2007 Annual Conference Continuing Competence: An Initiative to Measure and Inform Melanie Brim Michigan Bureau of Health Professions

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Practice Specialty 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, BOSACCME CME Patients, Payors, Insurers, JCAHO License Renewal State Medical Board

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Medical Profession Public/ Consumers/ Patients Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Medical Profession Public/ Consumers/ Patients Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Medical Profession Public/ Consumers/ Patients Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Public/ Consumers/ Patients Social Contract The Medical Profession

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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?

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Five Phases of Scenario Planning Gather data Assimilate and analyze Develop scenarios Discuss implications Develop action plan

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Summit 1 - Process Significant events over the last 100 years Key factors/driving forces over next 15 years Generate scenarios to explore possible futures

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Creating Scenarios Use two most “uncertain” and most “critical” trends to create scenario matrix More government Strong economy Less government Weak economy

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Physician Accountability for Physician Competence Summits

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Speaker Contact Information Melanie Brim Director, Bureau of Health Professions Michigan Department of Community Health P.O. Box Lansing, MI

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 2007 Annual Conference Continuing Competence: An Initiative to Measure and Inform Stephen G. Clyman, M.D. National Board of Medical Examiners

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation GMP-USA Documentation Of Achievement.. Assessment Continuous Improvement V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Continuous Improvement Assessment GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O Trusted Agent DATA COMP ILA TION

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O DATA COMP ILA TION Practitioner State Medical Board

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O DATA COMP ILA TION

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Practice Audit Longitudinal Observation Competency-Format Mapping Tool Class GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Longitudinal Observation MSF Chart Audit Competency-Format Mapping Tool Class Specific Tool GMP-USA Documentation Of Achievement Practice Audit.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Tool Class Specific Tool Longitudinal Observation MSF Chart Audit Practice Specific Customization Competency-Format Mapping GMP-USA Documentation Of Achievement Practice Audit.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Practice Audit Longitudinal Observation MSF Chart Audit Competency-Format Mapping Assessment Tool Class Specific Tool Practice Specific Customization GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Assessment Continuous Improvement Tool Class Specific Tool Practice Specific Customization GMP-USA Documentation Of Achievement.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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 Documentation Of Achievement.. V I R T U A L P O R T F O L I O

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Speaker Contact Information Stephen G. Clyman, M.D. Executive Director, Center for Innovation National Board of Medical Examiners 3750 Market Street Philadelphia, PA

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 2007 Annual Conference Continuing Competence: An Initiative to Measure and Inform David Watt, M.D. Federation of State Medical Boards

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Participants Medical Licensure Federation of State Medical Boards Iowa Board of Medical Examiners Kentucky Board of Medical Licensure Michigan Bureau of Health Professions North Carolina Medical Board Oregon Board of Medical Examiners South Carolina Board of Medical Examiners Virginia Board of Medicine Medical Education American Medical Association – LCME Association of Academic Health Centers Association of American Medical Colleges Coalition for Physician Enhancement East Tennessee State University Harvard School of Public Health Texas A&M UMDNJ School of Osteopathic Medicine University of Medicine and Dentistry of New Jersey University of Miami School of Medicine Physician Membership Organizations American Academy of Family Physicians American Medical Association American Osteopathic Association College of Physicians and Surgeons of Saskatchewan Council of Medical Specialty Societies The Medical Society of Virginia Health Systems and Payors American Hospital Association Blue Cross/Blue Shield Association Blue Cross/ Blue Shield of Illinois Catholic Health Initiatives Crozer Keystone Health System Specialty Certifying Boards American Board of Family Medicine American Board of Internal Medicine American Board of Internal Medicine Foundation American Board of Medical Specialties American Board of Surgery American Osteopathic Association American Osteopathic Board of Emergency Medicine Assessment/Accrediting Organizations Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education Clinical Skills Evaluation Collaboration Educational Commission for Foreign Medical Graduates The Joint Commission Medical Council of Canada National Board of Medical Examiners National Board of Osteopathic Medical Examiners Foundations and Public AARP Agency for Healthcare Research and Quality Bridgekeeper Citizens Advocacy Center Commonwealth Fund Consumers Union Milbank Memorial Fund National Committee for Quality Assurance Robert Wood Johnson Foundation Other Columbia Law School Physician Insurers Association of America Santa Fe Institute, Los Alamos National Laboratory Steege Thomson Communication Virginia House of Delegates

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Public/ Consumers/ Patients Social Contract Medical Profession

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation AMA Public/ Consumers/ Patients CMSS AAMC ACGME JCAHO AHA NBME ECFMG ABMS FSMB ACCME ABIM ACS SMBs ACP CMS BC/BS Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation AMA Public/ Consumers/ Patients CMSS AAMC ACGME JCAHO AHA NBME ECFMG ABMS FSMB ACCME ABIM ACS SMBs ACP AARP CU Public Voices CMS BC/BS Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Public/ Consumers/ Patients National Alliance for Physician Competence Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Public/ Consumers/ Patients National Alliance for Physician Competence Social Contract

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation National Alliance for Physician Competence Public/ Consumers/ Patients Social Contract Definition of Competence – Good Medical Practice – USA Training Level/Specialty Translators Lifelong Learning Portfolio Tools/Analyses/Measures

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation 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

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Next Steps Summit V – December 6-7, 2007 –Good Medical Practice document –National Alliance –Technology/assessment tools

Atlanta, Georgia 2007 Annual Conference Council on Licensure, Enforcement and Regulation Speaker Contact Information David Watt, M.D. Vice President, Professional Affairs Federation of State Medical Boards P.O. Box Dallas, TX