Guide to Good Medical Practice USA

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Guide to Good Medical Practice USA

• Toward a Common Language of Competency
• Carol A. Aschenbrener, MD
• Executive Vice President
• AAMC

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• When a community of people discovers that they
  share a concern, change begins. There is no
  power equal to a community discovering what it
  cares about. Meg Wheatley

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National Alliance for Physician Competence

• What is it?
• Voluntary, self-organizing coalition of
  organizations committed to improving patient care
• Over 40 organizations involved - professional,
  regulatory, accrediting, public
• Share common goal assuring the public of
  physicians competence throughout their
  professional lives

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Physician Summit IV Participants
American Osteopathic Association
Virginia Board of Medicine
University of Medicine and Dentistry of New Jersey
Association of American Medical Colleges
Catholic Health Initiatives
Federation of State Medical Boards
Accreditation Council for Continuing Medical
Education
Blue Cross/Blue Shield of Illinois
American Medical Association
American Osteopathic Board of Emergency Medicine
Michigan Bureau of Health Professions
Medical Council of Canada
American Board of Internal Medicine
Physician Insurers Association of America
Kentucky Board of Medical Licensure
Federation of State Medical Boards
National Board of Medical Examiners
University of Miami School of Medicine
Milbank Memorial Fund
Harvard School of Public Health
Accreditation Council for Graduate Medical
Education
Robert Wood Johnson Foundation
Consumers Union
Oregon Board of Medical Examiners
Joint Commission
Educational Commission for Foreign Medical
Graduates
Virginia Board of Medicine
Council of Medical Specialty Societies
Clinical Skills Evaluation Collaboration
Iowa Board of Medical Examiners
American Academy of Family Physicians
Santa Fe Institute, Los Alamos National Laboratory
College of Physicians and Surgeons of Saskatchewan
American Board of Surgery
South Carolina Board of Medical Examiners
Crozer Keystone Health System
Accreditation Council for Continuing Medical
Education
National Board of Osteopathic Examiners
American Association of Retired Persons
Coalition for Physician Enhancement
Blue Cross/Blue Shield Association
The Commonwealth Fund
North Carolina Board of Medicine
Federation of State Medical Boards
Citizens Advocacy Center
Steege Thomson Communication
American Board of Family Medicine
American Board of Internal Medicine Foundation
Oregon Board of Medical Examiners
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National Alliance for Physician Competence

• Why did it emerge?
• Public concern about safety, quality and
  competence of physicians
• Many initiatives, little coordination
• Risk that multiple MOC programs would be
  duplicative, burdensome
• Desire to create systematic approach to continued
  competence that serves physicians and public

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Threads in the Competency Framework

• Medical School Objectives Project
• ACGME Outcomes Project
• ABMS Maintenance of Certification
• FSMB Maintenance of Licensure policy
• Institute of Medicine Competencies
• Charter on Professionalism
• Good Medical Practice - UK

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ABMS Maintenance of Certification

• Replaced re-certification recognition of
  broader set of critical attributes
• Proposed 1999, approved 2001, transition 2005
• Embraced general competencies as measures of
  practice performance

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Maintenance of Licensure

• FSMB policy state medical boards should ensure
  physician competence at time of re-licensure
• Recommends approach based on ACGME/ABMS
  competencies, analogous to the ABMS MOC

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National Alliance for Physician Competence

• What are its goals?
• Stimulate ongoing dialogue across organizations
• Reduce bureaucracy and duplication
• Catalyze a continuum of competence
• Earn public trust

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Physician Accountability for Physician
Competence Summit
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• Question
• How will the healthcare community evaluate,
  measure and document for the public, the ongoing
  competence of a physician?

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http//innovationlabs.com/summit/
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Six Summits

• March 2005 developed possible future scenarios
• Dec 2005 explored implications of scenarios
  definition of competence idea for GMP notion of
  National Alliance for ongoing dialogue
• June 2006 developed framework for GMP
• January 2007 further development of GMP and
  exploration of concept of a continuum of
  competence Alliance to remain a voluntary
  coalition
• December 2007 focus on assessments, possible
  systems to document learning
• July 2008 revisions to GMP begin conditions
  appendix competence paradigm shift

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• What are the principles and values that describe
  a good doctor practicing under normal
  circumstances?

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Guide to Good Medical Practice USA

• Describes desirable characteristics of competent
  physicians
• Provides a common language and framework for
  thinking about competence
• A living document , will require frequent
  update
• Find it at www.gmpusa.org

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• Structure of Good Medical Practice-USA
• Six duties of the good doctor
• Specific behavioral expectations
• Patient perspective

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Some points for attention

• Explicit expectations for preventive care and
  cultural competency
• Expectations for counseling, educating patients
• Emphasis on skills of self-assessment and
  practice analysis
• Professional behavior
• Responsibility to add to body of knowledge
• Social responsibility

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Alliance Goals for GMP- USA

• Embraced by the profession, not imposed
• Inform design of educational programs
• Influence criteria for accreditation
• Framework for maintenance of certification and
  licensure
• Stimulate alignment along a continuum of
  competence

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Next steps

• Gather feedback on the GMP for next Summit
• Any behaviors critical to safe, competent medical
  practice missing?
• How might this document be used to improve
  physician education along continuum?
• To improve the fragmented regulatory system?
• Can you generally support the principles of the
  GMP-USA?

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• Other Streams of Work

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Conditions for Good Medical Practice

• Companion document to Guide to Good Medical
  Practice
• Identifies systems barriers to good medical
  practice
• Encourages physician leadership in addressing
  barriers
• Collaboration with other stakeholders critical

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Shifting Paradigm of Competence
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• For more information
• www.innovationlabs.com/summit
• Contact
• Carol Clothier
• Federation of State Medical Boards
• 817-868-4045
• cclothier_at_fsmb.org

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• Implications for Undergraduate Medical Education

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Utility Survey Summit Six

• Major uses of GMP-USA include
• Define goals for educational program
• Design learning activities
• Identify assessment methods
• Communicate core competencies
• Influence accreditation standards

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Potential Uses

• Inspire professional sense in pre-meds
• Add to admissions interviews
• Actively listen
• Honest and trustworthy
• Take care of own health
• Student learning about physician role
• Accountability to patients
• Conflicts of interest

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Potential Uses

• Added dimension to case discussions
• Sensitivity to individual patient characteristics
• Obtaining consent
• Faculty reflection at grand rounds
• What duties were hard to fulfill with this
  patient?
• Health care ecology course
• Responsibilities to society
• Their role in patient safety and quality

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• Its all about physician competence.