September 6, 2012
Highlights of 2011 on Video; Mandatory and Permissive Reporting; Delegation of Controlled Acts; Policy Rescinded; Draft By-Law Consultation; Physician Council Members and Conflicts; High marks for re-training course for FPs; Criminal Record Screening
Highlights of 2011 on Video
Why is self-regulation the best model for medical governance in Ontario? Watch our new 2011 Annual Report video and see the many reasons why medical self-regulation continues to thrive.
You can go to our website to watch the video of our key accomplishments last year and download a PDF version of the report. Don’t miss the interviews with our President, Vice-President, Public Member of Council and the Registrar.
We are proud of the work done in 2011. We believe it will provide a solid foundation for medical self-regulation for years to come.
Mandatory and Permissive Reporting
Following external consultation, Council has approved an updated policy that sets out the circumstances under which physicians are required or permitted to report particular events or clinical conditions to the appropriate government or regulatory agency.
The revised policy includes changes to improve clarity of content, and to provide information on important resources. Also, revisions have been made to accurately reflect current statutory language, and to address practical issues flagged by those agencies who receive reports.
Notably, the College’s expectations with respect to physician reporting of potentially incompetent or incapacitated colleagues have been clarified. This includes revisions to provide physicians with guidance on what may constitute appropriate action if a colleague’s pattern of care, health or behaviour poses a risk to patient safety. The policy also encourages physicians to inform patients, who may be unfit to drive for medical reasons, prior to making a report under the Highway Traffic Act. In circumstances where this is not possible, the College recommends that physicians do so after the report has been made.
We will publish the policy and an article about the updated policy in the next issue of Dialogue. And make sure you read the next Doc Talk column that provides guidance for physicians in speaking with a patient who may be unfit to continue driving. View revised policy online.
Delegation of Controlled Acts
After an external consultation, Council approved the updated Delegation of Controlled Acts policy.
The revised policy is based on the same foundational principles as its predecessor, but includes greater clarity and further guidance in key areas such as delegation of psychotherapy, delegation to unregulated individuals, and informed consent for delegation.
The policy and an article about the revised policy will be in the next issue of Dialogue. View revised policy online.
The Shadowing – Observing Physicians in a Clinical Setting policy has been rescinded. The “Shadowing” policy had addressed the practice of allowing internationally trained medical graduates to observe patient care in clinical settings. That relevant content is now captured in the revised Delegation of Controlled Acts policy.
Draft By-Law Consultation
The College has identified a need for adverse events reporting in the Out-of-Hospital Premises Inspection Program. Through the completion of assessments, previous experience and discussion, it has been determined that out-of-hospital premises should be required to report adverse events to the College for the purpose of protecting patients, maintaining public confidence and monitoring quality improvement in these facilities.
The College has developed a “two-tiered” system for the reporting of adverse events. We have developed a proposed by-law for the reporting of sentinel events (Tier 1 events). Tier 2 events will be tracked by the premises for quality improvement purposes and reported to the College on an annual basis.
Tier 1 events include: death within the premises; death within 10 days of a procedure performed at the premises; any procedure performed on wrong patient, site or side; and transfer of a patient from the premises directly to a hospital for care. A proposed list of Tier 2 events include: the number and type of infections occurring in the premises; an unscheduled return to the procedure room for an unexpected event; an unplanned stay at the premises for medical reasons that is longer than 12 hours post-procedure; or an unscheduled treatment of a patient in a hospital within 10 days of a procedure performed at a premises.
View backgrounder and the proposed by-law. We will also circulate the proposed by-law needed for the reporting of Tier 1 events in the next issue of Dialogue, and will include an article that details the proposed reporting system.
Physician Council Members and Conflicts
The College has dedicated itself to developing best practices in its governance and election protocols.
At its meeting, Council approved by-law amendments to address potential concerns with Council members who may have conflicts of interest with their role at the College. See updated by-law.
There was concern that existing provisions in the by-law were insufficient to deal with Council members who have conflicts with roles or positions held on physician advocacy organizations. Council made changes to the by-law and other governance processes to better govern this area.
The language used in the by-law is intended to convey explicit concern with a competing fiduciary obligation. In conjunction with this initiative, Council and committee members will provide annual disclosure of external board and work involvement that may pose a conflict of interest by virtue of having competing fiduciary obligations to the College and the other organization. See revised Declaration of Adherence forms in the Governance Process Manual.
Further, it is also proposed that a conflict declaration be incorporated as part of the district election process for all nominated candidates.
High marks for re-training course for FPs
At its meeting, Council was presented with the details of a one-of-a kind “refresher” program designed to equip primary care physicians with high quality skills for 21st century practice.
At its meeting, Dr. Alan Monavvari and Dr. Kate Hodgson, program co-directors of the University of Toronto’s Comprehensive Family Practice Review (CFPR) said that the program – the first of its kind in North America – was earning high marks from participants and leading to what appeared to be lasting changes in day-to-day practice.
The CFPR, which is in its third year of operation, has adopted the CanMEDS framework of competencies as a means of organizing the curriculum. Within the program, physicians are taught the skills needed to thrive in the roles of: Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. There is an additional stream to develop computer and Internet skills in web-based learning sessions, addressing several CanMEDS competencies.
The CFPR Program has been extensively evaluated and participants' learning outcomes have been assessed at multiple levels over the past two years. This program is rated consistently by the past and present participants as exceptional.
Most of the physicians in the course appear to be from two main camps, said Dr. Hodgson. There are those who take the course after deciding to return to family practice after a prolonged absence and those who wish to change their scope to family practice. Additionally, course organizers were delighted to discover a significant percentage of course participants take the course solely after self-reflection and a desire to update their practice. Read more about the CFPR Program.
Council members appeared heartened by the success described by the co-directors. There has been a well-recognized absence of formal retraining programs for physicians in practice. As such, the College has often been left with the challenge of developing ad hoc educational programs for each physician with an identified need.
Criminal Record Screening
Council has made minor housekeeping amendments to the College’s Criminal Record Screening policy.
The housekeeping amendments entail a number of minor, non-substantive changes to the policy to ensure it more accurately reflects the College’s current practices with respect to criminal record screening of physicians.
Read the updated policy on the College’s website.