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Patient Compass

April 2015

Mistreatment in medical training

Humiliation and intimidation by a physician have no place anywhere, including in the teaching of medical students. If this has been your experience during your education, where do you go to seek help?

Being a medical trainee is tough, and not just because of the workload. Sadly, rude, disrespectful, insulting, demeaning, threatening and bullying behaviour has been the experience for some medical students. A collection of research has explored the topic of mistreatment in medical training – raising the notion that there is a ‘hidden curriculum” where a lack of professionalism and a culture of disrespect are taught. These behaviours can negatively impact quality health care delivery and patient safety by breaking down the effective communication and collaboration that support good medical practice and medical education.

The College’s policy on Physicians Behaviour in the Professional Environment sets out expectations of physician behaviour and professionalism. A revised draft of this policy was out for consultation from December 2015 to February 2016, and a final revised version will be considered by Council this spring. The feedback we heard during the consultation period stressed the need for physicians to model appropriate behaviour, particularly with trainees.

While there may be a myriad of reasons for disruptive behaviour, whether personal, professional, or situational, physicians are nevertheless expected to demonstrate professional behaviour at all times. Physicians have a responsibility to the profession to demonstrate to trainees what it means to be a professional and foster a culture of respect within their practice setting or workplace. As a medical trainee, you need to be able to recognize those times when a doctor who is a position of authority over you has crossed the line.

Our Guidebook for Managing Disruptive Physician Behaviour is a companion to our Physician Behaviour in the Professional Environment policy, and can help you identify unprofessional behaviour. If you think you have been mistreated during your medical training, we encourage you to give us a call to discuss the situation. You can do so by contacting the CPSO’s Physician Advisory Services toll free at 1-800-268-7096 extension 606.

It may be feel extraordinarily intimidating to seek help, but reaching out to the College can be an important step to stopping an instance of inappropriate behaviour and making sure that your training environment is a healthy and productive one for everybody.

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Physician-Assisted Death

The College has recently approved its ‘Interim Guidance on Physician-Assisted Death’. Read about the landmark case that ushered in this change, and what it means for you.

On February 6, 2015 in its decision Carter v. Canada, the Supreme Court of Canada (SCC) unanimously agreed that the criminal prohibition on physician-assisted death violated the Charter rights of competent adults suffering intolerably from a grievous and irremediable medical condition. The SCC gave the federal government until February 6, 2016 to design a legal framework around physician-assisted death. 

In December 2015, the federal government requested and was granted a four-month extension from the SCC, giving them until June 6, 2016 to develop their framework.  The Court stated however, that from February 6 — June 6 2016, individuals could access physician-assisted death through a Court Order from a superior court in their jurisdiction. 

On January 26, 2016, we approved our Interim Guidance on Physician-Assisted Death. This document was developed to assist the profession in the absence of a framework to govern the provision of physician-assisted death. 

As medical students, you are in the unique position of entering the profession under this new landscape. It’s important to familiarize yourself with the College’s Interim Guidance on Physician-Assisted Death and how the expectations set out in this document may impact your work and that of your colleagues.

The key elements of the Interim Guidance document include:

  • Professional and legal obligations articulated in College policies and legislation that apply in the physician-assisted death context;
  • The criteria for physician-assisted death as set out by the Supreme Court of Canada; and
  • Guidance for physicians on practice-related elements specific to the provision of physician-assisted death, as set out in a Sample Process Map;

As we explained in the last issue of Medical Student Update in our feature article ”Ethical Imperatives”, consistent with the College’s Professional Obligations and Human Rights policy, physicians do not have to provide services that conflict with their conscience or religious beliefs. Where a physician declines to provide physician-assisted death for reasons of conscience or religion, he or she must make an effective referral in a timely manner to a non-objecting physician or agency.

The College’s Interim Guidance document was approved following consultation with the public, physician community and organizational stakeholders. Considerable feedback was received and is reflected in the final document. Upon its release, Dr. Eric Hoskins, the Minister of Health and Long-Term Care, commended the College’s initiative and leadership on the issue.

On April 14, 2016, the federal government introduced legislation on medical assistance in dying. It is expected that the government will finalize the proposed legislation for June 6 2016, when medical assistance in dying will become legal in Canada. The College will monitor the proposed legislation closely as it moves through the government approvals process and will ensure that our Interim Guidance document is revised to reflect the finalized legislation.

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Lifelong learning: The key to keeping current

The CPSO website is your first stop to discovering resources and requirements for continuing professional development

Last fall, we published an article outlining the importance of lifelong learning and continuing professional development (CPD). With regular improvements in technology, treatments and methods, entering the medical profession is a commitment to staying up-to-date on developments relevant to your practice. But after you graduate, you may be wondering what CPD activities are available to help you meet this mandatory requirement.

To help physicians fulfill this obligation to their practice and patients, we’ve launched a section of our website dedicated to providing information about CPD. In addition to listing approved tracking organizations, we share a variety of resources to support learning after convocation such as simulation-based courses and others on infection control and epidemiology; professionalism; leadership skills; medical record-keeping; and communication. Down the road you may become involved in programs and activities at the CPSO, such as peer assessment, for which CPD credits may also be claimed. The content is updated as new information becomes available, and serves as a great starting point for self-improvement and continuous learning.

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What to expect during medical encounters

The College of Physicians and Surgeons has developed an educational resource for patients that describes a typical physician-patient interaction.

The College of Physicians and Surgeons of Ontario (the College) has written a plain-language document for the general public that describes what patients can expect from their physicians during a medical encounter. The document, called What to Expect During Medical Encounters, contains content from The Practice Guide, the Maintaining Appropriate Boundaries and Preventing Sexual Abuse policy, the Boundaries Self-Assessment Tool, and Safe and Effective Office-Based Practices.

It describes the types of interactions that patients can generally expect when meeting with their physician, from how the physician will communicate with them, the parameters of a healthy professional relationship, what to expect during physical and intimate examinations, and how the College can help if they have questions or concerns about the care they received. This document does not create new expectations for doctors. 

While this document is intended as a tool to inform the general public, it’s still highly relevant to practicing physicians and medical students. This document provides a framework that will support and foster a healthy and productive physician-patient relationship, one that is grounded in professionalism, trust and mutual respect. It’s essential that Ontario medical students understand and internalize all the referenced College policies while still in school so that future interactions with patients will be based on a foundation of trust and respect. 

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Happy birthday, College

The CPSO celebrates its 150th anniversary this year

We’re very excited to announce that 2016 marks the College’s 150th birthday. Many of you may not realize this, but the CPSO — which held its first meeting on May 2, 1866 — actually predates Confederation. Back then, we were known as the General Council of Medical Education and Registration, and it was our responsibility to regulate the handful of doctors spread across the province of Ontario.

Of course, our mandate and focus have changed a lot since those days. For much of the 20th century, the College operated with the view that a medical degree from a recognized institution was sufficient to practise medicine dependably. We licensed qualified doctors, prosecuted unlicensed individuals, and disciplined members who had violated professional standards. That mandate began to expand starting in the 1970s and 80s, when the focus shifted towards ongoing competence of Ontario’s physicians through continuing professional education, assessment, and remediation.

To celebrate our birthday, we will be participating in Doors Open Toronto on the weekend of May 28 and 29, where members of the public will be welcomed to 80 College St. to see an exhibit that will trace the history of the CPSO and display historic artefacts related to the College’s beginnings and place in Ontario. If any med students in the GTA are free on either of those days, feel free to drop in and say hi!

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Open consultations

We encourage all medical students to participate in the open consultations that the College is currently running. Your perspectives are just as important as those of our membership, other health care professionals, and the general public, and we want to hear your feedback. The deadline for our current consultation is June 2, 2016.

  • Scope of Practice: The College is holding a consultation on physician scope of practice. The College is soliciting feedback on the current policy and also asking for comments about the concept of scope of practice more broadly. 

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We want to hear from you!

 
Do you have an idea for the next issue of Medical Student Update?

Are you looking for a CPSO policy expert or medical advisor to provide a guest lecture at your school? Let us be a resource for you. Contact us to arrange a presentation, or get more information about our range of seminars.

Contact our Outreach Team:
80 College Street
Toronto, Ontario
M5G 2E2
416-967-2600, Ext. 552
Email: outreach@cpso.on.ca

Our quarterly magazine contains important updates on policies, topics of interest, as well as a summary of recent disciplinary findings.
Read the latest issue here.
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