Sign In

e-Panel Survey Summary

Medical Professionalism

Synopsis

The CMA surveyed e-Panel members to learn more about their views on medical professionalism. The results provide a picture of how Canadian physicians demonstrate professionalism, how they are accountable for the care they deliver and perceived opportunities to enhance this accountability. A summary of the results of the e-Panel survey is presented below.

 

Survey – September 2015

The survey was sent to 4,305 e-Panel members; 858 responded, for a response rate of 20%.

 

Results

CanMEDS 2015 defines the role of the “medical professional” as “a commitment to the health and well-being of individual patients and society through ethical practice, high personal standards of behaviour, commitment to the profession, profession-led regulation, and maintenance of personal health.” Survey results indicate that this topic was only covered in some respondents’ formal education. They proposed a variety of ideas of how professionalism performance and the health care system can be improved, as well as varying views on professional autonomy.

Coverage of Professionalism in Formal Education

The amount of respondents who felt that the topic of professionalism was covered in their formal education varied, with 51% stating that there was limited or no coverage, and 38% stating there was good or very good coverage.

Opinion of Peers’ Performance

Participants were asked to reflect on how their peers demonstrate attributes of professionalism. Here are the results:

  • Seek out opportunities to enhance quality care (agree or strongly agree: 72%, disagree or strongly disagree: 7%)
  • Actively participate in collaborative care (agree or strongly agree: 69%, disagree or strongly disagree: 11%)
  • Maintain and promote a culture of collegiality and respect (agree or strongly agree: 69%, disagree or strongly disagree: 13%)
  • Seek out opportunities to improve patient safety (agree or strongly agree: 64%, disagree or strongly disagree: 9%)
  • Engage patients as equals in decision making about their health (agree or strongly agree: 51%, disagree or strongly disagree: 18%)
  • Demonstrate a commitment to personal health (e.g., maintain a healthy lifestyle, balancing demands of work and home life) (agree or strongly agree: 48%, disagree or strongly disagree: 21%)
  • Participate in regular self-assessment; e.g., 360 assessment or equivalent (agree or strongly agree: 31%, disagree or strongly disagree: 33%)
  • Recognize and respond to the unprofessional behaviour of others (agree or strongly agree: 31%, disagree or strongly disagree: 35%)

Tools to Assess Performance

Respondents were split on whether they had tools to assess their own performance, with 54% saying that they did. The tools that respondents currently use or have access to include:

  • Performance Assessment Reviews
  • 360 evaluations
  • Continuing Medical Education
  • Electronic Medical Records
  • Peer Review
  • Audits
  • College assessments
  • Benchmarking
  • Conferences

Respondents also proposed a variety of areas where tools should be implemented and developed:

  • Quality improvement tools
  • Performance statistics
  • 360 evaluations
  • Assessment from patients and other physicians
  • Assessment of non-clinical skills (e.g. communication)
  • Continuing Medical Education
  • Patient safety
  • Physician health

Improving patient-centred care, enhancing quality and accountability, and improving collaborative care

Participants were asked to what degree they support the following concepts to improve patient-centred care, enhance quality and accountability, and improve collaborative care. Here are the results:

  • Physicians should work in multi-disciplinary teams that are integrated across multiple care settings and will involve social and community services to address underlying social determinants of health. (Agree or strongly agree: 76%, disagree or strongly disagree: 10%)
  • Patients should be equal partners with physicians in decision making about their health. (agree or strongly agree: 76%, disagree or strongly disagree: 11%)
  • Physicians should be required to participate in a robust process of revalidation which includes regular testing of clinical competence. (agree or strongly agree: 51%, disagree or strongly disagree: 27%)
  • Physicians should be measured against a clinically relevant set of outcome measures and results will be available to colleagues and the public. (agree or strongly agree: 37%, disagree or strongly disagree: 42%)
  • Physicians should be held financially accountable for the outcomes of their clinical performance, whether delivered individually or as a team. (agree or strongly agree: 19%, disagree or strongly disagree: 65%)

Participants were asked to what degree they agree with the following. Here are the results:

  • Performance measurements including benchmarks and targets can be beneficial to medical practice provided they are developed by front-line practicing clinicians and have patient care as their primary motivation. (agree or strongly agree: 72%, disagree or strongly disagree: 12%)
  • Having data that allows me to see how I compare to my colleagues in terms of variation and patient outcomes would influence how I practice medicine. (agree or strongly agree: 69%, disagree or strongly disagree: 12%)
  • Fee-For-Service and other volume based payment models serve as a barrier for effective patient centred care. (agree or strongly agree: 45%, disagree or strongly disagree: 34%)
  • I struggle to balance the needs of my individual patients with the needs of the broader community in which I practice. (agree or strongly agree: 44%, disagree or strongly disagree: 25%)
  • Increasing physician accountability for patient and system outcomes would be a welcome development in Canadian health care. (agree or strongly agree: 44%, disagree or strongly disagree: 27%)

Professional autonomy

Respondents were asked: “what does professional autonomy mean for the modern physician?” They offered a variety of definitions, containing the following major ideas:

  • The ability to make clinical decisions without pressure from above
  • Freedom to uphold values, morals, ideals
  • Having the support of professional bodies while maintaining an arm’s length relationship with government
  • Having influence on how decisions are made in the health care system
  • Having control over where, when, and how to work
  • Balance of professional autonomy with system and patient needs

Respondents were also asked which components of autonomy should be preserved and valued. The following themes emerged:

  • All components
  • Decision making
  • Flexibility
  • Morals
  • Advocacy
  • Accountability
  • Patient-physician relationship

What is a “medical professional”?

Participants were asked to list the top adjectives they would use to describe a medical professional. Here are the results:

  • Dedicated
  • Compassionate
  • Competent
  • Available
  • Altruistic
  • Collaborative

Next Steps

This research will be validated through further engagement with CMA members over the course of a multi-year CMA strategic initiative which seeks to define a progressive vision for medical professionalism in Canada. Specifically, CMA members will be asked to comment on the results of this e-Panel and reflect on other opportunities which would enhance physician accountability for health outcomes. This will take place via the (gated) member dialogue.

Respondents told us

“Although there was no specific teaching or even mention of the subject teachers made abundantly clear by word and by action what was expected of a professional.”

“I am fortunate to work in a large group of likeminded colleagues who have strong professional ethics and commitment.”

“As a resident I certainly have access to my preceptors' subjective evaluations of my performance, which is invaluable – however objective measures which I can use to self-assess and improve are lacking.”

“I think assessment tools are important in all aspects of patient care. However, each physician should be able to devise their own assessment tools based on their practice population and setting. This is where research skills come in handy, as it allows a professional to answer the question: ‘Am I performing at a level where I should be?’”

“Fee-for-service may be a barrier, but not necessarily the most significant one. It has pros and cons, but addressing the system as a whole is more important. Improving primary care through government action on recommendations to make health care sustainable must be regarded together.”

Autonomy is “building a practice based on my interests and skills. Being able to practice with moral integrity - my set of moral values not those of others - and balancing that with patient autonomy. Finding a way that physician autonomy and patient autonomy can both be met.”