CAAM-HP 10TH ANNIVERSARY CONFERENCE- JULY 28-30, 2014.

PROFESSOR HOWARD SPENCERREGISTRAR, MCJ &CAMC

History of CAMC

Registration/Licensing

Registration/Licensing in CARICOM

The Challenges

The way forward

History of CAMC

First proposed as the Caribbean Medical Council

Cost implications of a Secretariat ruled out such an organization

Caribbean Association of Medical Councils agreed upon by Meeting of Chief Medical Officers.

Proposal accepted by COHSOD in 1998

New Institution’s Tasks

An acceptable examination for admission into medical practice

Accreditation of medical schools- CAAM-HP

Code of practice- database of medical practitioners- consultation on matters of discipline

Establishment of a specialist register

“The fundamental purpose of the Caribbean Association of Medical Councils shall be to

contribute to the attainment of the highest quality of health care to the people of the Caribbean

Region by ensuring the health professionals meet the highest standards of practice and the

protection of public health”.1998

1)To protect the health of the public through:

Maintenance of the highest standards of medical education and practice

Promotion of regional perspective on physician registration on issues relating to the licensing of physicians

Development and maintenance of a regional perspective on issues relating to the regulation of medical practice

2)To create a sustainable mechanism for collaboration and the exchange of information

MEMBER STATES ANTIGUA AND BARBUDA-

http://antiguabarbudamedicalcouncil.com/ 89,000

THE BAHAMAS-http://bahamasmedicalcouncil.org/about-us/

317,000 BARBADOS- http://health.gov.bb/

290,000 BELIZE -

http://health.gov.bz/www/

327,000

MEMBER STATES

DOMINICA- 73,000

GRENADA- 109,000

GUYANA- 740,000

HAITI- 9.8M

JAMAICA -http://jamaicamedicalcouncil.org/2.9M

MONTSERRAT- 5,000

ST. LUCIA-http://www.slmdc.org/162,000

ST. KITTS AND NEVIS-http://gov.kn/50,000

ST. VINCENT AND THE GRENADINES-http://www.health.gov.vc/ 103,000

SURINAME- 560,000

TRINIDAD AND TOBAGO-http://www.mbtt.org/

1.2M

CARICOM ASSOCIATE MEMBERS

CAYMAN ISLANDS-http://www.gov.ky/portal/page?_pageid=1142,1594768&_dad=porta 56,000

TURKS AND CAICOS ISLANDS- 36,600

CARICOM ASSOCIATE MEMBERS

ANGUILLA- 13,000

BERMUDA- http://www.bhec.bm/

67,000

BRITISH VIRGIN ISLANDS-http://bvimdc.com/BVI_Medical_%26_Dental_Council/Welcome.html 24,000

Establishing the CARICOM Single Market and Economy (CSME)

The decision in 1989 to establish the CARICOM Single Market and Economy (CSME) was a move to deepen the integration movement and to better respond to the challenges and opportunities presented by globalisation.

Establishing the CARICOM Single Market and Economy (CSME)

While a primary focus of the Common Market was on liberalising trade in goods among the Members, the Single Market and Economy not only expands this process to include services, but also provides for the free movement of capital (money), skilled labour, and the freedom to establish business enterprises anywhere in the Community.

It also deepens economic cooperation among the Member States participating in the Single Market and Economy.

The functions of the Council shall be-

(a) to register medical practitioners;

(b) to appoint examiners to conduct examinations in respect of persons applying for registration as medical practitioners as may from time to time be necessary under the provisions of this Act; and

(c) to ensure the maintenance of proper standards of professional conduct by registered medical practitioners

TYPES OF REGISTRATION

1)Full

2) Provisional

3)Locum provisional

4) Special

Provisional Registration available to graduates of recognised medical universities/colleges who wish to pursue internship. Note requirements vary based on the educational institution that the medical degree was obtained.

Temporary Registration available to graduates of recognised medical universities who have completed internship but are not eligible for Full registration. Sub-categories include Temporary Academic, Temporary Conditional and Special Temporary Registration

Full Registration available to graduates of recognised medical insitutions and U.S. or U.K. specialists. Fully registered Members of GMC or the Irish Medical Board are eligible to apply for this category. Doctors with Full Registration with MBTT can register post-graduate qualifications

The functions of the Council shall be-

(a) to register medical practitioners;

(b) to appoint examiners to conduct examinations in respect of persons applying for registration as medical practitioners as may from time to time be necessary under the provisions of this Act; and

(c) to ensure the maintenance of proper standards of professional conduct by registered medical practitioners

Why should there be an examination?

How many Councils had a Registration examination?

Who should do the examination?

Number of Operating Medical Schools (Source: IMED)As of February 6, 2014, there were 2,372 recognized and operating medical schools in 179 countries or territories listed in the International Medical Education Directory (IMED).

CAMC Dec 2012 24

Currently consist of

Part 1 – Multiple Choice Examination (online administration), and

Part 2 – Clinical (Practice-based) Examination

Only candidates who are successful in the Part 1 Examination will qualify to proceed to the Part 2 Examination

CAMC Dec 2012 25

The multiple choice examination (MCQ) is a test of the principles and practice of medicine in the disciplines of internal medicine, family medicine, emergency medicine, paediatrics, surgery, obstetrics, gynaecology, community health and psychiatry

The MCQ is in two parts (morning and afternoon sessions), each of three hours duration; each part contains 100 questions

The MCQ examination is held over one day, simultaneously at approved centres within the Caribbean, and has been administered electronically since October 2008

CAMC Dec 2012 26

The clinical examination evaluates clinical competence in terms of medical knowledge, clinical skills, problem solving and clinical decision-making and professional attitudes for the safe and effective clinical practice of medicine in the Caribbean region

The clinical examination consists of a multi-station structured assessment of clinical skills

Disciplines covered include: medicine and surgery, obstetrics and gynaecology, paediatrics, family medicine, emergency medicine, community health and psychiatry

CAMC Dec 2012 27

The clinical examination evaluates clinical competence in terms of medical knowledge, clinical skills, problem solving and clinical decision-making and professional attitudes for the safe and effective clinical practice of medicine in the Caribbean region

The clinical examination consists of a multi-station structured assessment of clinical skills

Disciplines covered include: medicine and surgery, obstetrics and gynaecology, paediatrics, family medicine, emergency medicine, community health and psychiatry

CAMC Dec 2012 28

The examinations are currently conducted bi-annually (April/May and October/November)

Candidates wishing to participate in the examinations must register at least one month prior to the written examination date

CAMC Dec 2012 29

Full launch of regional computer-based MCQ examination on 24th October 2008

Sites now include: Guyana, Trinidad, Barbados, Jamaica, Bahamas, St. Lucia, Belize, St. Vincent & Grenadines, Antigua

Aim to increase number of sites according to candidate requests and availability of locations with technical capacity

CAMC Jul 2013 30

Yearly Outcome of MCQ Examination

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

20

07

-1

20

07

-2

20

08

-1

20

08

-2

20

09

-1

20

09

-2

20

10

-1

20

10

-2

20

11

-1

20

11

-2

20

12

-1

20

12

-2

20

13

-1

Examination date all yrs

MCQ participants PASS

FAIL

Average Pass Rate: 53%

CAMC Jul 2013 31

Yearly Outcome of OSCE Examination

Average Pass Rate: 64%

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

20

07

-1

20

07

-2

20

08

-1

20

08

-2

20

09

-1

20

09

-2

20

10

-1

20

1-2

20

11

-1

20

11

-2

20

12

-1

20

12

-2

20

13

-1Examination date all yrs

OSCE participants PASS

FAIL

The functions of the Council shall be-

(a) to register medical practitioners;

(b) to appoint examiners to conduct examinations in respect of persons applying for registration as medical practitioners as may from time to time be necessary under the provisions of this Act; and

(c) to ensure the maintenance of proper standards of professional conduct by registered medical practitioners

Authority of Medical Boards/Councils:

In those parts of the Medical Act

which determines registration status of medical doctors

Which ensure the maintenance of proper standards of professional conduct by registered medical practitioners.

Differed significantly from one country to the other

IGA (Intergovernmental Agreement) This would ensure signatories were in agreement with decisions- draft by legal body of CARICOM little progress over the years .

Constitution. –Needs to be finalized following several decisions but awaits the IGA for completion.

CAMC Exam Part2. Clinical Exams currently only in Jamaica. Will require expansion to accommodate increase in number of candidates

CAUCUS OF HEALTH MINISTERS IN 2010 REQUESTED

The Accreditation of hospitals for internship, to create uniformity in the internship experience.

Create a database for vacancies in the medical profession which can be taken up by CARICOM national.

The registration of specialists.

Champion support for the accreditation of hospitals in the Region for internship to allow for standardisation of the experience of interns and provisionally registered doctors

Lobby CARICOM Governments to provide the budgetary support for the accreditation of hospitals to establish/increase internship posts.

Lobby support for the creation of a database of medical posts in all hospitals in the CARICOM countries to allow for greater access by qualified CARICOM Nationals to these posts

.

WAY FORWARD

Ensure Governments recognise the budgetary implications for making the CAMC examination the regional examination for licensing/registration of new doctors in CARICOM countries

Ensure that the Inter-governmental Agreement to allow for proper functioning of the CAMC is finalised

THE WAY FORWARD

Establish the relationship with graduates from recognised programmes worldwide

Establish the relationships with other medical registration bodies worldwide

Establish requirements for continuing medical education

Establish registration of specialists.

QUESTIONS