1. Knowledge is Power Enhancing Patient Care through Competence Assessment & Education
Bill O’Neill
Director, Communications and Outreach
CPEP
The Center for Personalized Education for Physicians

2. CE Information Learning Objectives Disclosure
Identify red flags or practice patterns that can be early indicators of poor or declining performance
Determine the best approaches to finding a solution
Implement processes or identify resources to support effective remediation while protecting patient safety
Disclosure
Speaker works for a non-profit in the competence assessment field

3. Medical Staff Services Professionals are…
Invisible when they do their job well
Front page news when a physician makes an error
Often THE continuity source in management of physician performance

4. Underperforming Physicians
What does the literature say?
U.S. study estimated that 6 – 12% of physicians were dyscompetent1
Canadian study of randomly selected physicians found 15% of FPs and 3% of specialists were practicing with considerable deficiencies2,3
1) J Contin Educ Health Prof. 2006 Summer;26(3):
2) Healthc Policy. 2009;42:141–160
3) CMAJ. 1990;143:1193–1199

5. Increasing Attention on Physician Quality
Focus on patient safety and quality
Expectation that physicians be held accountable for quality of care
Risk of negligent credentialing
Employed physicians
Increasing liability risk for hospitals
Quality concerns with newly acquired practices
Healthcare provider shortage
Need to retain doctors on staff
FPPE/OPPE processes
Use of performance data to evaluate performance and identify outliers

6. Alarm Bells Significant patient harm Multiple patient/staff complaints
Questions about procedural skills/decisions
Fitness for duty (following health issue)
Returning to practice after absence
Outside chart review identifies concerns

7. Times are changing - Before…
Peer review relied on primarily patient or staff complaints
Processes were variable
Objectivity was difficult
“He’s ok, I play golf with him every Wednesday”

8. Challenges to Self-Regulation
“Peer monitoring and reporting are the primary mechanisms for identifying physicians who are impaired or otherwise incompetent to practice, but data suggest that the rate of such reporting is lower than it should be.”
“… however, when faced with these situations, many do not report.”
17% (309) of physicians reported direct personal knowledge of a physician colleague who was incompetent to practice 
33% of those failed to report their colleague
Physicians’ perceptions, preparedness for reporting, and experiences relating to impaired and incompetent colleagues.. DesRoches, et al., JAMA. 2010;304(2):

9. Times are Changing - Today…
Implementing improved systems
Software systems compare physicians to peers or national data sets
Skills training available for physician leaders
Progressive levels of feedback and intervention becoming more common
Peer review increasingly presented as an educational process rather than punitive one

10. Common Model of Reporting
Medical Executive Committee
Care found appropriate?
Restriction of privileges?
Referral to CPEP or other resource?
Termination/Suspension
Peer Review Committee
Conducts deeper review of the case
Care found
appropriate
No further action
Medical QI Committee
Looks for possible trends
Conducts root-cause analysis
Reported Event, e.g.,
Patient complaint
Post-op infection
Readmission <30 days
Patient mortality

11. Importance of Early Intervention
If addressed early and effectively
Win-win situation for physician, medical staff and patients
If overlooked too long
Possibility of significant patient harm
Damaged relationships on staff
Legal consequences for hospital and physician

12. Resources for Intervention
FPPE process
Proctoring; chart reviews; consultations
External peer review or consultant visit
Health program evaluation
Voluntary remedial agreement (formal or informal)
Self-education plan
Research/report
Specific CME courses
Formal competence assessment/remedial education program

13. Resource Helps get Physicians Back on Track
Goals of Competence Assessment & Education
RESTORE physicians to safe clinical practice
RETAIN physicians on your staff
Help physicians REENTER practice after an absence

14. When to Consider an Assessment
Self referral
As part of credentialing process
As part of a voluntary remedial agreement
In anticipation of pending hospital review/investigation
As a provision of a disciplinary agreement
Prior to restoration of privileges

15. “Global” Nature of Assessments
Structured Clinical Interviews
Simulated Patient Encounters
Neuro-cognitive Screen
Procedure Simulations
NBME Exams
EKG or
Fetal Monitor
Exam

16. Benefits of External Assessment
Objective, third-party assessment removes even the perception of bias
Comprehensive assessment and report provide greater insight than chart reviews alone
Report can lead to an educational plan that can bring the participant back to safe, confident practice

17. Assessments & Educational Interventions
1) Diagnosis
2) Treatment
3) Post-test
Conduct comprehensive clinical competence assessment
Design and implement educational intervention
Determine effectiveness

18. Educational Intervention
Activities, intensity and length
Determined by areas of educational need
Impacted by participant motivation
Focus on application of knowledge to actual practice
Measurable performance objectives
Goal: Achieve and sustain improvements in practice
CPEP, The Center for Personalized Education
Assessment and Educational Intervention Program

19. Educational Plan Components
Common elements of an educational plan include
Medical Knowledge Enhancement
Evidence-based self study
Structured CME courses/activities
Point of Care Experience
May begin with direct supervision by preceptor
Progress through decreasing levels of supervision
Ultimately caring for patients independently
Pace of progress depends upon participant performance

20. Impact Competence Assessment Programs
Provide objective information to reach decisions about physician competence
Identify solutions to effectively remediate competence concerns
Focus on application of knowledge to practice and sustained improvement in care

21. Value of Assessment Programs
“[Program] provides experienced people to do a deep dive to figure out what is really going on with a physician… we are not going to find a colleague with the expertise or time to provide that kind of information.”
“We use these programs with the hope of saving a career and keeping a physician in our community…”
Lynn Stockton, Director, Medical Staff Services
Medical Center of Aurora

22. Competence Assessment Resources
FSMB Clinical Competence Assessment Resources
FSMB Directory of Physician Assessment and Remedial Education Programs
Coalition for Physician Enhancement

23. Who’s got questions? Thank You!! CPEP 222 North Person Street
Raleigh, NC 27601