New Attendee Orientation

1. New Attendee Orientation Physician Accountability for Physician Competence Summit VI July 8-9, 2008

2. Overview • Background • Streams of work underway • Status of conversation • What to expect next week

3. Background • First summit held in March 2005 • Broad spectrum of stakeholders invited • Accrediting bodies, professional organizations, licensing boards, payers, insurers, specialty boards, medical schools, residency programs, public • Scenario planning selected as format • Question: How will the healthcare community evaluate, measure and document for the public, the ongoing competence of a physician?

4. Developing Scenarios • Identified trends and drivers influencing environment, healthcare, medicine • Examples • Growing sophistication of patients/public • Globalization of economy/healthcare • Role of government in healthcare • Rapid changes in technology and science • Aging population • Rising costs of healthcare • Spread of internet

5. Developing Scenarios • Used most critical and unpredictable trends to create five stories describing US healthcare system in 2020 • Techno Community Alliance • Data Cacophony • Federal Tarbaby • Brave New World • happyhealthcare.com

6. Developing Scenarios • Using most critical and unpredictable trends, created five stories describing US healthcare system in 2020 • Techno Community Alliance • Data Cacophony • Federal Tarbaby • Brave New World • happyhealthcare.com

7. By the End of First Summit There Was… • Consensus that • Status quo not acceptable • Collaboration will be critical to effecting change • Agreement to meet again, continue dialogue • Willingness to use scenarios as mechanism for involving organizations in the conversation

8. Status of PAPC Initiative • Five summits to date, sixth July 8-9 • A variety of conversations along the way • Used scenarios to understand implications of measuring competence from five perspectives • Explored ways that competence might be measured within each scenario • Considered how regulatory system might look if critical components were “taken away” • Probed how future regulatory system “ought” to look in an ideal world

9. Evolving Streams of Work • Good Medical Practice-USA • Improving coordination along continuum (e.g., discussions between licensing and certifying boards to improve interface) • “E-folios” • National Alliance for Physician Competence

10. Good Medical Practice - USA • Emerged from recognition of need for a common framework and language • Describes behaviors and values that competent physicians demonstrate under normal circumstances • Envisioned as a blueprint or guide for physicians and those who educate, license and certify them • Ongoing questions about purpose, utility, level of detail • Website set up to post “living” document and capture feedback – https://gmpusa.org/

11. Observations • People are staying at the table • Number of participating organizations is growing • Learning is critical to creating shared mental models and finding “breakthrough” solutions • “Self-organizing” style of work minimizes “hierarchy” and politics • Summits are fun, intellectually stimulating

12. Challenges • Keeping people at the table • Engaging broader audience • Practicing physicians • Public • Understanding real-life implications to practicing physicians • Politics • Demonstrating outcomes

13. Lessons along the way • Community, conversation, collaboration are critical to success • A “shared” mental model of what “ought” to be helps people stay focused on the vision • Individual champions important, but “organizational” commitment needed to sustain effort

14. Looking to the Future • Need take the time to build consensus and ownership • Continue to introduce diversity into the conversation • People will self-organize around issues about which they are passionate • Find “wins” early on • View issues from perspective of constituents

15. Medical Licensure American Association of Osteopathic Examiners Federation of State Medical Boards Iowa Board of Medical Examiners Kentucky Board of Medical Licensure Michigan Bureau of Health Professions North Carolina Medical Board Oregon Board of Medical Examiners South Carolina Board of Medical Examiners Virginia Board of Medicine Medical Education American Medical Association – LCME Association of Academic Health Centers Association of American Medical Colleges Coalition for Physician Enhancement East Tennessee State University Harvard School of Public Health Johns Hopkins Medical Institution Texas A&M Health Science Center UMDNJ School of Osteopathic Medicine University of Medicine and Dentistry of New Jersey University of Miami School of Medicine Physician Membership Organizations American Academy of Family Physicians American College of Cardiology American College of Physicians American Medical Association American Osteopathic Association College of Physicians and Surgeons of Saskatchewan Council of Medical Specialty Societies National Medical Association The Medical Society of Virginia Health Systems and Payors American Hospital Association Blue Cross/Blue Shield Association Blue Cross/ Blue Shield of Illinois Catholic Health Initiatives Crozer-Keystone Health System Specialty Certifying Boards American Board of Family Medicine American Board of Internal Medicine ABIM Foundation American Board of Medical Specialties American Board of Pediatrics American Board of Surgery AOA Bureau of Osteopathic Specialists American Osteopathic Board of Emergency Medicine Assessment/Accrediting Organizations Accreditation Council for Continuing Medical Education Accreditation Council for Graduate Medical Education Clinical Skills Evaluation Collaboration Educational Commission for Foreign Medical Graduates The Joint Commission Medical Council of Canada National Board of Medical Examiners National Board of Osteopathic Medical Examiners Foundations and Public AARP Agency for Healthcare Research and Quality Bridgekeeper Citizens Advocacy Center Commonwealth Fund Consumers Union Milbank Memorial Fund National Committee for Quality Assurance National Institute for Quality Improvement and Education Robert Wood Johnson Foundation Other Columbia Law School Medbiquitous Physician Insurers Association of America Santa Fe Institute, Los Alamos National Laboratory Steege/Thomson Communication Virginia House of Delegates Participants (to date)

16. Questions?