An innovative approach to remedial continuing medical education, 1992-2002

The authors describe the process of remedial retraining programs organized and planned for Quebec physicians by the College des medecins du Quebec (CMQ) and report the outcomes of these efforts from April 1992 to March 2002. The CMQ (the Quebec medical licensing authority) developed a process to identify physicians who had shortcomings in their clinical performance, determine their educational needs, propose, in collaboration with the four medical schools in the province, personalized retraining programs (clinical training programs, tutorials, focused readings, workshops, and refresher courses), and subsequently evaluate the impact of these retraining programs. During the ten-year period reported, 305 physicians (216 family physicians and 89 specialists) were referred to the Practice Enhancement Division of the CMQ for personalized remedial retraining. The vast majority of these physicians were men (81%). The following difficulties were identified: therapeutic knowledge (37%), diagnostic knowledge (32%), record-keeping (14%), technical skills (10%), clinical judgment (5%), and communication skills (2%). A total of 329 personalized retraining programs were completed: 273 clinical training programs, 41 tutorials, and 15 focused readings. A reevaluation of all these physicians showed that 70% of the retraining programs had succeeded, 15% were partially successful and only 13% had failed. The remaining 2% involved missing data or withdrawal of physicians. The authors conclude that the collaborative CME process described has important and effective original features.