Evaluation of medical practices in France: Who is the best teacher?

Dear Sir

Evaluation of professional practices (EPP) is a key feature of continuous quality improvement. EPP is aimed at helping doctors to reflect on their own practices and enhance adherence to clinical practical guidelines.

In 2005, the French Assembly voted to oblige medical professionals continually to evaluate their practices, so that EPP is actually a legal obligation. Its methods are laid down by decree, but the text leaves a free choice as for the guidelines to be employed in the process.

After approval of the law, decrees and procedures were published specifying means for implementing EPP. However, the development of evaluative procedures (certification of the hospital, accreditation of the medical team, EPP, continuing medical education) is causing confusion regarding who is responsible for these procedures. Many organizations are involved in EPP (medical associations, hospital medical committees, regional union of physicians, specialty societies, the National Institute of Health, private organizations for continuing medical education), some of which are not acknowledged nor recognized by practicing physicians.

Recently, the Ministry of Health tried to simplify EPP procedures. A first effort was made to unify EPP with the Continuing Medical Education Program. Thereafter, attempts were made to involve specialty societies in the implementation of EPP.

Indeed, evaluation of professional practice is a “professional thing” and the involvement of specialty societies in EPP is a key component of its success. Influence of specialty societies is probably the most important contributor to doctors’ behavioural changes.

In a study carried out in 2005, we found that hospital physicians generally valued guidelines and hence adhered to them, according to their promoter, more than to the scientific consistency of guidelines (Vignally 2008).

Specialty societies were considered the most reliable promoter, more than the national health agencies or the pharmaceutical industries. Specialty societies were also the main vector of guidelines dissemination. Indeed, physicians became aware of guidelines through their specialty society followed from afar by medical congresses, hospital colleagues and medical publications. According to our results, peers and particularly specialty societies play a key role in informing doctors on medical guidelines in France.

We propose that involvement of specialty societies also contribute to the success of EPP activities.

Starting from this view, the national health agencies should integrate specialty societies in the EPP development process to enhance participation of medical professionals in peer teaching activities that are still an under-recognized source of education in the medical education continuum (Cate 2007).

Pascal Vignally

Sabina Gainotti

Italian National Institute of Health

Rome

Italy

Roland Sambuc

Stéphanie Gentile

Faculty of Medicine

Department of Public Health

Marseille

France

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