Published research

CMPA research is published in peer-reviewed medical and science journals, and informs collaborative research initiatives.

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Physicians in practice


Published articles

Using medicolegal data to support safe medical care: A contributing factor coding framework

This methodological paper discusses a new patient safety-informed framework developed by the CMPA, which acknowledges the effects of team, organizational, and system factors, in addition to physician care. This new approach revolutionizes the way the CMPA codes its medical-legal data, and improves understanding of the many factors that contribute to patient safety events.

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Improved hospital safety performance and reduced medicolegal risk: an ecological study using 2 Canadian databases

This paper analyzes two Canadian databases, the CMPA and the Discharge Abstract Database, to determine if there was a relationship between in-hospital patient safety events and medico-legal cases involving physicians in Canada. This study is novel in that there are very few like it based on Canadian data and it shows the practical use for medico-legal and patient safety data, which can be used to improve patient safety and quality of care.

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Physicians in training (residents and fellows)


Published articles

College complaints against resident physicians in Canada: a retrospective analysis of CMPA data from 2013 to 2017

This paper analyzes the trends and nature of College complaints filed against resident physicians, and examines the rates of College complaints involving residents relative to rates for other CMPA members.

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The medico-legal helpline: A content analysis of postgraduate medical trainee advice calls

This paper used CMPA advice calls to explore the frequency of and reasons behind why trainees called the Association. Our study found that physicians-in-training are calling the CMPA with increasing frequency, with the most common issue relating to managing confidential information, complex care situations, academic matters and patient safety incidents.

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Obstetrics


Published articles

Quality improvement initiatives in areas of practice with high medical-legal risk in obstetrical care: A systematic review

This paper reviews published evaluations of obstetrical quality improvement initiatives and identifies those that addressed areas of high medical-legal risk for physicians providing obstetrical care.

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Implementing Obstetrics Quality Improvement, Driven by Medico-legal Risk, is Associated With Improved Workplace Culture

This paper reports the findings from a collaborative, quality improvement program based on CMPA knowledge of medico-legal risk in obstetrics, and the impact of the program on workplace culture.

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A Quality Indicator Framework for High-Risk Areas in Obstetrical Care

This study describes the development of a set of quality improvement indicators for areas of practice associated with increased medical-legal risk in order to support measurable improvements in obstetrical practice. It illustrates the importance of balancing measures when creating quality metrics, as well as providing practical quality indicators for quality improvement teams and researchers to engage in improvements in obstetrics quality of care.

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Reports

Recommendations from a National Panel on Quality Improvement in Obstetrics

 This paper describes the recommendations of a national panel on quality improvement in obstetrics to identify priorities for action in five areas of greatest medico-legal risk.

Delivery in Focus: Strengthening Obstetrical Care in Canada
This report by the CMPA and HIROC aims to advance patient safety and quality improvement in obstetrical care by identifying key areas of risk and offering mitigation strategies for healthcare providers and organizations.

Obstetrics Services in Canada: Advancing Quality and Strengthening Safety
A collaborative report by Accreditation Canada, the Healthcare Insurance Reciprocal of Canada (HIROC), the Canadian Medical Protective Association (CMPA), and Salus Global Corporation that profiles the quality and safety of obstetrics services in Canada from 2004 to 2015.




Surgery


Published articles

Trends and contributing factors in medicolegal cases involving spine surgery

This paper describes closed medico-legal cases involving physicians and spine surgery in Canada. While previous studies have applied a medico-legal lens to their analyses, this study also applies a quality improvement and patient safety lens.

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Medico-legal Closed Case Trends in Canadian Plastic Surgery: A Retrospective Descriptive Study

This paper provides a retrospective descriptive analysis of the characteristics of medico-legal cases involving specialist plastic surgeons over a 5-year period. This study describes the medico-legal landscape in Canadian cosmetic and non-cosmetic plastic surgery, highlighting the importance of strong physician–patient communication, patient education, and informed consent in preventing complaints.

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Intraoperative injuries from abdominopelvic surgery: an analysis of national medicolegal data

This 5-year analysis of CMPA closed cases described the frequency and types of injury, clinical management and outcomes, and the contributing factors—both technical and nontechnical including the impact of documenting informed consent.

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Surgical Fires and Burns: A 5-Year Analysis of Medico-legal Cases

This paper provides a retrospective descriptive analysis of the contributing factors in medico-legal cases involving surgical fires and burns in Canada over a 5-year period. This study highlights a need for improved surgical safety interventions to address surgical fires and burns.

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Reports

Surgical Safety in Canada: A 10-year review of CMPA and HIROC medical-legal data

This is a retrospective analysis of Canadian surgical incident data, which includes recommendations to advance knowledge in patient safety concepts and lead to system and practice improvements. 

Surgical safety checklists: A review of medical-legal data

This review of CMPA medico-legal data points to the continued relevance of the clinical issues that the Surgical Safety Checklist (SSCL) is intended to address, highlights some of the barriers to its effective use, and identifies priority areas for system and individual practice improvements.

Surgical safety checklists: A review of medical-legal data [PDF]




Other specialties


Published articles

Medico-Legal Cases Involving Cardiologists and Cardiac Test Underuse or Overuse

This study showed that across 10 years of closed CMPA medico-legal cases, there were no peer expert criticisms of cardiologists for cardiac diagnostic test overuse, despite potential harms from overuse. Criticisms of cardiac test underuse were rare and related to issues with diagnosing symptomatic patients.

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Anesthesiology airway-related medicolegal cases from the Canadian Medical Protection Association

This paper provides a retrospective descriptive analysis of the contributing factors in medico-legal cases involving specialist anesthesiologists where airway management was a central issue, highlighting the importance of adherence to clinical practice guidelines.

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