[The process of evaluation and improvement of medical practice in Quebec]

In Quebec, the evaluation of health care providers' practices is organized for each professional group. It is an official part of the health care regulation policy and is defined by legal texts. Evaluation of medical practices is controlled by physicians through their professional order and consultative medical councils in hospitals. The role of the Collège des Médecins du Québec is to warrant the quality of medical acts. The College watches over the quality of the physician's initial education using a process of agreement for all training departments and for the medical school curriculum. Young graduates must pass the College's examination before being licensed to practice. The College watches over improvements in professional practices via inspections of individual practices and hospitals and continuous education programs. There are three levels of physician supervision: screening for poor practices, inspection, and in-depth investigation. In hospitals, a consultative medical council is in charge of assuring quality medial practice. Mortality and morbidity conferences, claims analysis, audits with explicit evaluation criteria and indicator monitoring are the basic tools used for assessing the quality of medical practice. The Quebec experience demonstrating how a medical profession can organize a full system for evaluating medical practice can be a model for other countries.