2012: Hurdling and hurling

It is generally accepted that physician medical error is a result of a system failure. Physician errors can be attributed to a number of factors including equipment failures or unfamiliarity, time pressures, distractions, training deficiencies, or simply not knowing what we don’t know.

The recent investigation into the CT misreads by four radiologists might seem remote for most of our clinical practices. But don’t be deceived. Not infrequently we perform clinical act­ivities that result in a mistake or near mistake that under the wrong circumstance can result in patient harm. However, these clinical activities do not often leave the same permanent footprint as a diagnostic imaging misread. 

It therefore comes as no surprise that the recent report compiled by Dr Doug Cochrane, chair of the Patient Safety and Quality Council, made recommendations that go far beyond the world of diagnostic imaging and will impose some serious hurdles for all physicians. 

Reviewing the 35 recommendations contained in the report is beyond the scope of this editorial. Instead, let me define a number of terms contained in the report that are important for you to know and are frequently misunderstood.

The granting of permission to practise medicine, which is done by each pro­vincial College and is subject to meeting training certification requirements (MD, LMCC, and CCFP or FRCP).

The process of evaluating the training, experience, and competence of physicians qualified to provide certain discipline services or procedures usually extra to requirements for licen­sing. For example, pulmonary function testing, electrodiagnostics, and CT colonography are skills usually obtained beyond the requirements for licensing. 

The process of granting privileges as permits to undertake specified clinical activities once licensing and credentialing requirements have been met. Physicians can only be given privileges for activities for which they have necessary credentials and may be de­nied privileges for lack of resources or need. For example, a cardiologist may be unable to perform interventional cardiology in a rural hospital even if he or she has the appropriate credentials.

The process of repeat validation of medical licensure by demonstrating competence. Revalidation requirements are evolving but, in future, will be more than providing evidence of CME.

Peer review
A proactive periodic review of clinical activities by peers for the purpose of education and improvement not 
in response to complaints or clinical concerns. This activity is normally highly confidential so as to promote full cooperation with the process.

Performance assessment
An ongoing evaluation of a physician’s work quality, objectives, contributions, and compliance with regulations. For example, hospital departmental requirements may require attendance at M & M rounds, have requirements for minimum number of procedures, participation in research, and satisfactory resolution of complaints. Performance reviews usually occur in conjunction with hospital staff re-appointments.

Multi-source feedback (a.k.a. physician achievement reviews or 360° reviews)
The process of providing feedback to physicians by patients, colleagues, and health care staff. The questionnaires can be designed to capture a range of competencies including communication, professional responsibility, professional development, and patient interaction.

A process for ensuring compliance of facilities, hospitals, or other organizations (not physicians) with preset and agreed-upon standards. In order for a facility to be accredited it may have to show compliance with medical staff performance management. 

Given these definitions, I will leave it up to you to connect the dots as to where the health authorities, Ministry of Health, and College are heading to comply with the Cochrane recommendations.

You probably thought I was referring to your possible emetic response to these recommendations in the title of this editorial. Far from it, hurling is the national sport of Ireland and only a sporting attitude will get us through the challenges that are about to unfold.

Willem R. Vroom, MD. 2012: Hurdling and hurling. BCMJ, Vol. 54, No. 1, January, February, 2012, Page(s) 7-9 - Editorials.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

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