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W Dale Dauphinee

Publications and source records attributed to W Dale Dauphinee.

9 recordsLinked to original sources
PubMed2006

Medical workforce policy-making in Canada, 1993-2003: reconnecting the disconnected.

The authors set out to review Canadian medical workforce policies for 1993 to 2003 and assess if data existed in the 1990s that could have reversed the policy decision to curtail the supply of physicians from Canada's medical schools just as Canada was about to experience a developing shortage. The authors reviewed existing descriptive data sources regarding Canadian physician workforce size and activity from 1986 to 2003, including the Canadian Medical Association workforce database. The review indicated that a significant loss of physicians to retirement was imminent. Physician workforce productivity had started to fall by the early 1990s. Emigration to the United States had risen above traditional levels in the early 1990s and remained higher into the late 1990s. Despite these existing findings, an integrated adjustment to physician workforce policies taken in 1993-94 only occurred after 1999. The authors recommend that policy makers and managers must monitor the numbers from existing sources. To optimize these sources, planned data tracking and linkages are essential. The period in question demonstrated major disconnects in coordinating implementation, wherein subject experts monitoring data trends were not adequately utilized by policy makers. Finally, in complex systems with regional differences, policy decisions based on normative data are insufficient.

Canada↗
PubMed2006

The circle game: understanding physician migration patterns within Canada.

This report explores the movement of physicians to, from, and within Canada and identifies recurring patterns of migration. The primary position of the report is that physician movement is part of reality both internationally and within Canada, and that movement of Canadian-trained physicians creates a need for international medical graduates (IMGs) in "physician-losing" locations. The report's argument is based on data retrieved from public sources on aggregate physician practice patterns in Canada and analyzed for migration patterns. In addition, literature was reviewed on factors affecting the migration patterns being described.Canadian-educated physicians have tended to move from less prosperous to more prosperous provinces and from rural to urban areas; because of the resulting need, the physician-losing locales generally have the highest proportions of IMGs. Physicians traditionally have tended to emigrate from Canada to the United States, thus increasing Canadian demand for IMGs, but recently this movement has slowed and even reversed. In Canada, liberalized immigration policies for physicians combined with a shortage of postgraduate training positions to create a serious bottleneck early in the current decade. However, this problem is now being resolved. In summary, physician migration within Canada shows specific long-term patterns, and IMGs will be needed in underserved areas for years to come. Well-informed policies for workforce management are essential in Canada to ensure an adequate physician supply consisting mainly of Canadian-educated physicians but also including IMGs. A role for nonadvocacy groups such as the Educational Commission for Foreign Medical Graduates may be to help ensure that recruitment of physicians from developing countries follows accepted ethical principles.

Canada↗
PubMed2005

Physician migration to and from Canada: the challenge of finding the ethical and political balance between the individual's right to mobility and recruitment to underserved communities.

Physician migration to and from countries results from many local causes and international influences. These factors operate in the context of an increasingly globalized economy. From an ethical point of view, selective and targeted "raiding" of developing countries' medical workforce by wealthier countries is not acceptable. However, within specific countries, additional factors need to be identified to moderate the situation. I discuss the context in which Canada, a developed country, has struggled with workforce planning, with troubling results. I identify challenges for Canada but emphasize that decisions based on sloppy assumptions or inadequate data can lead to invalid policies, and poorly coordinated implementation can lead to a waste of human capital. Myths and attitudes further complicate physician workforce planning. Implementing recommendations of the recently concluded Task Force on the Licensure of International Medical Graduates will hopefully ameliorate the situation.

Canada↗
PubMed2004

The need for evidence in medical education: the development of best evidence medical education as an opportunity to inform, guide, and sustain medical education research.

The development of the Best Evidence Medical Education (BEME) Collaboration is introduced in the context of other systematic review initiatives, specifically the Cochrane and Campbell collaborations. The commentary addresses two goals: to describe the current status of BEME and to situate BEME in the broader context of the medical education community's need to be accountable, to conduct research to understand educational processes and results, and the key role that medical educational research must play within the quality-improvement agenda. Lessons drawn from the evidence-based practice movement of the last ten years and the current experience with BEME suggest that, although BEME will inform some educational policies and practices, its initial success may be limited because of the paucity of studies that meet current standards for evidence and the great difficulty in conducting methodologically rigorous studies in the complex social interaction called education. Nonetheless, the need exists for medical education research to continue to address key issues in medical education using experimental designs, while at the same time anticipating the need for more situation-specific data to permit educators to monitor and benchmark their existing programs within a quality-improvement and accountability framework. The authors conclude that the very nature of being professional in today's social and fiscal context demands that medical educators provide evidence of effectiveness and efficiency of their programs while at the same time BEME and medical education research continue to grow and mature.

Benchmarking↗
PubMed2003

A sequenced OSCE for licensure: administrative issues, results and myths.

In response to stakeholder demands for a more cost-effective clinical examination, the Medical Council of Canada adopted a sequenced format for the OSCE component of its licensure examination. The sequenced OSCE was administered in 1997 at 14 sites and assessed 1,796 test takers. The 10-station screening test had an alpha = 0.66 (M = 61.3%, SD = 4.7%). The fail rate of 1.7% for Canadian first-time takers was the lowest since 1992. Significant savings were realized despite costs incurred by the new format. The logistical problems that were encountered were largely due to the constraints of administering a multi-site OSCE. Although the sequenced format was cost effective and psychometrically acceptable, the response of many test takers and faculty members was negative. Consequently, it is the logistical and political lessons that may be the most generalizable.

Canada↗
PubMed2002

Association between licensure examination scores and practice in primary care.

CONTEXT: Standards for licensure are designed to provide assurance to the public of a physician's competence to practice. However, there has been little assessment of the relationship between examination scores and subsequent practice performance. OBJECTIVE: To determine if there is a sustained relationship between certification examination scores and practice performance and if licensing examinations taken at the end of medical school are predictive of future practice in primary care. DESIGN, SETTING, AND PARTICIPANTS: A total of 912 family physicians, who passed the Québec family medicine certification examination (QLEX) between 1990 and 1993 and entered practice. Linked databases were used to assess physicians' practice performance for 3.4 million patients in the universal health care system in Québec, Canada. Patients were seen during the follow-up period for the first 4 years (1993 cohort of physicians) to 7 years (1990 cohort of physicians) of practice from July 1 of the certification examination to December 31, 1996. MAIN OUTCOME MEASURES: Mammography screening rate, continuity of care index, disease-specific and symptom-relief prescribing rate, contraindicated prescribing rate, and consultation rate. RESULTS: Physicians achieving higher scores on both examinations had higher rates (rate increase per SD increase in score per 1000 persons per year) of mammography screening (beta for QLEX, 16.8 [95% confidence interval [CI], 8.7-24.9]; beta for Medical Council of Canada Qualifying Examination [MCCQE], 17.4 [95% CI, 10.6-24.1]) and consultation (beta for QLEX, 4.9 [95% CI, 2.1-7.8]; beta for MCCQE, 2.9 [95% CI, 0.4-5.4]). Higher subscores in diagnosis were predictive of higher rates in the difference between disease-specific and symptom-relief prescribing (beta for QLEX, 3.9 [95% CI, 0.9-7.0]; beta for MCCQE, 3.8 [95% CI, 0.3-7.3]). Higher scores of drug knowledge were predictive of a lower rate (relative risk per SD increase in score) of contraindicated prescribing for MCCQE (relative risk, 0.88; 95% CI, 0.77-1.00). Relationships between examination scores and practice performance were sustained through the first 4 to 7 years in practice. CONCLUSION: Scores achieved on certification examinations and licensure examinations taken at the end of medical school show a sustained relationship, over 4 to 7 years, with indices of preventive care and acute and chronic disease management in primary care practice.

Certification↗
PubMed2002

Assessing the performance of doctors in teams and systems.

INTRODUCTION: Increasing attention is being directed towards finding ways of assessing how well doctors perform in clinical practice. Current approaches rely on strategies directed at individuals only, but, in real life, doctors' work is characterised by multiple complex professional interactions. These interactions involve different kinds of teams and are embedded within the overall context and systems of care. In addition to individual factors, therefore, we propose that the performance of doctors in health care teams and systems will also impact on the overall quality of patient care. Assessing these dimensions, however, poses a number of challenges. STRATEGIES: Taking a profile of a National Health Service, UK surgeon as an example, the team structures to which he or she may relate are illustrated. These include formal teams such as those found in the operating theatre, and those formed through various professional and collegial partnerships. The authors then propose a model for assessing doctors' performances in teams and systems, which incorporates the educational principles of continuous feedback to enhance future performance. DISCUSSION: To implement the proposed model, a wide range of professional, educational and regulatory bodies must collaborate. This raises a number of important implications for the future roles and relationships of these bodies, which are discussed. A strong and constructive partnership will be essential if the full potential of a more inclusive and representative assessment approach is to be realised.

Clinical Competence↗