Assuring Quality in Orthopedics

Q: How have traumatology and orthopedics professionals adapted to the slowdown in elective and non-urgent surgeries and how has the council supported them?

A: The pandemic had a significant impact on the private sector in terms of elective or non-emergency surgeries. And although there have been spikes and dips, the use of these services has been increasing as vaccinations have progressed and COVID-19 cases have decreased. In the public sector, which is more dependent on health policies, these types of surgeries fell to practically zero.

The council establishes standards so patients can be attended by certified physicians. It also develops strategies to verify quality and safety through continuing medical education. In that regard, the pandemic also had an impact on continuing education efforts, and on in-person events, in particular. We started promoting online activities, particularly webinars and virtual conferences, to maintain our quality standards and our number of professors. Currently, we host between two and four webinars per week.

Q: How do you establish links with under and postgraduate educational institutions to ensure programs remain as relevant as possible?

A: The council becomes more involved with specialists as soon as they graduate. The link with the universities and host hospitals is through professors who are already certified orthopedists. Our goal is to ensure continuous training for professors to ensure a certain quality in education and to provide trainees with information about the certification process.

Because orthopedics is a surgical specialty, teaching in this area has been profoundly impacted. The volume of practice has decreased but we have sought to strengthen academic and research processes. In some cases, we have worked with faculty and colleges to foment specific courses that develop surgical skills.

Q: How are you incorporating the latest trends in evaluation, such as simulations and OSCE, into your certification process?

A: Simulator-based training in orthopedics has had greater application in the subspecialties of the field. For general orthopedics, there are still very few practical models in the country. We still do not have sufficient technology but our future plans include allowing the evaluation of surgical skills on simulators.

Q: How do you ensure that certified physicians are keeping up-to-date? What areas of opportunity in this process have you identified and how do you plan on tackling them?

A: The certification process must be renewed every five years and includes two modalities. The first is curricular, in which orthopedists must demonstrate that they have attended a number of continuing medical education events. Some examples are conferences, maintaining a continuing practice or participation as a professor in academic activities or in undergraduate and postgraduate courses. The second modality is through an exam.

As for the areas of opportunity, one of the main areas is technology. Previously, the process was done manually, but we are establishing a platform to bring the application online and to automate it. This will allow us to have an electronic record of the country's professionals. We are also collaborating with hospitals to establish the necessary infrastructure to carry out the exam in the hospital itself to reduce the need for doctors to travel to different parts of the country.

Q: How does the council establish alliances with private companies to ensure early adoption of innovative technologies?

A: Once COFEPRIS approval has been obtained, the colleges are the ones that create this link for the development of continuing education programs. Although there is no direct link between the council and these companies, we seek to standardize the academic and scientific aspects. The council participates with colleges to develop continuing education plans, verify academic quality and ensure that there is no commercial bias.

Q: How have regulatory changes regarding CONACEM and SEP’s DGP affected the council’s work?

A: There have been no changes within the council, nor have we been affected. Our relationship is with CONACEM, which is the observer body for certification, and the DGP, which grants specialist certificates. The processes are harmonized and there is no competition between the agencies.

Q: What steps must the country take to ensure a more balanced healthcare provider network and how can the council help?

A: The health system has measures in place to ensure that the hiring process requires certification. We have initiated outreach campaigns through the orthopedic colleges to promote the continued validity of certification and to keep all professionals certified. This is how we maintain the quality of orthopedic care.

Q: Nationally, the council is the leading authority in trauma and orthopedics. What role does the council play in the international arena and how could it improve?

A: The council plays an important role in regulations and in the dissemination of academic information. Internationally, about 80 percent of Latin American countries do not have this certification procedure and we act as consultants for the implementation of these processes. The Mexican orthopedics segment has international projection through our colleges, which establish links with other countries. The council is in charge of establishing regulations so that, having participated in international events as an assistant, speaker or professor, the professional is awarded points for his or her certification process.

The Mexican Council of Orthopedics and Traumatology (CMOT) is a collegiate organization responsible for certifying and recertifying medical specialists.