Volume 198 - Issue 5
Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia
Author: Kerry J Breen
Med J Aust 2013; 198 (5): 257-258. || doi: 10.5694/mja12.11572
Published online: 18 March 2013
Published online: 18 March 2013
To the Editor: While using medical board data for research purposes is very welcome, I have some reservations about ethical aspects of the study by Elkin and colleagues.1 Prospective ethics review of human research is intended to protect participants from foreseeable and avoidable harm. I suggest that, in this instance, avoidable harm has resulted, through generalised adverse and possibly unfair publicity about particular groups of ...
To the Editor: While using medical board data for research purposes is very welcome, I have some reservations about ethical aspects of the study by Elkin and colleagues.1 Prospective ethics review of human research is intended to protect participants from foreseeable and avoidable harm. I suggest that, in this instance, avoidable harm has resulted, through generalised adverse and possibly unfair publicity about particular groups of international medical graduates.
Although identifying “complainant factors” as one source of potential bias, the authors interpreted the data as if this potential bias could be ignored. The surprising difference in complaint frequency between Victoria and Western Australia might say something about these complainant factors, but this is left unremarked. In addition, they failed to identify another potential source of bias in the outcome data, namely the potential for medical board adjudicators to assess complaints in a prejudiced way. Without knowledge of the nature of the complaints, the investigative findings and the outcomes that resulted, readers cannot assess the possible existence and impact of such biases.
A claim is made that complaints represent a form of sentinel-event surveillance system that flags problems, which may be true for investigated and substantiated complaints. But this cannot be asserted when, in this study, 70% of complaints were not investigated and of the 1606 that were investigated, 1233 apparently did not result in an adverse finding.
In my view, at the very least, the study should not have been published in the format chosen. Any important potential conclusions relevant to the regulator and the wider medical profession need not have identified specific countries of origin. I feel deeply for the vast majority of doctors in the identified so-called high-risk groups who have never been the subject of a complaint. I hope that the authors, the human research ethics committee involved, the reviewers and your editorial team will, after reflection, act to ensure better participant protection in the future.
Competing interests
No relevant disclosures.
References
- Elkin K, Spittal MJ, Studdert DM. Risks of complaints and adverse disciplinary findings against international medical graduates in Victoria and Western Australia. Med J Aust 2012; 197: 448-452. 0_IDEFJGJC