International Briefs

Three key agencies involved in medical regulation in Canada have announced they are launching a new process for foreign-trained physicians who want to apply for a medical license in that country — with the goal of streamlining and simplifying the process electronically.Human Resources and Skills Development Canada (HRSDC), the Federation of Medical Regulatory Authorities of Canada (FMRAC) and the Medical Council of Canada (MCC) will collaborate on the new process, which will allow physicians to apply for a medical license electronically to multiple locations in Canada, and support their application by providing access to credentials stored in a national repository.“This investment is part of the federal government's overall action plan to work with the provinces and territories to ensure that licensing bodies put in place better programs to recognize foreign credentials,” said Citizenship, Immigration and Multiculturalism Minister Jason Kenney.Currently, physicians must complete a separate application for each province or territory. Once the new process launches, they will be able to apply through a simplified, electronic system to multiple regulatory authorities.“FMRAC and its members have been working diligently to streamline requirements across the country for physician licensing by developing national standards,” said Dr. Bill Lowe, President of FMRAC. “The new national standards will enable regulators to better facilitate physician mobility.”The application process will build on the MCC's Physician Credentials Repository, which gathers, verifies and permanently stores electronic copies of physicians' credentials.“Once the application for medical registration launches in 2012, the process to apply for a medical license will become much easier,” said Dr. Trevor Theman, Vice-President of the MCC. “Physicians will only have to submit a pre-populated electronic application and provide access to authenticated credentials.”Source: Medical Council of Canada news release, September 2010The United Kingdom's General Medical Council (GMC) has published a summary of input from various stakeholders in Scotland on its proposed transition to a new system of re-licensure of physicians, known as “revalidation.”The 60-page report, titled “Revalidation: The Way Ahead — Response to Our Revalidation Consultation,” provides extensive analysis of input from physicians, patients, nurses and a range of other health care professionals and health care organizations on how revalidation should be structured and implemented in the UK.Like many countries globally, the various nations of the UK are working to transform their system of licensure to provide a stronger environment for lifelong learning and maintenance of skills.The UK's revalidation efforts are built on principles similar to the effort under way in the United States to establish a Maintenance of Licensure (MOL) system.According to the GMC, the purpose of revalidation is to “assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and are practicing to the appropriate professional standards. Although it is widely understood that the delivery of medical care to patients will always involve an element of risk, revalidation will help doctors, employers and the GMC to provide further assurance to patients and the public that doctors working in the UK are fit to practice.”When revalidation is introduced, doctors who want to maintain their license will be required to demonstrate their ability to practice to the GMC periodically, by participating in a comprehensive system that evaluates performance. The proposed revalidation cycle calls for physicians to go through the process every five years, but the GMC stresses that it won't be a single “point-in-time assessment.” Rather, skills will be assessed through a “continuing evaluation of a doctor's practice in the place in which the doctor works.”A key part of the UK's strategy in moving toward revalidation was the creation of a “consultation” with stakeholders on various issues and aspects of the transition to a re-licensure system. Between March and June of 2010, the GMC received nearly 1,000 responses from its stakeholder groups. Feedback was received formally, as well as during a series of public events held across the UK.More than 70 percent of the responses were from individuals, with the remainder from organizations. Nearly 80 percent of those who responded were physicians.In announcing publication of the report, GMC said that its consultation with stakeholders showed considerable support for many of its proposals for a revalidation system, but that “there are still some genuine concerns about the process of revalidation and how it will be introduced.”“The message we heard consistently was that it must be straightforward and proportionate and must not place excessive burdens on doctors or employers,” said Sir Peter Rubin, GMC Chair. “We are committed to reviewing the proposals in the light of the responses and we are determined that revalidation should add value for both patients and doctors and must be workable in the pressured and busy environments in which most doctors work.”According to the report, five key themes emerged during the consultation process. These included:In response to the fifth theme — the need for more testing and evaluation — an additional year of testing in England has been announced by the Secretary of State for Health, which GMC said will provide “an opportunity to gather further information about the practicalities, costs and benefits of the process,” and “to widen the scope of current testing to evaluate if the model is feasible and applicable for doctors working across different environments and with varied work patterns.”Other principles that have been adopted as fundamental to the revalidation include creating a system that:According to the report, results of the four-month consultation indicated a preference for rolling the system out in stages throughout the United Kingdom. “We also remain of the view that revalidation should be introduced and rolled out incrementally, and that there should not be a ‘big bang’ approach. Different regions and different organizations will be ready at different times and it makes no sense to wait for the slowest to be ready before its introduction,” the report states, concluding: “In any event, revalidation will evolve as it is implemented, and over time, in response to ongoing evaluation, quality assurance and a more established evidence base, all of which support a phased introduction.”The GMC has begun testing how revalidation might work in practice. Pilot projects have begun across the UK, involving “thousands of doctors working in different specialties and sectors,” according to the report. The GMC will use results from these projects to modify or fine tune elements of the revalidation plan.The GMC approach to implementing revalidation is geared towards ensuring the new system is well-thought-through and tested before pressing for its adoption. “Revalidation should only be rolled out when local healthcare organizations are ready and local systems of appraisal and governance are in place and sufficiently robust,” the report recommends.The report also touches on the need for better information technology systems in order to effectively implement revalidation — a need that is also being expressed as the United States explores an MOL system: “Because revalidation is concerned with how doctors perform in practice, workplace systems of clinical governance and appraisal need to be sufficiently mature to enable doctors to collect the information they need for their revalidation and for that data to be properly evaluated in the workplace,” the report concludes.For more information about the UK's revalidation effort, visit www.gmc-uk.org. To download a copy of the report, visit www.gmc-uk.org/doctors/revalidation/5786.asp.Source: GMC website, October 2010

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