This is the sixth in a series of seven articles looking at international trends and forces in doctors' continuing professional development

While health care is being reformed throughout the Western world, another change has emerged without as much public attention: the appearance of strategies to increase the degree of accountability of medical practitioners. As part of this interest in accountability, the scope of standards for practice has widened to include activities beyond the traditional actions of regulating bodies, such as dealing with doctors' misconduct and impairment and relying on patients' complaints to detect these. The approaches to and pacing of these changes differ, but the underlying trends are the same. Strategies to anticipate and prevent a decline in doctors' performance are now a central concern for regulating bodies, which are increasingly adopting proactive or interventional methods. 1 2

We describe the recent changes in the ways in which the medical profession is regulated in the United Kingdom and some developments in Canada to enhance doctors' performance. We will discuss the implications flowing from the introduction of a minimum standard, the methods by which it is defined and assessed, and the emerging approaches to monitor and enhance doctors' performance.