How will we judge fitness-to-practise?

3 minute read

Medical Board reforms to ensure fitness-to-practise are underway


The Medical Board of Australia is asking doctors to help shape new proposals for professional development and screening of “at-risk” doctors under a revalidation plan revealed on Tuesday.

MBA Chair Dr Joanna Flynn said the board intended to introduce reforms next year to strengthen professional education and early detection of doctors who might be at risk of slipping below professional standards.

“Many, many doctors are practising well into older age but some of them, for a range of reasons, are slipping down,” Dr Flynn said, releasing an interim report by the board’s expert advisory group on revalidation.

But she said the reforms would be thrashed out via consultation with the profession, including the board’s first online discussion forum, adding they needed to be “practical, effective and evidence-based”.

“Most of the practitioners in the at-risk groups will be able to demonstrate that they are performing satisfactorily, just as most people who are screened in a public health intervention do not have the disease for which the screening program is testing,” Dr Flynn said.

The interim report outlines a “two by two” approach – recommending a revamp of CPD and ways to “proactive identification and assessment” of poor performers, with consultations to continue this year and a pilot scheme to be adopted in 2017.

“CPD alone, however rigorous, may not identify the practitioner who is putting the public at risk,” it said.

As a guiding principle, the strengthened CPD regime should “increase effectiveness but not require more time and resources”.

The report said all countries had a small proportion of doctors who were not performing to expected standards, while another group was at risk of poor performance.

“Developing accurate and reliable ways to identify practitioners at risk of poor performance and remediating them early is critical, with considerable transformative potential to improve patient safety,” the report said.

To this end, the board would also investigate how to deal with privacy barriers that block information-sharing among agencies.

It also needed to define who was responsible for reporting poorly performing practitioners to the regulator and who was responsible for supporting and remediating doctors who did not meet a threshold for regulatory referral.

Referring to overseas experience, the report conceded  little was known about the effectiveness of remediation programs in improving doctors’ performance.

“The current knowledge-base about remediation processes and outcomes is not as well developed  as knowledge about performance assessment, and is fragmented and diverse,” it said.

The RACGP had yet to comment on the report, saying the implications were still being digested.

The report and a discussion paper are available here.

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