Insightful Practice:A Method to Address a Gap in Medical Regulation

Risk from sub-optimal medical practice remains a perennial international problem. While regulatory efforts for improvement have been significant, new thinking and innovation is needed. In an ideal world, professional career paths would be enhanced, supported and successfully maintained from medical school to retirement. Regulatory outcomes would be made resilient to public and professional challenge. Professional development, with quality improvement at its heart, would be maximized, and concerns about medical competency would be highlighted and acted upon at an early stage -- before they become “a fitness to practice” matter. At this early stage, referred to in this paper as the “amber zone,” concerns about an individual's ability to practice medicine competently may emerge, but they are not considered of sufficient severity to warrant a referral to a fitness to practice inquiry by medical regulators. The introduction of a concept called Insightful Practice is one attempt to address the unmet challenge of the amber zone. A surrogate measure of professionalism, Insightful Practice is a method that assesses medical professionals' engagement with the system within which they work and with feedback on their performance for any given work role. In addition and crucially, the method considers medical professionals' insight into what they need to change and their plans for improvement. Potential problems are identified early, increasing the likelihood that remediation measures will be successful. An application using Insightful Practice is described here, examples of its use given, and a discussion is provided of the concept's advantages, limitations and potential to help regulatory authorities and other health care agencies address the challenge for regulatory systems to identify and remediate medical professionals who find themselves in an early amber zone of concern. The application described is based on humans' long understood struggle “to see ourselves as others see us,” and is an attempt to support and channel medical professionals' integrity and drive for improvement in order to protect patients. While the Insightful Practice concept is discussed in this paper in the context of the UK's regulatory system, its principles are applicable to other medical regulatory systems around the world.