Intended for healthcare professionals

Education And Debate

Continuing medical education: Maintaining standards in British and Canadian medicine: the developing role of the regulatory body

BMJ 1998; 316 doi: (Published 28 February 1998) Cite this as: BMJ 1998;316:697
  1. Lesley Southgate (, professor of primary care and medical educationa,
  2. Dale Dauphinee, executive directorb
  1. a Centre for Health Informatics and Multiprofessional Education (CHIME), University College London Medical School, Whittington Hospital Campus, London N19 5NF
  2. b Medical Council of Canada, Ottawa, Ontario, Canada
  1. Correspondence to: Professor Southgate

    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.

    Forces for change

    In both North America and the United Kingdom the pressure for greater accountability of doctors is being felt at all levels of governance and regulation of practitioners: in hospital standards committees, in utilisation review by public agencies and third party payers, and in various professional regulatory and licensing bodies.3 The movement is away from the traditional approach of primary reliance on setting standards for entry into practice and towards placing new emphasis on maintaining standards in practice.

    Summary points

    In the United Kingdom and Canada there is increased interest in the accountability of medical practitioners

    Regulating bodies are adopting proactive methods, and emphasis …

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