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24 Mar 2015

Doctors could face more regular and stringent aptitude tests as part of proposals being considered by the medical profession regulator to make sure patients are shielded from sub-standard care.

The Medical Board of Australia has commissioned an international review of arrangements used by countries to ensure medical practitioners provide safe and ethical care throughout their professional career.

The review is the latest step in the Board’s plan to address concerns that the current regime may not be rigorous enough.

While Australian doctors must meet registration standards and participate in continuing professional development activities, the Board has pointed to the results of Canadian research to suggest that the performance of more than 1350 currently registered Australian practitioners might be unsatisfactory.

 “We started a conversation about revalidation in Australia in 2012 as part of our commitment to making sure doctors…maintain the skills to provide safe and ethical care to patients throughout their working lives,” Medical Board Chair Dr Joanna Flynn said. “Commissioning this research will help make sure that the decisions the Board makes in future about revalidation are effective, evidence-based and practical.”

Proposals to introduce a revalidation scheme in Australia are controversial, with concerns it will impose a regulatory burden on the medical profession out of all proportion to the scale of the problem.

Dr Flynn told the AMA National Conference in 2013 that of 95,000 registered practitioners in Australia, less than 5000 were the subject of complaints each year, and only a small number of these were upheld and resulted in regulatory action. The Conference was told that just 3 per cent of doctors were the source of 49 per cent of complaints.

But she said the complaints system by itself was not sufficient to provide assurance that all practising doctors were competent, citing examples where doctors continued to work despite being the subject of multiple complaints.

Dr Flynn told the conference that to maintain the trust of the public, the medical profession had to accept the need for a system that verified the competence of practitioners.

“We will need to do something beyond what we are currently doing,” Dr Flynn said, adding that claims that CPD programs provided sufficient assurance were unconvincing.

“Can you assure me that everyone who has done your CPD program is actually competent and practising at a reasonable standard?” she asked. “My sense is that, for most CPD programs, they don’t do that, or at least, not to a high enough level of certainty.”

The regulator said the Medical Board did not have any preconceived ideas about what an Australian revalidation system would look like.

In 2012, Dr Flynn said many countries had begun to undertake more formal cyclical processes of revalidation for doctors, and the Board needed to consider if current arrangements were sufficient or “do we need to take on the bigger challenge and…devise an evidence-based, multifaceted, valid and cost-efficient way to ensure that every registered practitioner demonstrates that they continue to be able to meet the standards that both the profession and the community expect? It is time to begin that conversation.”

The Board has commissioned the Collaboration for the Advancement of Medical Education, Research and Assessment at Plymouth University Peninsula Schools of Medicine and Dentistry to conduct the research.

In particular, it has asked the researchers to assess evidence about the effectiveness of revalidation regimes in countries similar to Australia, identify best practise and any gaps in knowledge, and propose a range of models for possible adoption.

The Board is due to receive and consider the study in the second half of the year.

Adrian Rollins

 


Published: 24 Mar 2015