The Second International
MOL/Revalidation Symposium
Sharing Best Practices, Lessons Learned
Hosted by
Federation of State Medical Boards (U.S.)
General Medical Council (U.K.)
Washington, D.C.
October 7–8, 2013
Historic Meeting of International Regulators
Contents
Executive Summary2
Revalidation in the United Kingdom
4
Maintenance of Licensure in the U.S.
6
Continuing Professional Development Models from
Australia, New Zealand and Ireland 8
Continuing Professional Development in
the Canadian Provinces12
15
In the following pages of these proceedings of the Symposium is a series of fascinating progress reports
from regulatory leaders in the United Kingdom, the United States, Australia, New Zealand, Ireland and
Canada. The proceedings conclude with several illuminating presentations addressing the role of medical
specialty certification in the assessment of physicians, and lessons the medical profession can draw from
the airline industry’s system of testing pilots.
Never has it been more essential for medical regulators worldwide to work together to find solutions to the
many common challenges we face. In times of volatility and change, we must learn to adapt — a process that
is enhanced by our ability to connect and partner with others. We hope you find these proceedings helpful
as this important conversation continues through the sharing of best practices and lessons learned.
Sincerely,
Humayun J. Chaudhry, DO, MS, MACP
President and Chief Executive Officer
Federation of State Medical Boards
Niall Dickson
Chief Executive and Registrar
General Medical Council
2014 Second International MOL/Revalidation Symposium |
Assessment Systems for Medical and Surgical Specialty
Certification and Recertification, and in Other Industries
Health care systems around the world face great challenges and uncertainty today as dramatic policy
changes are implemented, demographic changes accelerate and new technological tools and infrastructure
transform our work. With their critical role in the health care system of public protection, the world’s
medical regulators are being challenged more than ever to innovate and adapt to address these challenges.
This innovative spirit was clearly demonstrated at the Second International MOL/Revalidation Symposium —
the latest chapter of a growing worldwide movement in medical regulation to assure the public that doctors
are competent and fit to practice throughout their careers.
1
Executive Summary
Symposium identifies common ground and goal to ensure physician competence
T h e S e c o n d I n t e r n at i o n a l
“There is a lot of commonality in what we’re doing — how
of these programs involve a major culture shift and
Maintenance of Licensure/Revalidation Symposium,
do we assure the public, which is what all medical regulatory
they take time to implement.
Sharing Best Practices, Lessons Learned, held on 7 and 8
authorities are about, of the continuing competence of
October 2013 in Washington, D.C., brought together nearly
physicians, regardless of what jurisdiction they practice in?”
40 participants from seven countries to continue a
said Humayun Chaudhry, DO, President and CEO of the
process that began three years earlier, of sharing experiences
Federation of State Medical Boards. “As our nations embark
in developing and implementing systems that assure the
on these important measures, there is a lot to be shared.
public that doctors are competent and fit to practice throughout
This movement is growing; it is no longer confined to a handful
their careers.
of countries but is becoming a global issue.”
Hosted jointly by the Federation of State Medical Boards (U.S.A.)
Over the two days of the symposium, participants shared more
and the General Medical Council (U.K.), participants sought to
than a decade’s worth of regulatory experience and some of
share lessons in their efforts to develop and implement systems
the lessons learned on the way to developing their competence
commonly referred to as Maintenance of Licensure, Revalidation,
assurance programs.
another hill in front of them.”
Continuing Professional Development.
• Continuing professional development should be the key
Participants agreed that a continuing commitment to sharing
motivator. The programs are not intended to be punitive,
Although named differently across the world, participants
but rather to encourage and enhance self-assessment,
found that regulatory programs developed to assure
reflection, lifelong learning, and professionalism.
third symposium in Montreal, Quebec in October 2015 under
• Communication with physicians, the public and key
Regulatory Authorities. We look forward to seeing you there.
Recertification, Maintenance of Professional Competence or
physicians’ ongoing knowledge and skills within their respective
countries have much more in common than expected. They
are universally supported by a clear consensus that physicians
basis. They are also a vital part of a broader international
movement to improve the quality of health care and better
assure patient safety. By fostering physician self-reflection
and professional development, they directly support quality
improvement across the profession.
stakeholders are critical to the programs’ success.
Dickson, Chief Executive and Registrar of the GMC, feels that
becoming a global issue”
• Governments are no longer asking “if” medical regulators are going to implement these systems but “when,” and are beginning to inquire about the results and impact of these
and other initiatives aimed at improving standards in
health care.
“we’ve (the GMC) come a long way, but we are like the hill
walker who reaches the top of the hill and realizes there’s
best practices and information is critical to the ongoing growth
and success of these initiatives and agreed to convene for a
the auspices of the International Association of Medical
As one meeting participant — Professor Kieran Murphy, former
• Doctors are increasingly accepting that participating
president of the Medical Council of Ireland — noted, “One
in competence assurance programs is a requirement of
of the advantages of these sorts of meetings is seeing that
their profession and that participation in the process
is of significant benefit to them.
•The pace of progress is deliberately slow — there is a
general understanding that the development and rollout
— Humayun J. Chaudhry
across the world there are many ways of doing the same thing.”
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2
should be able to demonstrate their competence on an ongoing
With regards to the Revalidation program in the U.K., Niall
“As our nations embark on
these important measures,
there is a lot to be shared.
This movement is growing;
it is no longer confined to a
handful of countries but is
3
Revalidation in the United Kingdom
The United Kingdom’s system of Revalidation was officially
implemented in December 2012. Prior to Revalidation,
doctors remained on the register indefinitely as long as
they paid their annual fee and didn’t get into difficulties
that led to referral to the General Medical Council (GMC)
for investigation of their fitness to practice. It was
up to doctors to remain up to date and maintain their
fitness to practice. The GMC effectively relied on doctors’
innate professionalism to do what was right for their
own development.
Moderator:
Niall Dickson, Chief Executive and
Registrar, General Medical Council
Presenters:
Una Lane, Director, Registration and
Revalidation, General Medical Council
Michael Marsh, Medical Director and
Responsible Officer, University Hospital
Southampton
——————————————————————————————
Una Lane
Revalidation is about:
• Finding and addressing potential problems earlier
• Be based in training and education, not Human Resources
• Be supportive and robust
• Include well-trained appraisers
“The concept of Revalidation is
about having safety and quality of
care at the core of the profession
of medicine.” —Una Lane
Most of the feedback the GMC received from doctors about
engaging in Revalidation was that they were nervous about
patient feedback. But most have discovered that patients are
very positive. It is important for doctors to reflect on what
patients are saying about them — “360 feedback” can be a
little bruising but a lot of doctors have found it really useful.
——————————————————————————————
Michael Marsh
In terms of implementing a system like Revalidation, there
must be recognition of the pressures and stresses of modern
day health care. Doctors are busy, so they may not take the
time to review information in detail. Therefore, myth busting is
• Affirming a doctor’s professionalism
important. Special efforts must be made to engage doctors
• Good Medical Practice
in the process and to help them understand that this is about
improving quality, not a threat to their livelihoods. If doctors
Revalidation is not about a point-in-time test or a pass/fail exam, don’t engage in this process, it’s worthless. A late start with
nor is it about a new way to raise concerns with the GMC. It is also engagement is better than an early start without engagement.
not the only purpose, or outcome, of appraisal of doctors.
•Bringing doctors into a structured process and
encouraging self-reflective practice
The regulators can’t do this alone. The General Medical
Council is dependent on the system — specifically, they’re
dependent on the 800 legislatively-designated organizations
that are responsible for conducting the annual appraisals of
doctors participating in Revalidation. In turn, there is a huge
amount of work involved for these designated organizations.
Several fundamental principles for ensuring an organization’s
readiness for Revalidation are that the process should:
The benefits of Revalidation so far include higher quality
appraisals, recognition of the importance and quality of patient
feedback, an increased ability to deal with “difficult characters,”
development of a culture of improvement, and a greater focus
on personal development plans and patient outcomes.
However, we are not sure if we are sufficiently robust in
evaluating doctors; if we are effectively engaging with outside
organizations to learn how to improve and be proactive; and
if we are too distant from what is happening “on the ground.”
We also recognize that some of the areas where we’re weakest
is where the potential is greatest, e.g., locum doctors.
• Challenge people when appropriate
Lessons Learned / Best Practices
• Have adequate appraisal support
• The profession has to be with you. It’s very important to
make an argument for Revalidation — it’s not enough for
regulators to simply insist that it is proper and right for
every doctor to do this.
Even then, a number of things can hinder successful
implementation, including:
• Lack of leadership from the CEO, Board, and/or
Responsible Officer
• Conflicts of interest
• Lack of an appraisal system and appraisers
• Time required to complete the appraisal and portfolio
• Data transfer between and among organizations
• Prolonged rollout
Frontline engagement and leadership at every level is critical,
and the organizations need adequate resources to do the job.
It is also important to make sure patients are engaged in the
process. In the U.K., the public assumed there was a system
already in place and were surprised when they found out
there wasn’t.
• We must make the purpose of Revalidation — a
contribution to developing and improving clinical
governance and quality of care — absolutely clear to
the profession. It is part of a wider agenda of quality
of care and patient safety.
• It is important to get a basic model in place and make
refinements over time. Where we start isn’t where
we’ll end up.
• This isn’t about individual doctors, but doctors being part
of a wider team and part of the organizations they work for.
• Consult, pilot and evaluate impact before roll out.
•We must ensure Revalidation doesn’t drive individualism
at the expense of teams.
• Focus must be on patients and improving quality of care.
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• Improving the governance of medical practice
A key question to consider is whether Revalidation is about
improving practice and moving the bell curve to the right or
removing bad apples. These two ideas are not mutually exclusive.
In the U.K., it’s about contributing to quality of care, but also
about making a contribution to identifying poor performers much
earlier to prevent patient harm. We hope Revalidation will drive
many more doctors to properly begin to evaluate their practice
in relation to their peers. It goes back to the core values
of Good Medical Practice, which effectively set out values and
principles we expect every doctor to meet — not just on the day
they register, but continuously throughout their careers.
5
Maintenance of Licensure
in the U.S.
The Federation of State Medical Boards, consistent with
policy originally adopted in 2004 and a framework adopted
in 2010, continues its efforts to introduce a new system of
ensuring the continued competence of licensed physicians
through Maintenance of Licensure (MOL). A vital step on
the path to MOL implementation by state medical and
osteopathic boards in the United States is determining
what impact this might have on state regulatory authorities
and what professional development training tools —
both new and existing — physicians could use to meet a
state’s requirement for MOL. Feasibility studies to help
evaluate these issues and to advance understanding of
the MOL concept are currently underway in several states.
Moderator:
Humayun Chaudhry, DO, MACP, President and CEO, FSMB
Presenters:
Jon Thomas, MD, MBA, Chair,
Federation of State Medical Boards
Frances Cain, MPA, Assistant Vice President of
Assessment Services, FSMB
70 medical board jurisdictions isn’t the goal anyone seeks,
so some element of commonality is crucial for the success of
MOL. The Federation of State Medical Boards (FSMB) recognizes
that MOL will be an evolving program and will take time and
attention to be fully realized nationwide.
——————————————————————————————
Frances Cain
The FSMB is currently collaborating with other stakeholders to
conduct state-level feasibility studies to advance understanding
of the process, structure and resources necessary to develop an
effective and comprehensive MOL system. Among the key areas
that we are exploring include the readiness of a medical board
to implement MOL; the potential impact on a state medical
board’s license renewal process; and just as importantly, how
do we support physicians’ participation in MOL? As we surveyed
and listened to medical boards and practicing physicians, we
expanded our thinking to include how we could support state
boards and physicians in the overall broader system of continuing
professional development (CPD).
Through this process we have learned that communication is key
to making sure the needs of both physicians and state medical
boards are met as they explore implementation of MOL. Issues
such as costs and potential negative impacts on the physician
workforce (e.g., will older physicians retire rather than participate in
MOL?) must be taken into account as state medical boards consider
implementing MOL. Episodic opposition from state medical
societies, difficulty in amending Medical Practice Acts, and turnover
in state board members are also challenges to implementation.
Mark C. Watts, MD, President, Colorado Medical Board
——————————————————————————————
Jon Thomas, MD, MBA
A unique challenge to implementing MOL in the United States
is that there are 70 medical licensing authorities within the
50 states, each with its own governance structure, laws and
regulations. Implementation of MOL may require amendments
to some states’ Medical Practice Acts — their statutory authority
for licensing and regulating doctors. Finding common language
and standards will also be important. Currently, states seem to
prefer working in a coordinated fashion, which is particularly
relevant as more and more physicians are practicing in multiple
states. Having 70 different MOL systems in each of the
Currently, Colorado only has very basic and minimal requirements
for medical license renewal — updating demographic information,
an attestation that the licensee has malpractice insurance
at prescribed levels, disclosure of certain legal charges and
malpractice cases. Colorado is in the minority of states in
that physicians are not required to complete CME (continuing
medical education) as part of the license renewal process —
in fact, it is statutorily prohibited. Implementation of MOL in
Colorado would require a significant amendment to the state’s
Medical Practice Act.
However, there is a growing awareness that the state medical
board should have a responsibility to ensure competence
through regulation. This awareness is principally an outgrowth of
the enormous amount of work done to craft a comprehensive
opioid drug policy to address the prescription opioid drug crisis
within the state. There is also recognition of the body of
evidence pointing to, and supporting, the need for ensuring
physicians remain competent throughout their careers and
demonstrate a commitment to lifelong learning.
Adoption of MOL would require significant legislative effort.
Colorado’s legislature is grappling with multiple major issues.
This year it had to respond to widespread damage caused by
a series of state-wide hundred-year floods and the ongoing
regulation of medical and recreational marijuana. In addition,
there was a historically unprecedented recall of two legislators
related to new gun control legislation. Currently, MOL seems
like a “back burner” issue. It may be one that the legislature
might be unwilling to tackle in the current legislative session.
The medical board is part of a larger regulatory agency (the
Department of Regulatory Agencies, or DORA), and as such, the
board would need to obtain approval from DORA to implement
any part of MOL that would require a legislative fix.
As the board has looked at MOL, we have recognized that
partnership with the state medical society is important. Due to
a series of regulations, we as a board are unable to send out
surveys, polls, or request feedback from our licensees with the
renewal of their licenses. In addition, the medical board itself
cannot introduce a bill into the legislature. Although DORA has
a mechanism to introduce legislation, a limited number
of bills can be introduced and many times these bills are fixes
to existing legislation. Most recently the medical board worked
closely with the state medical and osteopathic societies with
the introduction of the FSMB’s MOL feasibility studies. The
medical board will likely work closely with the societies on
introduction of legislation to implement MOL. That would
naturally require the full board’s approval.
Communication is also critical. We have learned through our
feasibility study work with FSMB that physicians in Colorado
do not know much about MOL. While that is not necessarily
a bad thing — it perhaps means that people do not have a
preconceived notion about what MOL may mean — we have
recognized the importance of communicating with frontline
doctors about what MOL is really about.
Some of the issues we are evaluating as part of a situational
assessment in Colorado as we consider implementing MOL are:
• How do you engage physicians?
• Will MOL have an effect on disciplinary cases?
• Is MOL part of the answer to other medical and
healthcare-related issues in the state?
•Does the protection gained by the public with MOL overcome
the regulatory and financial burden to licensees?
Lessons Learned / Best Practices
• With 70 individual U.S. medical board jurisdictions, the
MOL framework must be flexible enough to be easily
adapted into the licensing processes of any state, but
also must encourage uniformity from state to state with
key overarching principles.
• Continual communication with the physician community to
“myth bust” misperceptions about MOL is critical.
• Work closely with a small, manageable cross-section of
boards to conduct feasibility studies that later can be
adapted by boards across the country.
• Make sure MOL programs are administratively nonburdensome to physicians and align as much as possible
with CPD activities physicians are already engaged in.
• Engage physicians at the grass-roots level through
surveys and focus groups to gauge their understanding
and/or misperceptions of MOL.
• Through collaboration with key stakeholders, identify a
wide array of easily accessible resources and tools for
physicians to use to meet MOL requirements.
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A rigorous process to gain initial licensure is in place in the United
States, but there is very little required afterward of most physicians:
they pay a fee and may be required to complete CME, but little else
is required. From the public’s perspective, this is not appropriate.
“One lesson we have learned over
the past decade is that myths —
for example that MOL will require
physicians to take a high-stakes
exam, or that state medical boards
will require specialty board
certification for license renewal —
are persistent. Clear, continuous
and consistent communication
is important.” — Jon Thomas
——————————————————————————————
Mark Watts, MD
7
“Communication with
frontline doctors and
partnership with
state medical societies
is critical.” — Mark Watts
Continuing Professional Development (CPD) Models
from Australia, New Zealand and Ireland
There is a strong relationship between the medical
regulatory authorities in New Zealand and Australia.
Both countries also recognize Ireland as a “competent
authority.” Therefore, physicians who graduate from
medical schools in Ireland have virtually automatic entry
into New Zealand and Australia as well. In recent years
the medical regulatory authorities in these nations
have recognized that the thinking about Continuing
Professional Development is changing internationally
toward a greater emphasis on systematic efforts to
deliver educational interventions, and to encourage
self-reflective practice and performance improvement
over time. Above all, these CPD programs are intended
to foster professionalism and ensure patient safety.
Presenters:
Moderator and Presenter: Philip Pigou, Chief Executive
Officer, Medical Council of New Zealand
Dr. Joanna Flynn, Chair of the Medical Board of Australia
Professor Kieran Murphy, Former President, Medical Council
of Ireland
——————————————————————————————
Joanna Flynn
give patients the assurance they seek
that any doctor is competent and fit
to practice, yet do so in a way that does
not undermine trust and professionalism.”
— Joanna Flynn
• help keep the public safe by ensuring that only health
practitioners who are suitably trained and qualified to
practice in a competent and ethical manner are registered
One way to begin to look at this is — If Revalidation is
the answer, what is the question?
• To address or prevent problems...
—in competence/performance of individuals?
—in trust and confidence in the profession?
—in trust in the regulatory standards and processes?
• facilitate provision of high quality education and training
• Identifying “bruised apples”?
• facilitate workforce mobility, access to care and enable the continuing development of a flexible health workforce
• Assuring the public that “all apples” are good?
Regulation of physicians is the responsibility of the Medical
Board of Australia. The Medical Board has adopted a CPD
Registration Standard by which physicians maintain, improve
and broaden knowledge, expertise and competence and develop the personal qualities required in their professional lives.
It requires a range of activities to meet individual learning
needs, including practice-based reflective elements (e.g., audit,
peer review or performance appraisal), as well as activities
to enhance knowledge. The Medical Board also has other
processes in place to assist in ensuring physicians’ ongoing
competence and fitness to practice, including random audits
of compliance with the CPD standard, declarations at the
time of registration renewal regarding compliance with CPD
standards, criminal history, etc.
However, not all doctors are included in these processes, so
that has led to a conversation about whether CPD is enough
or whether we should move toward Revalidation in Australia.
Although we are looking at the models and systems that are
taking shape in other countries, we have said to the profession
that we are not looking at a system akin to that in the U.K.,
because we have a much more public-private mix in Australia.
However, we are grappling with the same questions raised
by the U.K. and other countries.
Similar to other countries, we have been asking ourselves
some key questions, including:
• What is the interface between professional regulation and
health system regulation and clinical governance?
• Is this diagnostic or developmental or both?
• Is it for everyone or only for high risk groups? Or should
we have screening for everyone and greater depth of
requirements for those picked up on initial screen?
• Should this be “point in time,” cyclical or a
continuing evaluation?
• Is this formative or summative?
• Should there be a focus on testing or a focus on learning
and demonstrating mastery?
• What tools can assist physicians? We have been looking
at multi-source feedback from patients, co-workers,
colleagues; practice visits by peers; review of practice data;
audit; self-assessment of knowledge; and formal testing
of knowledge.
• But, it must be recognized that the practice of medicine is
complex and diverse and can’t be reduced to discrete,
measurable outcomes
• It is important not to harm the fragile trust people have in
the profession by raising too many concerns about the
profession, but equally important is that this is not an
excuse to not address the problem.
Ultimately, all of us are better professionals if we’re doing it
because we intrinsically know that it is important to do rather
than because someone is forcing us to do it. We want to
encourage people’s professionalism rather than do anything
that potentially harms it. We want to do something with
intrinsic worth and that people find valuable and available
around the country.
—————————————————————————————
Kieran Murphy, MD, PhD
“We should be trying to foster intrinsic
motivation. The model shouldn’t
be lots and lots of rules to force doctors
into doing what they should be doing.
It should be about providing a framework
by which doctors can facilitate and
fulfill their own inherent professionalism.”
— Kieran Murphy
We have identified some answers as well, though —
• We must be clear that this is about a focus on
patient safety
• We will encourage self-reflective practice and improve
performance of everyone over time and ensure minimum
standards are met by all
The Medical Council of Ireland is almost unique in that it
has a very broad scope of responsibilities — accrediting all
undergraduate and postgraduate training, registering doctors,
investigating complaints and now ensuring all practitioners
are competent and maintaining professional competence.
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“The overall aim of our efforts is to
In 2010, Australia moved to a single National Registration and
Accreditation Scheme (National Scheme) for all registered
health practitioners. The objectives of the National Scheme
are to:
9
For a regulator to be competent and credible it must have the
trust of the public and the profession. This is a tough line to
walk as these are not necessarily opposing but challenging
perspectives. Philosopher Onora O’Neill says that for a
system to be seen as trustworthy by the public you have to
actually demonstrate that you’re trustworthy, and you must
demonstrate that you are vulnerable. Within the concept of
regulation, as a regulator you must show that your processes
are transparent and robust. And as a practitioner, you must
demonstrate that you’re prepared to undergo a process that
will demonstrate you are fit to practice.
There is a high degree of trust in doctors in Ireland — they are
rated by the public as the most trusted profession. The public
has confidence in how well doctors do their jobs. However, we
also know that studies show that as age increases, there is a
higher chance of error creeping in. This brings us back to the
issue of trust.
Scandals within the health care system led to new legislation
in Ireland in 2008. As a result, there is now a legal obligation for
doctors to maintain their professional competence, and there
is also a legal obligation on the medical council to ensure
physicians’ competence. Our perspective is that the majority
of doctors are already engaged in this voluntarily; this is just
formalizing a process doctors have already been engaged in.
• An assessment system is targeting the tail, the
underperforming doctors.
In Ireland, we have primarily a learning model. However, it is
important to keep in mind that a system will always be dynamic
and will not be cast in stone. A system should evolve. We have
started a process that we have demonstrated is feasible and
credible and well regarded by both the profession and public,
but we would now hope to evolve that system to include more
of the assessment elements.
Doctors’ participation in the system is not just ticking a box,
it’s much more formal. After assessing their needs, doctors
plan their activities over the year, and then reflect on their
performance and plan action based on that. The activities and
processes need to be relevant to and integrated into doctors’
everyday practice. There is no point in having a wonderful
system that is completely disconnected to doctors’ everyday
practices. They have to see that it’s relevant to themselves
rather than a bureaucratic exercise that is useless to them.
Finally, we should be trying to foster intrinsic motivation. The
model shouldn’t be lots and lots of rules to force doctors into
doing what they should be doing. It should be about providing
a framework by which doctors can facilitate and fulfill their
own inherent professionalism.
• Ensure professional leadership and build support
• Hold workshops with patient representatives and doctors
• Survey doctors to understand their views and concerns
As we developed the system, we also recognized that we
needed to determine what type of system this should be —
learning or assessment:
Philip Pigou
The Medical Council of New Zealand’s (MCNZ) traditional approach
to ensuring competence uses CPD as a proxy for ensuring
competence. Since 1995, CPD — or Recertification as it was
called in the legislation — has been mandatory for all New
Zealand doctors and includes CME, peer review, and an audit
of medical practice. The CPD has been based on self-directed
learning with minimal peer assessment or guidance.
Since 2008, however, the Council has recognized that thinking
about CPD is changing internationally. There is greater emphasis
on systematic and concerted efforts to deliver educational
interventions, and how you identify what those interventions
should be. For example, self-assessment is important, but
what about doctors who don’t have the ability to accurately
self assess? How do they get feedback in the development
they need and want?
The MCNZ’s regulation philosophy is that Council interventions
should be targeted to situations where there is an elevated
risk, and where the profession and other stakeholders may
not be effective at mitigating that risk.
There is an emphasis on profession-led development and
on a “right touch” approach by the regulator. Our key
principles are that:
• All doctors should regularly assess and reflect on their
performance with the assistance of their CPD provider
• Review should be undertaken in a doctor’s own work
environment and be tailored to their own practice
• Start simple, basing our efforts on voluntary structures
that work
• Consult with all stakeholders on rules and standards
—————————————————————————————
“In 2008, there were numerous
questions about why we need to
do this. Now we are moving to
how we are going to do this.”
— Philip Pigou
The ultimate goal is to improve the quality of care that a
doctor’s patients receive by facilitating the doctor’s professional
development. We are currently drafting our future Vision,
which includes the following:
• CPD providers would be expected to offer tools which are
intended to help doctors to reflect on their own practice and
identify areas for improvement. The key difference between
the current situation and the vision is that the Council
would expect the providers to review the results of CPD
activities with the doctor.
• A tiered system with increased assistance for the provider
if areas for improvement are identified.
• Specific CPD targeted to doctors who may need increased
assistance — a quality assurance approach.
• A protocol that identifies the small number of doctors who
require referral to the regulator where risk to public health
and safety is identified.
——————————————————————————————
Lessons Learned / Best Practices
• To start, formalize professional responsibility and voluntary
practice — use that as the basis for further development of
the system.
• Communicate, engage, and build support — with the
profession and the public to ensure it is supported. If
people on the ground don’t buy into it, it won’t go anywhere.
• Keep things straightforward — doctors are very busy and
don’t want to be burdened with a complicated system.
• Ensure the system is practice-based.
• The activity should link to a professional development
plan for the doctor
• Keep an eye to process and focus on outcomes.
• Standards of the profession should be emphasized
• Be honest about limitations.
• Oversight and enforcement — must be built on trust.
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Our overriding principle was to establish a system that was
feasible and credible — we didn’t want to start with a very
complex system that was destined to fail. Involving the
profession in the development of the system was critical to its
success. Consultation with the public and other stakeholders
was also important. Some key steps we took were to:
• A learning system is purely a CPD approach. The motivation
is to shift the curve to the right and to raise the floor for
all doctors.
11
Continuing Professional Development
in the Canadian Provinces
In Canada, there is a long history of work on this topic
that serves as the foundation for the current work. This
was formalized 20 years ago, when the registrars of the
provincial and territorial colleges made a request to the
Federation of Medical Licensing Authorities of Canada
(now the Federation of Medical Regulatory Authorities
of Canada) to start working on a program to assure the
maintenance of performance in physician practice. FMLAC
then held a series of workshops with medical regulators
and leaders to start working on a national strategy to build
consensus on key terms and goals, and best practices.
Moderator:
Mark Staz, MA, Director,
Continuing Professional Development, FSMB
Presenters:
Trevor Theman, MD, FRCSC, Registrar, College of Physicians
and Surgeons of Alberta
Bill McCauley, MD, Medical Advisor in Practice
Assessment and Enhancement, College of Physicians and
Surgeons of Ontario
——————————————————————————————
Trevor Theman, MD
In Canada, Revalidation focuses on demonstration of competent
performance rather than just on competence. We believe the
assurance of performance must be relevant to the physician’s
practice. We want the process to be largely formative rather
than summative, reflecting our view that what we’re seeing is a
snapshot in time, and that the goal is continuing improvement
over time. Currently, most Canadian jurisdictions require
The concept of Revalidation in Canada began with a series of
conferences in the 1980s, which led to development of the
“wedding cake” model:
• Step 1: screening of all physicians and subsequent feedback
• Step 2: more in-depth review, such as peer review
• Step 3: very detailed needs assessment.
The College of Physicians and Surgeons of Alberta’s Physician
Achievement Review (PAR) program, which has been in
place since 1999, is aimed at accomplishing Step 1. The goal
of PAR is to provide feedback to all physicians about their
practice; to help identify learning needs and, when needed,
to look more closely at a physician’s practice. The information
gathered is confidential and entirely for the purpose of quality
improvement; the tools have been created by peers and
scientifically validated.
Information from PAR is protected from the College’s
complaint process, although the rules for its administration
allow for the identification of a physician who is believed to
be putting patients at risk.
Findings from physicians who have participated in PAR indicate
that 49% of participants said they made a change in their
practice as a direct result of PAR. Most changes focused on
aspects of patient care, communication with patients, colleagues
and co-workers, and stress management. We think this is
pretty profound. The feedback from colleagues, coworkers and
the public is meaningful because physicians tell us they’ve
made changes to their practice. And physicians care how they
rate relative to their peers. We think the program has largely
met its objectives.
One of the most important outcomes — but one that is impossible
to measure — is the value of PAR simply because we have it.
We now have a profession with 9,000 practicing doctors in
Alberta, and almost everyone undergoes PAR every five years;
the profession accepts it. As we develop more tools and
create more requirements for our members in terms of their
demonstration of competent performance throughout their
careers, the fact that we’ve gotten the profession to accept
this is really important.
Some of the critical success factors we have identified are:
• Communication — frequent communication was essential;
frequent messaging was needed to address various myths that arose
• Goal — that this was meant as a pure quality
improvement program
“Our big goal is to do our best to raise
the tide for everyone — because a rising
tide lifts all boats. We also need to be aware
there may be a small fraction of our
membership that is putting our patients at risk
and we need to identify and act on those.”
— Trevor Theman
We’ve also identified a number of issues and concerns:
• Results not available to the regulator
• Not the best assessment for the clinical expert role
• Exemptions (numbers should be higher)
•We understand physicians make changes to their practice
as a result of assessment, but we’re not so sure how
significant they are, how meaningful they are to patient
outcomes, and how much it feeds into their continuing
professional development
• Frequency — only occurs once every five years
• Interpretation of scoring
•Results considered in isolation — not combined with other
knowledge about the physician/practice
Overall, though, we’ve found it’s doable. It isn’t cheap, but not
too expensive either. It assesses certain competencies better
than others, but we know it’s relevant and physicians make
changes based on feedback. We know we can do this across
the various domains of practice and that it works in various
settings. We know that for the fraction of our membership
that are flagged (about 10%), they get really good value. We’re
not so sure the other 90 percent of our members who easily
complete the review get the same value; that’s where we need
to do more work.
• Organizational support and buy-in
In terms of what we would consider ideal, the following have
been identified:
• Clarity of purpose
• Multiple and integrated sources of regular feedback
• Instrument construction
• Addressing all aspects of a practice
• Logical, efficient processes
• Relating to all roles (CanMEDS)/competencies
• Testing — reliability, validity, utility, feasibility
• Patient outcome information
• Implementation — mechanics, feedback report, follow-up
• Focused learning and measurable changes in practice
• Reported to a “responsible agency”
2014 Second International MOL/Revalidation Symposium |
2014 Second International MOL/Revalidation Symposium |
12
Revalidation in Canada is based on the idea that physicians
must remain competent throughout their careers. As regulators,
we also believe that all physicians can benefit from continuous
quality improvement. As in other countries, the public in
Canada believed this was already being done.
participation in CPD, and physicians are required to track and
document CPD activities. The CanMEDS competencies/roles
serve as the basis for the Canadian Revalidation system.
13
Assessment Systems for Medical and Surgical Specialty
Certification and Recertification, and in Other Industries
——————————————————————————————
Bill McCauley, MD
We’re trying to develop a system in which physicians are
regularly provided with feedback on their performance, either
through activities they undertake themselves, or through
activities they undertake with regulatory authorities, with their
hospitals or colleagues — feedback that helps them know what
they’re doing, how well their doing, and how they can improve.
In many respects Canada is far down the road. We have
a lot of tools that can be used, such as the PAR program;
the Colleges of Ontario and Quebec have very robust peer
assessment programs that have been in place for years. What
we don’t have is a national framework. But we are in the early
stages of developing one.
In 2004, FMRAC sponsored a Revalidation Working Group, which
developed a Revalidation definition and position statement:
Revalidation Definition:
“A quality assurance process in which members of a provincial/
territorial medical regulatory authority are required to provide
satisfactory evidence of their commitment to continued
competence in their practice.”
Although this position was endorsed by FMRAC, a process did
not exist. As a result, there has been fallout. Although multiple
provinces now have mandatory CPD requirements (Alberta,
British Columbia, Manitoba, Nova Scotia, Ontario, Quebec) as
a direct result of the Revalidation position statement, many
jurisdictions adopted or endorsed the statement but may not
have a process in place. Similarly, while many jurisdictions
are using mandatory multi-source feedback as part of their
process, there is no national implementation strategy. Canada
is much like the U.S. in that there are multiple (13) jurisdictions; it is possible to come up with an implementable national
Revalidation process, but at this stage we’ve just started to
think about that.
FMRAC currently has a “Working Group on Physician
Performance Enhancement” (WG-PPE), whose goal is to
develop a pan-Canadian strategy for physician performance
enhancement to help:
• All practicing physicians in identifying opportunities
for improvement
Moderator:
Jon Thomas, MD, MBA, Chair, FSMB Board of Directors
General
• All stakeholder organizations in identifying their roles and
responsibilities in physician performance enhancement
Presenters:
• Communication; understanding
Lois Margaret Nora, MD, JD, MBA, President and
Chief Executive Officer, American Board of Medical Specialties
• Time, cost, administrative burden of participation
Capt. (Ret.) Peter J. Wolfe, FRAeS, Executive Director,
Professional Aviation Board of Certification
•Relevance
Manoj S. Patankar, PhD, FRAeS
We have noticed, however, that certification and MOC is making
a difference. For example, there is an increased focus on
professionalism, including positive regard for push-style continuing
education, improvements in simulation training and assessment,
MOC is improving evidence-based decisions about laboratory
testing, and MOC is impacting population health (e.g., pediatric
screening and referral patterns, adult immunization).
The Vision for the Working Group is that 1) Canadians are
assured of the competence of physicians; and 2) physicians
are supported in their continuous commitment to improve.
Guiding Principles are also being developed — around WHO
participates, WHAT should be assessed, HOW the assessments
should be carried out, and WHAT resources need to be available post-assessment. The guiding principles describe a broad
assessment framework that will allow 1) all physicians to receive
feedback on their performance (primarily formative), 2) medical
regulatory authorities to dig deeper when concerns are identified,
and 3) stakeholders to participate using their areas of expertise.
Questions and challenges remain in terms of developing and
implementing a national Revalidation strategy — e.g., Would medical
regulatory authorities and the public be sufficiently reassured if
this process were in place?, How do we assess professionalism?,
Authority rests with medical regulatory authorities and government,
but is there universal buy-in to get a “National Strategy”? The
Working Group will continue to develop recommendations to
operationalize the Guiding Principles and to consider a Revalidation
framework. This will include external consultation with all
stakeholders and, ultimately, support of the medical regulatory
authorities in their implementation of Revalidation.
——————————————————————————————
Lessons Learned / Best Practices
•
CPD programs should focus on the demonstration of
competent performance rather than just on competence
— the assurance of performance must be relevant to the
physician’s practice.
•The key program used in some provinces identifying
physicians with learning needs (Physician Achievement
Review) is relevant to physicians — half of the physicians
who participate make changes in patient care, commu­
nication with patients, colleagues and co-workers, and
stress management as a direct result of their participation.
• The program works across the various domains of practice
and it works in various settings. For the fraction of our
membership that is flagged during the process, they receive
excellent feedback to help them improve.
——————————————————————————————
Lois Margaret Nora, MD, JD, MBA
The mission of the American Board of Medical Specialties
(ABMS) is to serve the public and the medical profession
by improving the quality of health care through setting
professional standards for lifelong certification in partnership
with Member Boards. While ABMS and board certification is
distinct from licensure to practice medicine, from specialty
societies, and from medical education accreditation, it is part
of the education/assessment/regulatory system that engages
all of these organizations.
•Change
• Perceived conflicts of interest
Proxy
“The extraordinary opportunity
for Maintenance of Certification is to positively
impact the care of patients and communities,
our national capabilities and outcomes,
Unlike medical licensure, specialty board certification is a
voluntary process. Following initial certification by an
ABMS Member Board, physicians participate in continuing
certification through a process called Maintenance of
Certification (MOC). Currently:
physician learning, and health care conversations; to support the social compact between
the Public and Profession, and by doing so to help maintain medicine as a profession; and
• More than 800,000 U.S. licensed physicians have initial
ABMS Board Certification
• More than 500,000 U.S. licensed physicians are
participating in MOC programs
to support physicians throughout their careers.”
— Lois Margaret Nora
For many years, the Board Certification process included initial
certification only (i.e., a “diploma” or “point-in-time” model”).
Over time, however, there was consensus to move to continuing
certification. Three broad categories of anti-MOC sentiment
were expressed during the transition to continuing certification:
• Leadership makes a difference
Specific aspects of the MOC program
• ou cannot over-communicate
• Prove it
• The “why” is important
• High stakes, secure exam
• Changes the relationship between the Boards and
the diplomates
• Part IV requirements
A number of valuable lessons learned have also been identified:
• Change management and cultural change is difficult
• Frequent communication is essential to address the various
myths that arise about CPD programs.
• Attention to the appropriate level (granularity) of
the requirement
• The program is economically viable.
• Don’t require what is not available
2014 Second International MOL/Revalidation Symposium |
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14
Revalidation Position:
“All licensed physicians in Canada must participate in a recognized
revalidation process in which they demonstrate their commitment
to continued competent performance in a framework that is fair,
relevant, inclusive, transferable and formative.”
• All medical regulatory authorities in identifying physicians
who may benefit from focused assessment and enhancement
15
——————————————————————————————
Captain (Ret.) Peter J. Wolfe, Executive Director,
Professional Aviation Board of Certification; and
Manoj S. Patankar, PhD, FRAeS
The Professional Aviation Board of Certification is an independent,
non-profit organization serving as the certifying body responsible
for professional airline pilot preparedness. It sets training
standards for aspiring professional pilots, certifies (tests) pilots’
knowledge against those standards and has established criteria
for keeping the certification current over time.
The dominant process used today for the initial training and
recurrent training of airline captains is called the Advanced
Qualification Program (AQP), and is a significant change from
previously prescriptive criteria that relied on counting classroom
and flight hours, and event cycles (i.e., takeoffs and landings)
as a measure of competency. AQP has identified the full spectrum
of knowledge, skills, and attitudes needed by pilots and evaluates
their performance in each subject and skill area over a threeyear cycle. AQP recurrent training includes classroom and online
studies, simulator training and flight checks that confirm the
pilots’ capability to exercise command authority and compliance with federal and company standards for aircraft and crew
operations. AQP recurrent training also includes Line Oriented
Flight Training ( LOFT), a series of simulator tests that include
a complicated mix of scenarios such as mechanical problems,
weather changes, medical emergencies, etc. — similar to
some patient care issues — to train and assess crew responses
to such events. Airlines have found the LOFT program to be
extremely valuable because of its relevance and realism.
It is important to note that the vast majority of the above
reports come from voluntary safety programs that derive
information from onboard flight data recorders that show what
the airplane did at any given moment in the flight — but not
why. The recorder data, coupled with narrative reports from
the pilots of the flight enable the regulators, companies and
pilots to draw high value information from an event that is then
distributed as noted above.
Trust is the key to the success of this incredibly effective safety
system. This collaboration includes the regulator, the flight crew,
the airline and a representative from the union. Everyone holds
each other accountable for the integrity of this process, because
they all understand that any breach of confidentiality in the
system will cause an immediate cancellation of the entire
process and the immediate loss of the many thousands of
reports it has collected over its more than 20 years of operation.
In 2012, the International Civil Aviation Organization (ICAO) —
the aviation arm of the United Nations — created a set of core
competencies, several of which are similar to ones identified by
medical regulatory community. The ICAO wanted to identify the fact
that training and checking should be performance and competency
based and include a combination of knowledge, skills and
attitudes, with subsets of competencies that include observable
behaviors. These will be published as a global guideline for airlines
and represents a quantum leap in our industry in the endeavor
to globally harmonize airline pilot training and assessment.
Speaker Biographies
Frances Cain is Assistant Vice President
of Assessment Services for the FSMB and
has responsibility for FSMB’s Maintenance
of Licensure initiative. The Assessment
Services department provides registration
services for Step 3 of the United States
Medical Licensure Examination and the Post-Licensure
Assessment System, both of which are collaborative
initiatives with the National Board of Medical Examiners to
provide assessment tools to assist state medical boards
in assessing physicians’ knowledge and competence for
licensure purposes.
Dr. Joanna Flynn is Chair of the Medical
Board of Australia and a member of the
Management Committee of IAMRA. A
general practitioner in Melbourne, Victoria,
Dr. Flynn has been involved in medical
regulation for more than 20 years. In 2009
she was appointed the Inaugural Chair of the Medical Board
of Australia, which is now responsible for registration and
regulation of all doctors in Australia. Prior to 2010, Australia
had medical boards in each state and territory. Dr. Flynn also
has served as President of the Australian Medical Council,
which is the independent national standards body for the
country’s medical education and training, and she chaired the
working party that developed the seminal ‘Good Medical Practice:
A Code of Conduct for Doctors in Australia’ in preparation for
the introduction of national medical registration.
Una Lane, Director, Registration and
Revalidation, General Medical Council,
joined the General Medical Council in
October 2002, taking responsibility for
planning and implementing reforms to the
GMC’s fitness to practice procedures.
In 2010 she became Director of Continued Practice and
Revalidation, successfully steering the GMC towards the
implementation of Revalidation in 2012. She now leads the
Registration and Revalidation Directorate. She previously
worked at the Legal Services Commission and was responsible
for the quality assurance program for legal aid practitioners
and managing the Commission’s contracts with suppliers of
legal services in London.
Dr. Michael Marsh, Medical Director and
Responsible Officer, University Hospital
Southampton, is a consultant in Paediatric
Intensive Care. In 1998 he was named
Director of Paediatric Intensive Care at
Southampton and led the development of
the service. In 2006 he was appointed Clinical Lead for Child
Health leading on the integration and modernization of
paediatric services. In 2007 he became Divisional Clinical
Director for Women and Children’s services. From 2002-2008
he served as Honorary Secretary for the Paediatric Intensive
Care Society providing leadership and specialist advice on
children’s intensive care. He assumed the position of Medical
Director for University Hospital Southampton in 2009.
Dr. Bill McCauley was appointed as
Western University’s representative to the
Council of the College of Physicians and
Surgeons of Ontario in 2002 and he was
subsequently hired by the College to serve
on staff as a Medical Advisor in Practice
Assessment and Enhancement. This position gives Dr. McCauley
the opportunity to be involved in education and assessment
program development both at the CPSO and through interaction
with many external stakeholders to the College’s work. Dr.
McCauley is the Past President of the Coalition for Physician
Enhancement, and he continues to practice Emergency Medicine
in London, Ontario, Canada.
Dr. Jon Thomas is Immediate Past Chair
of the FSMB and a Past President of the
Minnesota Board of Medical Practice. He
also is the President and CEO of Ear, Nose
and Throat Specialty Care of Minnesota. Dr.
Thomas was appointed to the Minnesota
Board of Medical Practice in 2001 and was reappointed
in 2005 and 2010. He has served on a variety of FSMB
committees and task forces.
continued on next page
2014 Second International MOL/Revalidation Symposium |
2014 Second International MOL/Revalidation Symposium |
16
“Requalification” for pilots occurs before a pilot returns to line
flying duties after taking personal, academic or medical leave for
an extended period of time, i.e., a Family Medical Leave absence
or a U.S. military member called up for duty for an extended
period. Requalification requirements, again, are set on a caseby-case basis. A pilot may only have to successfully complete
the company’s recurrent training program or, for extensive
absences, may have to complete the entire initial qualification
course for new hire pilots. The intent is to bring the pilot up to
speed and make sure he or she is ready to safely resume flying.
The training curriculum is largely driven by data provided by a
wide range of safety reports from the National Transportation
Safety Board (NTSB), mechanical reports from manufacturers,
and the safety management systems (SMS) of the pilots’
respective companies. Airlines continually receive reports about
safety issues that occur within their respective organizations,
as well as aggregate and de-identified data from across the
industry. As this information comes in, each carrier incorporated
the lessons learned into courses, special training modules/
events, operating procedures and checklists.
17
continued on back page
Speaker Biographies continued from previous page
Dr. Kieran Murphy was appointed to the
Medical Council of Ireland in 2004. He was
subsequently elected President in 2008 and
served a five-year term which concluded
earlier this year. In 2012, he was elected
to the Management Committee of IAMRA,
and earlier this year he was appointed to the Council of the
Pharmaceutical Society of Ireland, the country’s pharmacy
regulator. In 2002, he began his current appointment as
Professor and Chairman of the Department of Psychiatry for
the Royal College of Surgeons in Ireland and as Consultant
Psychiatrist in Dublin. He runs a Behavioural Genetics Service
in association with the National Centre for Medical Genetics
and also a tertiary-level Neuropsychiatry service in association
with the National Neuroscience
Centre.
Lois Margaret Nora, MD, JD, MBA
President and Chief Executive Officer
Dr. Lois Margaret Nora is President and
CEO of the American Board of Medical
Specialties. The mission of the American
Board of Medical Specialties (ABMS) is to
serve the public and the medical profession
to ABMS, Dr. Nora served as Interim President
byPrior
the quality
of health care
andimproving
Dean of The Commonwealth
Medical College
(TCMC) in Scranton, Pennsylvania, one of the nation’s
through setting professional
standards
forleadership,
lifelong certification
newest medical schools.
Under Dr. Nora’s
TCMC achieved major milestones en route to fulfilling
promise to improve
health careDr.
in northeastern
in partnership with itsMember
Boards.
Nora has more than
Pennsylvania through innovative, community-focused,
patient-centered,
medical education.
From 2002-2010, Dr.
Nora served as with a career
20 yearsevidence-based
of experience
in academic
medicine,
President and Dean of Medicine at Northeast Ohio Medical University (then NEOUCOM).
During
Dr. Nora’s tenure,
institutional
accomplishments
included the founding
of a College
of
including
roles
as clinician,
teacher,
scholar,
medical
school
Pharmacy and College of Graduate Studies; a founding partnership in the Austen BioInnovation
Institute
in Akron; and
selection
as one ofPrior
Ohio’s best
workplaces,
among
others. Previously,
president
and
dean.
to
joining
ABMS,
Dr.
Nora
served
as
Dr. Nora served as Associate Dean of Academic Affairs and Administration and Professor of
Neurology
at thePresident
University of Kentucky
College
of Medicine,
and Assistant
Dean and Assistant Medical
Interim
and
Dean
of
The
Commonwealth
Professor of Neurology at Rush Medical College in Chicago.
College in Scranton, Pennsylvania, one of the nation’s newest
Dr. Nora’s scholarly work focuses on issues in medical education, particularly the student
environment, and issues at the intersection of law and medicine. Her honors include the
medical
andPresident’s
from Recognition
2002-2010
American
Medicalschools,
Women’s Association
Award, theshe
AAMCserved
Group on as President
Educational Affairs Merrel Flair Award in Medical Education, The Phillips Medal of Public Service
and
Dean
of College
Medicine
at Medicine,
Northeast
Ohio
Medical
University.
from
the Ohio
University
of Osteopathic
and the 2010
Northeast
Ohio
Dr. Lois Margaret Nora is President and Chief Executive
Officer of the American Board of Medical Specialties
(ABMS). ABMS is a not-for-profit organization that
supports its 24 medical specialty Member Boards in
developing and implementing educational and
professional standards to certify physician specialists and
encourage lifelong learning and assessment. Through
these efforts, ABMS helps ensure high quality health care
for patients, families and communities.
Medical University College of Pharmacy Dean’s Leadership Award, among others.
Dr. Nora received her medical degree from Rush Medical College, a law degree and certificate
in clinical medical ethics from the University of Chicago and a Master of Business
Administration degree from the University of Kentucky Gatton College of Business and
Economics.
Philip Pigou has been Chief Executive
Officer of the Medical Council of New
She is Board Certified and participating
in Maintenancesince
of Certification
in neurology
the
Zealand
2005
andbyserved
as Chair
American Board of Psychiatry and Neurology.
of the International Association of Medical
Regulatory Authorities from 2012-2014.
He has a background in strategy and change
management, introducing a strategic program in the Medical
Council. He has also led major initiatives in primary health
care in New Zealand.
Dr. Trevor Theman was elected to the
Council of the College of Physicians and
Surgeons of Alberta and served two terms
as Council President prior to accepting a
position as an Assistant Registrar for the
College’s complaints department. This
position sensitized Dr. Theman to the systems of care in which
physicians and other health care workers practice, and led
to his interest in patient safety. Dr. Theman assumed the
position of Registrar in 2005. He is a keen advocate of
quality and measurement in medical practice, and believes
that the future of medical regulation is in the use of databases
to proactively monitor processes and outcomes around quality
patient care.
Dr. Mark Watts earned his BA in Molecular
Biophysics and Biochemistry from Yale
University in 1986 and he earned his
medical degree from Stanford University
School of Medicine in 1991. Dr. Watts then
went on to a general surgery internship and
neurosurgical residency at The Johns Hopkins Hospital under
then Chairman Dr. Donlin Long. He also completed his
two-year fellowship in Neuro-Oncology at Johns Hopkins under
the direction of Dr. Henry Brem. In 2004 he accepted a
position with Kaiser Permanente and he joined the staff at
Exempla Saint Joseph Hospital. In 2008 Dr. Watts was
appointed Vice-Chair of Surgery at St. Josephs and in 2011 he
was subsequently appointed Chief of Surgical Services and
Medical Director of the Operating Room and Perioperative
Services. In 2007 Dr. Watts was appointed by the Governor to
the Colorado Medical Board, where he currently serves as
Immediate Past President.
Captain Peter Wolfe is the Executive
Director of the Professional Aviation Board
of Certification. PABC is an independent,
non-profit organization now being developed
to serve as the worldwide certifying body
responsible for assuring the preparedness
of pilots to enter qualification training for employment by
commercial and business air services. PABC sets the global
pre-employment standards for knowledge training, and tests
candidate pilots against those standards. Previously, Captain
Wolfe served at Southwest Airlines as a line pilot and human
factors specialist for Flight Operations. A retired U.S. Air Force
colonel, he held a variety of staff and command positions
involving flight operations, safety, maintenance and training,
including duty as the Assistant Director of Operations for the
North American Air Defense Command.