Competency Based Licensure and Implications for Continuing Medical Education

1. Competency Based Licensure and Implications for Continuing Medical Education James N. Thompson, MD President and CEO

2. Overview • The Federation of State Medical Boards • Organization, services, and programs • State Medical Boards • Current mechanisms to assess competence • Use of CME • Trends in Medical Licensure • Initiatives to enhance competency assessment • Implications for CME

3. FSMB – The Organization • 70 member state medical boards • Non-Profit Association since 1912 • Located in Dallas/Fort Worth • Improving the quality, safety and integrity of health care through the development and promotion of high standards for physician licensure and practice

4. FSMB – Services and Programs • Examination and Post-Licensure Assessment Services • Federation Credentials Verification Service • Physician Data Center • Policy development, education, publications, legislative, and library services

5. FSMB - Policy Development • FSMB develops model policy to assist medical boards in protecting the public, available at www.fsmb.org: • License portability • Office-based surgery • Complementary and Alternative Medicine • Internet prescribing • Pain management • Model medical practice act

6. State Medical Boards - • Current Mechanisms to Assess Physician Competence • Initial Licensure • United States Medical Licensing Examination • Credentials Verification/Disciplinary History • License Renewal/Reregistration • Periodic (annual or biennial) • Continuing medical education • Post-licensure • Complaints and reports from peers, external entities • Post-licensure assessment system • Physician health programs

7. Continuing Medical Education • State Medical Boards use CME for the purposes of -- • Licensure • License renewal • Demonstrates physician’s commitment to competence • Discipline • Remediation of identified deficiencies

8. Continuing Medical Education • 56 of 70 medical licensing boards require physicians to engage in CME for purposes of license reregistration • Variance among jurisdictions • Number of hours • Content specific • Accrediting organizations • Exemptions

9. Shifting Priorities • Deficiencies of current system • Reliance on CME to assure competence after initial licensure • Reactive vs. proactive • Process vs. outcome • Lack of collaboration • Recognition of need for change to better protect the public

10. Competence Competence —Possessing the requisite abilities and qualities (cognitive, non-cognitive, and communicative) to perform effectively in the scope of professional physician practice while adhering to professional ethical standards. FSMB Policy: “Quality of Care & Maintenance of Competence” (1999)

11. Enhancing Medical Licensure • Initiatives • USMLE 2 Clinical Skills • Beginning Summer 2004, the national medical licensing examination will include a test of clinical and communication skills to complement the already rigorous assessment of medical knowledge.

12. Medical Board Initiatives • Nevada State Board of Medical Examiners • Proposed set of rules released (May 2003) • Proposal to be finalized late 2003 • Medical Board of California • Discussions regarding recertification of physician licenses initiated in 1997 • Texas State Board of Medical Examiners • Adoption of resolution supporting establishment of a requirement for periodic demonstration of current competence by licensees (2002)

13. Changing CME Requirements • An increasing number of states have content-specific requirements • Scope of practice of specialty • Pain management/EOL care • HIV/Aids • Risk Management • Medical errors/patient safety • Medical ethics

14. Implications for CME • In light of current environment focusing on patient safety and ongoing physician competence, it is imperative for stakeholders to critically evaluate how CME can be restructured to better effect physician performance and improve patient outcomes

15. CME: a new paradigm • Evidence-based, current, objective, self-directed, interactive • Objective measurable outcomes – provide data that evidences positive practice changes • Be an integral, positive element of a physician’s practice involvement in lifelong learning and maintenance of competence

16. CME: a new paradigm • Support the full range of physician’s duties and responsibilities, including participation in systems • Credible mechanism for public assurance of continual maintenance of competence

17. James N. Thompson, MD President and Chief Operating Officer PO Box 619850 Dallas, TX 75261-9850 Tel: 817.868.4060  Fax: 817.868.4097 Email: jthompson@fsmb.org