The College of Physicians and Surgeons of Ontario: Revalidation Consultation and Future Plans

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The College of Physicians and Surgeons of
Ontario Revalidation Consultation and Future
Plans

• Bill McCauley MD, MHPE, FRCPC
• Medical Officer, Physician Enhancement, CPSO
• Associate Professor, Department of Medicine
• Schulich School of Medicine Dentistry

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Session Objectives

• Review the history behind the CPSOs Revalidation
  initiative
• Review the results of the revalidation
  consultation process
• Review directions approved by the Council of the
  CPSO
• Review the current challenges

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Re-validation System 2010
Random Age 70
Proof of Competence POC
Commitment to Competence CTC
Demonstration of Competence DOC
Possible Performance concern
Refusal
Successful Completion
Participation
Re-validated
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Commitment to Competence

• Every Physician every five years
• Self Assessment of physicians practice using
  tools developed by CPSO
• Multisource Feedback (360º assessment)
• Self-Reflective Exercise to develop personal
  learning objectives

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Demonstration of Competence

• Peer Assessment Program
• Essentially unchanged from previous
• Refusal to participate in the Commitment to
  Competence program may result in a Peer
  Assessment, at the members expense
• Still random targeted gt age 70

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Proof of Competence

• Physician Review Program (PREP) for Family
  Physicians and GPs
• Specialists Assessment Program (SAP) for
  specialists
• Unchanged

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Revalidation ConsultationComponents

• Meetings with the profession
• Release of the consultation paper
• Involvement of the national specialty colleges
  and other stakeholders
• Expert panel review
• Independent surveys of physicians and the public

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Meetings with the Profession

• September 2005 to April 2006
• Presentations at 46 locations
• 1400 physician attendees
• Approx 400 feedback forms received
• 50 indicated willingness to participate in pilot
  project
• Presentations by President, Registrar, Council
  Members, CPSO staff physicians
• Assessors Conference
• Chiefs Day

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Consultation Paper

• November 2005 consultation paper sent to every
  member of the College
• Invited to submit feedback through form or
  website
• Approx 750 responses heard

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Involvement of Specialty Colleges

• Members of RCPSC and CFPC staff involved in
  development of initial revalidation plan
• Revalidation Task Force and Working Group
• RCPSC
• CFPC
• MCC
• OMA
• CPSO

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Expert Panel Review

• Question of evidence from educational literature
• Convened panel to look at literature and evaluate
  evidence for revalidation approach
• Provincial, national, international experts on
  performance assessment, CME, evidence based
  medicine, communication skills

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Independent Surveys

• Decima Research
• Anonymous on line surveys of public and
  physicians
• 1,623 members of public
• 1,015 physicians
• Not solely related to revalidation

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Major Themes Identified

• Universal commitment to continuing professional
  development
• Duplication of national specialty college
  programs/credentialing processes at hospitals
• Trust in the College
• Acceptance of self-reflection exercises
• Uncertainty about multisource feedback proposal
• Evidence for revalidation.

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Commitment to CPD

• Overwhelming majority of members
• All professional organizations
• Believe physicians MUST participate in CPD
  throughout their career
• This is a professional responsibility that we
  all share. If we are to remain self-governing, we
  must take this on as a requirement of maintenance
  of that status.

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Duplication of Efforts

• Recurring theme
• Worried about duplication of the RCPSC (MOC) and
  the CFPC (Mainpro) programs
• Many felt a revalidation program was not
  necessary because physicians are self-motivated
  and professionals
• Involve only those 6,000 MDs not members of
  specialty colleges. Revalidation is not necessary
  for physicians already within RCPSC or CFPC.

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Trust in College

• Concern about having the regulator oversee the
  educational components of revalidation
• Feedback often commented on lack of trust of the
  CPSO
• Work with systems that are already there, e.g.
  OMA, RCPSC, CFPC. Allow them to run the program
  and give CPSO input as to how and what the
  requirements are. CPSO should not be running
  this.

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Acceptance of Self Reflective Exercise

• Majority indicate they currently do informal
  self-reflection
• Most agreed self-assessment is an integral part
  of CPD programming
• The primary advantage of the CPSOs proposed
  system is that it will help us look at those
  areas which we think we know, in a context that
  is directly relevant to our patients, and thus
  improve our practices from the inside out.

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Uncertainty about Multisource Feedback

• Significant concern about receiving feedback from
  colleagues, specialists and especially patients
• Concern about unknown validity or effectiveness
  of this
• I question the role/usefulness of feedback from
  multisources. Is this a popularity contest or an
  assessment of competence?

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Evidence for Revalidation

• Lots of questions and many demands for evidence
  of revalidation efforts before implementation
• Given that there is no evidence linking the
  proposed tools with either overall physician
  competence or improved patient safety, and there
  is ample evidence that current CPD strategies are
  ineffective, there is an opportunity to learn
  more about this method.

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Surveys - Public
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The next few questions relate to the expectations
people have about their doctors. For each of the
following, please indicate if you believe it is
definitely true in Ontario today, probably true
today, or is not true today that doctors are
REQUIRED to?
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Once a doctor is licensed, it is possible that
they could receive their certificate, practice
independently, and never participate in any
meaningful educational activity throughout their
entire career.   Doctors may also choose to be
members of organizations/hospitals that require
them to take courses in order to keep up-to-date,
but this is not mandatory at this time.   One of
the goals of the College is to ensure that
doctors in Ontario stay up-to-date to practice
medicine. To what extent would you agree that the
current system is meeting the goal of ensuring
that doctors in Ontario stay up-to-date to
practice medicine?
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Please indicate to what extent you agree that
each of the following should be required of all
physicians in Ontario.
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Surveys Physicians
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For each of the following, please indicate if
you believe it is definitely true in Ontario
today, probably true today, or is not true today.
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Do you find it acceptable that, in Ontario
currently, a physician could receive his or her
certificate, practice independently and not
participate in any meaningful educational
activity throughout their entire career?
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Physicians vs. Public
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Please indicate which of the following bodies
you would prefer have responsibility for
overseeing a system of revalidation in which
continuing professional development and
communications feedback was required of
physicians in Ontario.
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Consultation Review

• Results reviewed by CPSO council at meeting in
  April 2006
• A number of recommendations from Council

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April 2006 Council Recommendations

• CPSO will work closely with the RCPSC, CFPC,
  OCFP, MCC and FMRAC to develop and deliver the
  best possible continuing professional development
  (CPD) system that is national, mandatory and
  portable
• CPSO will work to continuously increase and
  enhance the physician assessment programs that
  are strongly supported by the profession
• CPSO will work with the national specialty
  colleges to further study and develop assessment
  and education programs designed to improve
  communication and collaboration skills
• CPSO will work to develop an evaluation
  methodology that will measure the outcomes of CPD
  systems on patient care and outcomes using, as
  one indicator, the CPSOs practice assessment
  processes.

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Work to Date

• Mandatory CPD regulation change
• Strategies to increase number of peer assessments
  from 700 to 2000 by 2010
• Working with MCC on communication skills pilot
  project
• Current CPSO communication skills course
  cancelled
• Working to develop alternative strategies
• RD department of CPSO working on evaluation
  strategies

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Proposed Regulatory Change

• 38.1 (1) Every member shall participate in
  established programs of continuing professional
  development required by the College of Family
  Physicians of Canada, the Royal College of
  Physicians and Surgeons of Canada or an
  alternative program as approved by Council.
• (2) The continuing professional development
  requirements referred to above shall be specified
  in a policy that is approved by the College
  Council and published and distributed by the
  College to its members.

Passed at Council September 2006
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Mandatory CPD

• RCPSC and CFPC on board
• Can participate in MOC and Mainpro programs
  without becoming a member of either college (for
  a fee!!)
• Approximately 6000 physicians not members of
  either college

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Other Regulated Health Professionals in Ontario

• 20 other regulated health professions
• All have some requirements for ongoing education
• Many have credit systems
• Many have Personal Learning Portfolios
• Self Assessment
• Education Plan
• Implementation
• Documentation of outcome
• Some require regular submission
• Many require it to be available upon request

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Other Medical Jurisdictions in Canada

• No other jurisdiction has mandatory education
• Alberta has PAR (Physician Achievement Review)
  Program Multisource Feedback
• Nova Scotia has NS-PAR Program
• Federation of Medical Regulatory Authorities of
  Canada (FMRAC)

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FMRAC Revalidation Committee

• Draft Position Statement
• All licensed physicians in Canada must
  participate in a recognized revalidation process
  which includes opportunities to demonstrate their
  commitment to continued competent performance in
  a framework that is accountable, fair, relevant,
  inclusive, transferable and formative.

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Next Steps

• Review Mandatory CPD regulatory change feedback
• Develop CPSO policy to support regulatory change
• What is an acceptable alternative education
  program?
• Define components
• CPSO not interested in reviewing individuals CPD
  experiences

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Possibilities

• CPSO defines what major components of a CPD
  program are mandatory and
• Have programs apply to CPSO for acceptable
  status (including RCPSC and CFPC)
• CPSO has Educational Colleges do above
• An arms-length organization be created to
• Accredit all CPD programs (?in Canada)
• Ensure CPD programs contain essential elements
• RCPSC and CFPC programs would also be accredited
  by this body

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QUESTIONS