Good Medical Practice USA: The Path to its Creation

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Good Medical Practice USA The Path to its
Creation

• Richard E. Hawkins, MD, FACP
• Vice President, Assessment Programs
• National Board of Medical Examiners, USA

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Presentation Outline

• Competence Frameworks and Models
• Recent Efforts
• Physician Accountability for Physician Competence
  Summits
• National Alliance
• Good Medical Practice USA

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Frameworks for Physician Competence Recent
History

• Medical School Objectives Project (MSOP)
• ACGME Outcomes Project
• ABMS Maintenance of Certification
• Maintenance of Licensure
• Institute of Medicine Competencies
• Charter on Professionalism

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Medical School Objectives Project

• Initiative begun in 1996 ? response to concerns
  about doctors preparation for practice
• Purpose ? align educational content and goals
  with
• Societal needs
• Practice changes
• Scientific developments

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Medical School Objectives Project

• Guide to establishing objectives in individual
  medical schools
• Delineation ? essential attributes to inform
  learning objectives
• Physicians must be
• Altruistic
• Knowledgeable
• Skillful
• Dutiful

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Key Concepts
The Outcome Project is a long-term initiative by
which the ACGME is increasing emphasis on
educational outcomes in the accreditation of
residency education programs.
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ACGME Outcome Project

• Accreditation of Educational Programs

Structure Process (Potential)
Learning Outcomes (Accomplishments)
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ACGME Outcome Project

• Identification of 6 general competencies ()
• Identification of assessment tools (/-)
• Creation of a timeline ? increase integration
  into learning and assessment of individuals and
  programs

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ACGME/ABMS Competencies

• Medical knowledge
• Patient care
• Interpersonal and communication skills
• Professionalism
• Practice-based learning and improvement
• Systems-based practice

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ABMS Maintenance of Certification

• Replaced re-certification
• Recognition of broader set of attributes
• Proposed 1999 ? approved 2001 ? expected
  transition 2005
• Embraced general competencies as measures of
  practice performance (ACGME / ABMS General
  Competencies)

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ABMS MOC Four Components

• Professional standing
• Maintain valid, unrestricted license
• Life-long learning and self-assessment
• Engage in CPD (CME)
• Cognitive expertise
• Periodic formal examination
• Practice performance assessment
• Specialty-specific / General competencies

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Maintenance of Licensure

• FSMB policy requiring state medical boards to
  ensure physician competence at time of
  re-licensure
• Recommends approach analogous to ABMS MOC
  incorporating ACGME/ABMS general competencies

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IOM Vision for Education

• All health professionals should be educated to
  deliver patient-centered care as members of an
  interdisciplinary team, emphasizing
  evidence-based practice, quality improvement
  approaches, and informatics

IOM, 2003
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IOM Five Competencies

• Patient-centered care
• Work in interdisciplinary teams
• Employ evidence-based practice
• Apply quality improvement
• Utilize informatics

IOM, 2003
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IOM Competency Model
IOM, 2003
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Charter on Medical Professionalism

• Embraced by other organizations and institutions
• Representative of a national trend in USA
• 3 fundamental principles 10 responsibilities
• Broader, more inclusive perspective on
  Professionalism

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Charter on Medical Professionalism

• Responsibilities
• Commitment to professional competence
• Commitment to improving quality of care
• Commitment to professional responsibilities

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Leading into the Summits Prevailing Competence
Framework

• ACGME / ABMS Competency Model
• Only framework for GME and MOC
• Encompasses the IOM competencies
• Being adopted in Undergraduate Medical Education
• Recommended framework for
• Maintenance of Licensure
• Credentialing and Privileging (JCAHO)

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Physician Accountability for Physician Competence
Summits

• 1st Summit March 2005 (Fort Worth, TX)
• Sponsor - Federation of State Medical Boards
• Participants 34 organizations representing US
  healthcare healthcare regulation
• Facilitation Innovation Labs
• Summit Focused on Scenario Planning
• Healthcare and regulation in 2020
• Assurance of physician competence
• 5 scenarios circulated for discussion/reaction

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Physician Accountability for Physician Competence
Summits

• 2nd Summit December 2005 (Chicago, IL)
• Shared sponsorship (8 organizations)
• Participants 36 organizations
• Results
• Idea Creation of a National Alliance
• Definition of Physician Competence and the Good
  Doctor
• First draft of Good Medical Practice USA
• Circulated for discussion / edits

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Physician Accountability for Physician Competence
Summits

• Summit 3 June 2006 (Philadelphia, PA)
• Continued work on GMP document
• Continued planning for National Alliance
• Emerged - Portfolio/Trusted Agent System

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Physician Accountability for Physician Competence
Summits

• Summit 4 January 2007 (Tampa, FL)
• GMP and TA /portfolio
• Frame and support education, assessment and
  competence maintenance
• Plan
• Continued development of GMP document
• Collaboration in TA/portfolio projects
• Explore structures for National Alliance
• Next meeting December 2007

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GMP USA

• Origins in GMP UK and collaboration with
• GMC Picker Europe
• Built on existing ACGME / ABMS framework
  retains similar language to GMP UK
• Seeking broader input including public

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GMP USA

• Seeking to define its role along the continuum
  of competence
• Inform design of educational programs
• Criteria within accreditation processes
• Blueprint for licensing / certifying examinations
  
• Framework for maintenance of licensure and
  certification
• Contribute to development of legal requirements
  and policy documents