59% after remediation), diagnostic accuracy (32% before and 61% after remediation), and patient treatment and follow-up (31% before and 67% after remediation). DISCUSSION Participation in a CMQ remedial professional development program can result in improved clinical performance, as assessed through peer review.
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Affiliation(s)
- François Goulet
- Collège des Médecins du Québec (College of Physicians of Quebec), Montreal, Quebec, Canada.
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20
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Turnbull J, Cunnington J, Unsal A, Norman G, Ferguson B. Competence and cognitive difficulty in physicians: a follow-up study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2006; 81:915-8. [PMID: 16985357 DOI: 10.1097/01.acm.0000238194.55648.b2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE Remediation of incompetent physicians has proven difficult and sometimes impossible. The authors wished to determine whether such physicians had neuropsychological impairment sufficient to explain their incompetence and their failure to improve after remedial continuing medical education (CME). METHOD Between 1997 and 2001, the authors undertook neuropsychological screening of 45 participants of a physician competency assessment program. For those physicians reassessed after a period of remediation, the authors relate the findings of the physicians' competence reassessments to their neuropsychological scores. RESULTS Nearly all physicians performing well on competency assessment had no or mild cognitive impairment. Conversely, a significant number of physicians performing poorly on competency assessment had sufficient neuropsychological difficulty to explain their poor performance. The cognitive impairment was more marked in elderly physicians, and referencing the neuropsychological scores to an age-matched normative population underestimates the impairment. No physician with moderate or severe neuropsychological dysfunction had successful competency reassessment. Increasing age was associated with poor performance on competency testing, but was less strongly associated with unsuccessful reassessment. CONCLUSION A large minority of the physicians who fell significantly below desired levels of competence had cognitive impairment sufficient to explain their lack of competence and their failure to improve with remedial CME.
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Williams BW. The prevalence and special educational requirements of dyscompetent physicians. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2006; 26:173-91. [PMID: 16986149 DOI: 10.1002/chp.68] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Underperformance among physicians is not well studied or defined; yet, the identification and remediation of physicians who are not performing up to acceptable standards is central to quality care and patient safety. Methods for estimating the prevalence of dyscompetence include evaluating available data on medical errors, malpractice claims, disciplinary actions, quality control studies, medical record review studies, and in-stream assessments of physician performance. These data provide a range of estimates from 0.6% to 50%, depending on the method. A reasonable estimate of dyscompetence appears to be 6% to 12%. Age-related cognitive decline, impairment due to substance use disorders, and other psychiatric illness can contribute to underperformance, diminishing physicians' insight into their level of performance as well as their ability to benefit from an educational experience.Currently, dyscompetent physicians in the United States are identified through either the legal system or peer review. The primary method of resolving issues of underperformance in physicians is through continuing medical education (CME). Although a number of specialized assessment and education programs exist in the United States, these programs are largely underutilized. Similar programs exist in Canada and have provided evidence of the efficacy of a more specialized and individualized educational approach for underperforming physicians. Current specialty programs focused on this population employ individual assessments of knowledge and performance, individually designed educational programs, long-term plans for maintenance of educational activity, and repeated assessment of performance level. Noting that few CME programs offer these requirements, a number of changes to current medical quality assurance programs that might foster such educational requirements for underperforming physicians are provided.
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Affiliation(s)
- Betsy W Williams
- Office of Continuing Medical Education, Rush University Medical Center, Chicago, IL 60612, USA
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Schleyer TKL, Dodell D. Continuing dental education requirements for relicensure in the United States. J Am Dent Assoc 2005; 136:1450-6. [PMID: 16255471 DOI: 10.14219/jada.archive.2005.0060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Mandatory continuing education (CE) is an almost universal requirement for relicensure of dentists in the United States. In recent years, computer-based methods have become more widely adopted as a vehicle for earning CE credits. To obtain a comprehensive overview of CE requirements in the United States, the authors conducted a survey on how computer-based CE methods are regulated. METHODS The authors reviewed the dental statutes of 50 states and the District of Columbia regarding the license renewal period, required number of CE hours, limitations on clinical and nonclinical subjects, on-site versus independent-study courses, and other requirements regarding CE. RESULTS The authors found that 45 states and the District of Columbia mandate CE for relicensure at this time. Most dentists were required to complete approximately 20 hours per year. Ten states specified a minimum number of clinical hours, 17 states limited nonclinical hours, and seven states placed constraints on both clinical and nonclinical CE. Sixty-five percent of states limited the number of CE credits that could be accumulated through independent study. Specific requirements for computer-based methods of earning CE credits were absent in general. CONCLUSIONS State licensing boards across the United States have implemented comprehensive requirements for CE. Few, if any, provisions addressed computer-based methods of earning CE credits. PRACTICE IMPLICATIONS Given the increasing adoption of computer-based methods of earning CE credits, state dental boards and accrediting agencies may want to consider steps to improve the quality of computer-based methods of earning CE credits.
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Affiliation(s)
- Titus K L Schleyer
- Center for Dental Informatics, School of Dental Medicine, University of Pittsburgh, Pa. 15261-1933, USA.
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Goulet F, Jacques A, Gagnon R. An innovative approach to remedial continuing medical education, 1992-2002. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:533-40. [PMID: 15917355 DOI: 10.1097/00001888-200506000-00004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The authors describe the process of remedial retraining programs organized and planned for Quebec physicians by the College des medecins du Quebec (CMQ) and report the outcomes of these efforts from April 1992 to March 2002. The CMQ (the Quebec medical licensing authority) developed a process to identify physicians who had shortcomings in their clinical performance, determine their educational needs, propose, in collaboration with the four medical schools in the province, personalized retraining programs (clinical training programs, tutorials, focused readings, workshops, and refresher courses), and subsequently evaluate the impact of these retraining programs. During the ten-year period reported, 305 physicians (216 family physicians and 89 specialists) were referred to the Practice Enhancement Division of the CMQ for personalized remedial retraining. The vast majority of these physicians were men (81%). The following difficulties were identified: therapeutic knowledge (37%), diagnostic knowledge (32%), record-keeping (14%), technical skills (10%), clinical judgment (5%), and communication skills (2%). A total of 329 personalized retraining programs were completed: 273 clinical training programs, 41 tutorials, and 15 focused readings. A reevaluation of all these physicians showed that 70% of the retraining programs had succeeded, 15% were partially successful and only 13% had failed. The remaining 2% involved missing data or withdrawal of physicians. The authors conclude that the collaborative CME process described has important and effective original features.
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Affiliation(s)
- François Goulet
- Practice Enhancement Division, Collège des médecins du Québec, Canada.
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Abstract
Our students trust that we will provide them with information and opportunities to practice what they have learned in the classroom. When students are not meeting established objectives in the clinical environment, the possibility for error increases, frustration and the students' stress levels escalate, and patient safety is jeopardized. Traditional remediation methods may reduce students' already low levels of confidence, putting more stress on the students and creating an environment prone to errors. We devised a remediation plan using the human patient simulator to meet the needs of such students and their clinical preceptors, while preserving patient safety. The simulation laboratory is a safe place to practice skills until a specified level of proficiency is reached. In this environment, students gain back confidence in their abilities. By using the simulator in this novel way, student learning is enhanced, while patient care and safety is optimized.
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Affiliation(s)
- Leah M Haskvitz
- Nurse Anesthesia Program, School of Nursing and Health Studies, Georgetown University, Washington, DC 20057-1107, USA.
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Riley RH, Grauze AM, Chinnery C, Horley RA, Trewhella NH. Three years of “CASMS”: the world's busiest medical simulation centre. Med J Aust 2003; 179:626-30. [PMID: 14636135 DOI: 10.5694/j.1326-5377.2003.tb05722.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2003] [Accepted: 09/25/2003] [Indexed: 11/17/2022]
Abstract
Medical simulation is a relatively new teaching modality suitable for medical education at all levels, although its long-term benefits have not yet been validated. Simulation allows the participant to practise diagnosis, medical management and behavioural approaches in the care of acutely ill patients in a controlled environment. Simulators have achieved widespread acceptance in the fields of anaesthesia, intensive care and emergency medicine. More recently, team training for pre-hospital and within-hospital multidisciplinary medical response teams has become popular. The increasing number and diversity of courses at "CASMS" parallels the evolution of simulation centres into regional clinical skills centres elsewhere. Such centres are likely to become a cost-effective means of achieving greater consistency in medical skill acquisition and may improve patient outcomes after medical crises.
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Affiliation(s)
- Richard H Riley
- Centre for Anaesthesia Skills and Medical Simulation, Clinical Training and Education Centre, University of Western Australia, Perth, WA, Australia.
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The Use of a Human Patient Simulator in the Evaluation of and Development of a Remedial Prescription for an Anesthesiologist with Lapsed Medical Skills. Anesth Analg 2002. [DOI: 10.1213/00000539-200201000-00028] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Rosenblatt MA, Abrams KJ. The use of a human patient simulator in the evaluation of and development of a remedial prescription for an anesthesiologist with lapsed medical skills. Anesth Analg 2002; 94:149-53, table of contents. [PMID: 11772818 DOI: 10.1097/00000539-200201000-00028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The New York State Society of Anesthesiologists' Committee on Continuing Medical Education and Remediation has been charged by the Office of Professional Medical Conduct of the New York State Department of Health to develop a remediation program for individuals ordered into retraining. We describe the development of an anesthesiology-specific evaluation to identify areas of deficiency to both determine a candidate's suitability, as well as to facilitate the creation of an appropriate prescription for retraining. A human patient simulator was used to aid in the gathering of information during the evaluation process. Specifically, the use of simulation allowed the exploration of a candidate's preparation, approach to clinical situations, technical abilities, response to clinical problems, ability to problem solve, and accuracy of medical record keeping. Human patient simulation should be considered a valuable tool in the process of evaluating physicians with lapsed medical skills.
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Affiliation(s)
- Meg A Rosenblatt
- Department of Anesthesiology, The Mount Sinai School of Medicine, New York, New York 10029-6574, USA.
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Cunnington J, Southgate L. Relicensure, Recertification and Practice-Based Assessment. INTERNATIONAL HANDBOOK OF RESEARCH IN MEDICAL EDUCATION 2002. [DOI: 10.1007/978-94-010-0462-6_32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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