From Our International Exchanges

At its most recent meeting, the College of Physicians and Surgeons of Alberta (College) Council approved the following criteria for specialist recognition for internationally trained physicians:

• Four years postgraduate specialty training similar to training available in Canada

• Specialty certification from another jurisdiction (e.g., the Certificate of Completion of Training for a physician who completed postgraduate training in the United Kingdom)

• A full-time academic or public service appointment, or full-time position in an under-serviced Alberta community (e.g., recruitment by a health region to fill a Part 5 Special Register position)

• Successful completion of an assessment satisfactory to the Registrar

• Licensure in the Province of Alberta

Until the present time, physicians who met the above criteria but had challenged and failed the certification exams of the Royal College of Physicians and Surgeons of Canada were denied specialist recognition. These physicians could work in Alberta in the area of their specialty and training but were not entitled to bill as specialists. The newly approved criteria will correct that inequity. This change does not change the College’s registration or licensure standards — the only effect is with respect to category of billing. Neither does this change affect the College’s position as to the desirability of all specialists in Alberta achieving Royal College certification in their area of practice. Royal College certification is still necessary to achieve full licensure (and mobility) as a specialist. We have notified the Royal College of Physicians and Surgeons of Canada, the Alberta Medical Association, the regional health authorities and Alberta Health and Wellness of these criteria.

The College recently has received feedback regarding Council’s decision not to publish the name of Dr. A07, a physician who was suspended for poor prescribing, facilitating a patient’s addiction to narcotics and for using crack cocaine with the patient.

The feedback, both from physicians and the public, has been that the College should have named the physician, particularly in light of the fact the physician was suspended rather than struck from the practice of medicine.

As noted in the Registrar’s Report, the decision regarding whether or not a physician’s name will be published is solely at the discretion of the Council. Council may order publication when a physician is found guilty of unprofessional conduct and a penalty greater than a reprimand is issued. The feedback from Dr. A07 suggests both the public and the profession are seeking greater transparency around the discipline process.

The College will soon fall under the Health Professions Act (HPA), which mandates important changes about the public’s access to information about disciplinary hearings, including:

• Hearings are open to the public unless there is a valid reason to hold all or part of the hearing in private.

• The public can examine the decision and the record of the hearing, except for the part of the record that relates to a part of the hearing that was held in private.

• If a member’s practice permit is suspended, cancelled, or conditions are imposed as a result of discipline, this information must be made available to a member of the public upon their request.

Under HPA, the College will be posting upcoming hearing dates on their website. The information will include the name of the physician, the charges against him or her and the date of the hearing. Following the hearing, the decision will be posted on the website for the information of the profession and the public for 10 years.

Reprinted from the June 2007, Issue 135 online version of the Messenger, published by the College of Physicians and Surgeons of Alberta .

Since August 2005, the Clinician Assessment for Practice Program (CAPP) has conducted three assessments for International Medical Graduates who wish to practice family medicine in Nova Scotia. During this time, 129 candidates have been assessed and 31 candidates have been deemed eligible for a defined license by the College of Physicians and Surgeons of Nova Scotia. Twenty-three of these physicians are now in practice. These physicians have taken up general practice in communities including Truro, Amherst, Springhill, Annapolis Royal, Halifax, Coldbrook, Wolfville, New Glasgow, Bridgewater, Lunenburg, Yarmouth, Weymouth, Clare, Sydney and Glace Bay. CAPP is extremely grateful for ongoing support provided by the Nova Scotia Department of Health, the DHA Chiefs of Staff, the Learning Resource Center and Department of Continuing Medical Education at the Dalhousie University Faculty of Medicine. Special thanks go to the many family physicians who have served as mentors, examiners and external assessors for the program.

Approximately 680 members completed the College of Physicians and Surgeons of Nova Scotia (College) 2007 online survey that was distributed by e-mail in early February. The College thanks all members who supplied feedback. This year marked a record response rate of more than 34 percent. Overall findings suggest that respondents’ opinions of the College and its services remain largely positive. For example: Compared to five years ago, would you say the services the College provides you today have:

• Improved greatly/somewhat: 39 percent

• Remained the same: 58 percent

• Worsened greatly/somewhat: 3 percent

Compared to five years ago, would you say that your opinion of the College has:

• Improved greatly/somewhat: 31 percent

• Remained the same: 62 percent

• Worsened greatly/somewhat: 7 percent

The majority of the remaining quantitative and qualitative feedback was similarly favorable. Nevertheless, the College pays particular attention to critical feedback and suggestions for improvement. For example, a significant minority of open-ended feedback contained comments and concerns that deserve attention and/or explanation. The major themes of this feedback are listed below in order of their frequency. Each item is followed by a description of the situation and/or actions the College is taking:

The most prevalent theme in critical feedback related to concerns about the size of the annual license fee or to the College’s fiscal management. The College’s fees and finances are determined and overseen by Council, which consists of elected physicians, appointed physicians and public members. The College’s recent National Quality Institute Award of Excellence recognized the College’s high degree of fiscal responsibility. College fees are consistent with those charged by medical regulatory authorities across the country. Members who have specific concerns or questions about College finances are encouraged to contact their respective Council member.

Respondents suggested that the College become more publicly visible and/or pay more attention to explaining itself to its members. Others remarked that they had difficulty distinguishing between the College and organizations such as Doctors Nova Scotia, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada. While the College has made earnest attempts in all of these areas, more work is clearly needed and will take place in the coming year. In the meantime, members with questions about the College’s role and mandate may wish to consult “Ten things you always wanted to know about the College”, which appeared in the Winter 2000 Alert.

Nova Scotia Physician Achievement Review (NSPAR) Program is awaiting results from a program evaluation and survey of participating physicians. This research addresses the value that physicians place on NSPAR feedback, the actions that physicians have taken as a result of the review, and the availability of CME /CPD opportunities to meet the needs identified by the review. The research is also designed to identify perceived strengths and weaknesses in the program and to identify possible areas for improvement. For this reason, all physicians who have completed the NSPAR review process are encouraged to complete the follow-up survey and provide feedback.

The investigations department is involved in research with physicians and complainants to identify and implement process improvements. Developments in this area will be reported to members in the near future.

The College’s Clinician Assessment for Practice Program (CAPP) has been responsible for the placement of 23 defined licensees in communities across Nova Scotia. The result of a creative partnership between the College, the Nova Scotia Department of Health, Dalhousie University and Doctors Nova Scotia, CAPP exemplifies the College’s commitment to IMGs and to Nova Scotians.

The College does not tolerate rudeness by staff to any College member or client. This policy has been reiterated to all staff. College staff are obligated to show politeness and respect, and a have a right to expect the same from the individuals with whom they deal.

Several members have indicated that anonymous summaries of complaint investigations are particularly useful educational tools.

The College has a small staff and many demands, particularly during busy times of the year such as the December registration period. As part of its continuous quality improvement program, response times for most College functions are tracked and benchmarked. Efforts are underway to use technology and other cost-effective means to improve upon staff response times.

In the two years since online re-registration was introduced, some members have encountered occasional technical problems, such as the need to allow “pop-up” windows used by the re-registration website, difficulty entering new addresses on the online form and paying for more than one license at a time with the same credit card. Most such issues have been or soon will be resolved.

Reprinted from winter 2007 online version of Alert, published by the College of Physicians and Surgeons of Nova Scotia.

The General Medical Council (GMC) recently launched a consultation to find out how doctors and patients can best work together to make decisions about treatment. The GMC is seeking the views of patients and doctors about draft guidance that sets out principles for good practice in making decisions. The guidance will, for the first time, provide advice for doctors on how to communicate the risks and possible side effects of treatment with patients. It aims to provide doctors with a framework that can apply to the range of situations that they face in practice. The GMC’s consultation ran until Aug. 20, 2007.

The guidance, Consent: patients and doctors making decisions together will cover issues including the language and timing of discussions with patients and will explain how to handle difficulties such as uncertainty over the level or nature of risk. It will also reflect changes in the law, including the new legal safeguards for patients who lack capacity to make their own decisions which are outlined in the Mental Capacity Act 2005 (in England and Wales) and the Adults with Incapacity Act 2000 (Scotland).

Dr Edwin Borman, chair, Consent Review Working Group said, “Our draft guidance stresses that the act of getting the go-ahead for treatment is more than simply asking a patient to sign their name or tick a box. Consent is part of a wider decision-making process. The purpose of this guidance is to encourage doctors to re-think their approach to getting permission from patients for treatment. Doctors need to work with patients to ensure that both parties are fully informed before they make decisions. We hope that this guidance, once published, will help doctors understand what is expected of them. We’d like to hear from doctors and patients about what they think.”

The guidance will have an impact on all patients but in particular on those who may need support to make decisions about their care. As part of the consultation, the GMC are working with The Alzheimer’s Society, the Scottish Dementia Working Group and Age Concern in Northern Ireland to hold five workshops across the U.K. The aim of the workshops is to provide an informal opportunity for doctors, patients and their carers to discuss their views and concerns together.

At each event, doctors, people with dementia and their carers will be invited to participate in an acted scenario involving a person whose capacity to make decisions is fluctuating as a result of early-stage dementia. The real-life scenarios will take those involved through a range of medical situations — from a GP appointment to being treated in hospital following an emergency admission. The workshops will raise issues about how to approach discussions and look at what factors contribute to successfully working together to make joint decisions. The workshops are being scripted and performed by TheatreWorks, part of the National Theatre.

Neil Hunt, chief executive of the Alzheimer’s Society, said, “It is vital that people with dementia are involved in making decisions about their care and treatment. We hope these workshops will help ensure doctors are provided with the right guidance and support to make this possible. Sometimes people affected by dementia find it difficult to respond to written consultations so these workshops are a valuable and innovative way of hearing their views on this incredibly important issue.”

Four medical schools in the United Kingdom, for the first time, were able to award their own primary medical qualifications, as of June 13, 2007. The schools have completed a quality assurance program carried out by the General Medical Council.

The four schools include two new medical schools, University of East Anglia Medical School and Peninsula Medical School. Two existing medical schools, Warwick Medical School and Cardiff Medical School can now begin awarding degrees independently from their parent universities, having completed the GMC’s Quality Assurance Program. This brings the total number of medical schools as recognized in the Medical Act from 23 to 27.

Part of the GMC’s responsibility as the United Kingdom’s medical regulator is to set standards for basic medical education and to ensure that these standards are met. To do this the GMC regularly visits and assesses medical schools. New schools must pass the GMC’s thorough assessments before they can award degrees. The GMC sets the standard that students must demonstrate before they can award degrees. The GMC sets the standard that students must demonstrate to graduate but schools devise their own curriculum to enable medical students to put into practice the principles that the GMC expect of doctors throughout their careers.

Professor Peter Rubin, chair of the GMC Education Committee said, “We work closely with new medical schools, engaging them well before their first intake of students. Under our Quality Assurance for Basic Medical Education Program, we put the schools through a rigorous five-year assessment, taking account of developments in educational theory and research, and professional practice.” He continues, “For this we bring in a diversity of educational, lay and medical experts, who can highlight good practice and also share innovations in medicine across a range of specialist fields. ‘Tomorrow’s Doctors’, our guidance for medical schools, is designed to take a practical, outcomes-based approach, with emphasis on ensuring that medical students are going to be able to put into practice the principles laid out in ‘Good Medical Practice’, our core guidance for doctors.”

The GMC has pioneered a world-class quality assurance framework designed to drive high standards across medical education. It is in the interests of both doctors and patients that the U.K. has the highest quality of training and medical education which promotes equality and values diversity in order to prepare medical students for a career in medicine.

Reprinted from the General Medical Council website.

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