Improving the standard of medical practice

In recent years the regulatory authorities and the Royal Colleges have been paying more attention to the maintenance of practice standards in the medical profession. This is as it should be. If commercial pilots were incompetent or impaired, disasters could occur, so there are procedures in place to ensure that appropriate standards are met. Obviously, the same should apply to the medical profession.

The principle is sound but the problem is in achieving the desired outcome. For example, common observation shows that it is possible to dream one’s way through an educational lecture, and there are those who take part in peer review meetings without gaining apparent benefit.

Consider, for example, the Canadian study in which five dyscompetent physicians participated in ‘a polyvalent, intensive, prolonged’ remedial educational program that lasted three years and consisted of ‘individualised review, ongoing small group and evidence-based discussions, simulated patients and role playing, formal chart review and peer review’. Few existing CME programs approach this level of intensity. At the end of the program, one physician had improved, one remained the same, and three deteriorated.