Physician Accountability for Physician Competence: Summit VI

The Alliance for Good Medical Practice


The National Alliance for Physician Competence Summit was held on July 7-9, 2008 in Baltimore, MD (this was previously known as the Physician Accountability for Physician Competence Summits).

The primary question behind each of the Summits held to-date is: How will the healthcare system determine, measure, evaluate, and assure the public of a physician’s competence through the course of his or her professional career?

Summit VI was a time for making substantial moves forward. The first day of the Summit employed three intense rounds of work in small groups to re-immerse the participants in the work that has been underway over the past five Summits. The rounds also allowed for the polishing and synthesis of various models and documents so that they could be presented to the whole group in plenary for final adjustments and consensus (good enough for now). The first round of work asked all of the participants to develop models that described the shift in the paradigm for Competence. Each of nine teams looked at the shift from different perspectives: UME-GME, CME, Specialty Boards, Licensing Boards, Payers-Purchasers, Health Care Organizations, Patients-Family-Consumers, Physicians in Practice, and Program Accreditors. Later in the day a team rolled the nine models up into a single model that described fourteen components of the shift in competence between now and some point in the future. This model will play an important role in the future work of the Alliance, as it provides many opportunities for concerted thought and action to help move the paradigm shift along.

The second round of work focused on Good Medical Practice (GMP). Ten teams focused on various aspects. One team summarized the shift models as described above. A second team reviewed version 0.2 of the document to adjust the wording to align better with the intended use of the document. A third team imagined an alternative to GMP and in so doing generated several suggestions for the current document. They also added the idea of linking the GMP to cultural change in the system that is reflected in the Shift in Competence model. A fourth team worked on the evolution of the GMP and proposed a "go live" date of September 21, 2008, at which point the participants in the Alliance would be ready to distribute the document along with a cover letter for structured feedback. They also reinforced the need to think of GMP as a living document. The fifth team generated some exciting ideas for GMP pilots at the statewide level. Team six talked about how to use GMP in a pilot program  in general.  Team seven looked at how Licensing Boards might use GMP. Teams eight and nine focused on the NBME Survey that could be used to gather feedback on each of the bullets within what is currently Appendix 1 of the GMP document. They provided some feedback on the tool and generated ides on how it should be used in the future. The tenth team listed some general guidelines for the use of the GMP document and recommended that no separate guidebook needed to be created.

The third round of work focused on the Alliance and the eFolio project. Once again, ten teams were formed to look at various aspects. The first team reviewed the Alliance Participant Agreement that was created in the last summit. Team two updated a Human Resources plan to support the Alliance--in particular to help guide and support the increasing volume of work that is beginning to happen between summits. The third team reviewed a draft of a potential website for the Alliance. A fourth team created a model for how the Alliance makes decisions. Teams five, six and seven worked on the eFolio framework, and ideas for data sharing infrastructures and what role the Alliance might play in working on these. Team eight developed a first draft of a model of the larger system conditions that should change in order to enable GMP. The GMP document, Shift in Competence Model and System Conditions model make a nice collection of models to both describe system wide change on various levels and help the Alliance understand and select new scopes of work in the future. Team nine continued a final review of the GMP document from the previous round and team ten continued the development of a plan for dissemination of the GMP document.

After these three rounds, the group as a whole was prepared to move forward.

The last day of the Summit began with a number of reports and detailed discussion on the work that was done the previous day. The GMP document--renamed as the Guide to Good Medical Practice USA--was approved with what became known as a sense of the commons. Some areas of disagreement were noted and will be addressed in sidebars in the final document so that everyone who comments on the document can see the issues and also get a reinforced sense that the document is a living document that welcomes various opinions and creative tension as it moves forward. There was also a brief presentation on the IPIP project as an example of the overall shift to a culture of continuous learning and improvement.

The reports and discussion were followed by one final round of work in teams. A dissemination plan was agreed to. The revised Alliance Participant Agreement was presented and approved by a sense of the commons. Another team worked on some parameters for the next summit, which is tentatively scheduled for February 2009 to allow the first round of feedback on the GtGMP-USA document to be collected and analyzed.

Three teams also began to think ahead to the next scope of work that the Alliance might take on. One team listed a number of examples of interesting projects and initiatives out there that we could learn from and possibly tie into future work on Systems Conditions, Shift in Competence or as applications for the GtGMP-USA document. Another team expanded on the System Conditions for Good Medical Practice, which implies stronger, broader and deeper relationships with a more varied set of stakeholders from across the entire system. The third team discussed and seven possible next steps for the Alliance to take with respect to the Shift in Competence model.


If you have any questions regarding the material posted here please contact Carol Clothier at 817.868.4045 or Michael Kaufman at 510.903.0652.

We would like to acknowledge the following organizations for their contribution to making this conference a success: