Knowledge is PowerEnhancing Patient Care through

Competence Assessment & EducationBill O’Neill

Director, Communications and Outreach

CPEP

The Center for Personalized Education for Physicians

• Learning Objectives• 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

CE Information

• 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

Medical Staff Services Professionals are…

• 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

Underperforming Physicians

1) J Contin Educ Health Prof. 2006 Summer;26(3):173-91.

3) CMAJ. 1990;143:1193–1199

2) Healthc Policy. 2009;42:141–160

• 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

Increasing Attention on Physician Quality

• 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

Alarm Bells

• 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”

Times are changing - Before…

• “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

Challenges to Self-Regulation

Physicians’ perceptions, preparedness for reporting, and experiences relating to impaired and incompetent colleagues.. DesRoches, et al., JAMA. 2010;304(2):187-193

• 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

Times are Changing - Today…

Common Model of Reporting

Reported Event, e.g.,• Patient complaint• Post-op infection• Readmission <30 days• Patient mortality

Medical QI Committee• Looks for possible trends• Conducts root-cause analysis

Peer Review Committee• Conducts deeper review of

the case Care found appropriate

No further action

Medical Executive Committee

• Care found appropriate?• Restriction of privileges?

• Referral to CPEP or other resource?• Termination/Suspension

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

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

Resource Helps get Physicians Back on Track

RESTORE physicians to safe clinical practice

RETAIN physicians on your staff

Help physicians REENTER practice after an absence

Goals of Competence Assessment & Education

• 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

When to Consider an Assessment

“Global” Nature of Assessments

Neuro-cognitive Screen

Simulated Patient

Encounters

Structured Clinical

Interviews

NBME ExamsProcedure

Simulations

EKG orFetal Monitor

Exam

• 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

Benefits of External Assessment

Assessments & Educational Interventions

1) Conduct comprehensive clinical competence assessment

2) Design and implement educational intervention

3) Determine effectiveness

1) Diagnosis 2) Treatment 3) Post-test

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 EducationAssessment and Educational Intervention Program

• 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

Educational Plan Components

• 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

Impact

“[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 ServicesMedical Center of Aurora

Value of Assessment Programs

• FSMB Clinical Competence Assessment Resources• http://fsmb.org/licensure/spex_plas/plas_clinical

• FSMB Directory of Physician Assessment and Remedial Education Programs

• http://fsmb.org/Media/Default/PDF/USMLE/RemEdProg.pdf.pdf

• Coalition for Physician Enhancement• http://cpe.memberlodge.org/

Competence Assessment Resources

Who’s got questions?CPEP

222 North Person StreetRaleigh, NC 27601

919-238-6436www.cpepdoc.org

Thank You!!