CMPA research is published in peer-reviewed medical and science journals, and informs collaborative research initiatives.
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Browse published articles and reports
Physicians in practice
Medico-legal cases associated with older physicians’ cognitive ability to practice medicine
This study examines the potential medico-legal consequences of physicians with cognitive impairments.
Family physicians’ questions about the COVID-19 pandemic: a content analysis of 2,272 helpline calls
This analysis of family physician calls to the CMPA’s helpline provides insights into family physicians' challenges and experiences during the pandemic.
Identifying a list of healthcare “never events” to effect system change: A systematic review and narrative synthesis
This systematic review aims to identify the most serious and preventable “never events” to support efforts to improve patient safety.
Diagnostic delays in sepsis: Lessons learned from a retrospective study of Canadian medico-legal claims
This article aims to identify areas of focus to assist physicians with the early recognition of sepsis, using medico-legal data.
Defining healthcare never events to effect system change: A protocol for systematic review
This article outlines the protocol for a forthcoming systematic review that will identify events that are consistently or frequently labelled as never events, work that will allow organizations and researchers to direct resources to the events most amenable to reduction efforts.
Physician questions and concerns related to COVID-19: A content analysis of advice calls to a medico-legal helpline
This paper evaluates themes across calls made by physicians to a medico-legal helpline during the first eighteen months of the COVID-19 pandemic. It explores associations between the volume and content of calls, and the geography and intensity of the pandemic.
Optimizing your diagnostic reasoning – Themes from CMPA medico-legal cases
This blog post provides an understanding of some common causes of diagnostic error. Diagnostic errors are an inherent risk of clinical practice and a common theme in CMPA closed cases. Even when errors are identified, learning from them can be challenging.
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.
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.
Physicians in training (residents and fellows)
Patterns and trends among physicians-in-training named in civil legal cases
This study presents civil legal case rates for physician-in-training in Canada. It analyses case rates over a 25-year period, describing case duration, medico-legal outcome, and patient harm. It also examines physician specialties and practice characteristics in a subset of cases.
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.
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.
Promoting best practices in Assisted Human Reproduction
This retrospective analysis of CMPA data identifies contributing factors to medico-legal risks for Canadian physicians providing Assisted Human Reproduction (AHR) services.
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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.
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.
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.
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.
Characteristics and contributing factors of diagnostic error in surgery: Analysis of closed medico-legal cases and complaints in Canada
This analysis seeks to characterize diagnostic error in the preoperative, intraoperative, and postoperative surgical phases, describe their contributing factors, and quantify their impact related to patient harm.
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.
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.
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.
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.
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]
Medico-legal risk of infectious disease physicians in Canada: A retrospective review
This study identifies the causes of medico-legal risk for infectious disease specialists in Canada, with the goal of improving patient safety and outcomes.
Medico-legal issues related to emergency physicians’ documentation in Canadian emergency departments
This study provides examples of documentation issues attributed to physicians practicing emergency medicine, as identified by peer experts in medico-legal cases in Canada.
Medico-legal cases in breast imaging in Canada: A trend analysis
This study evaluates the key medico-legal issues of breast imaging in Canada and their implications for healthcare providers and patient safety.
Medico-legal risk and use of medical directives in the emergency department
This study describes and analyzes factors associated with medico-legal risk in cases involving medical directives in the emergency department.
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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.
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.