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

Beyond medical errors: Exploring the interpersonal dynamics in physician-patient relationships linked to medico-legal complaints

This study aims to identify factors impacting the interpersonal dynamics between physicians and patients. It uses real patient cases to understand how patients perceive doctor-patient relational problems that can lead to dissatisfaction and subsequent medico-legal complaints.

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Evaluating literature reviews conducted by humans versus ChatGPT: Comparative study

This study aims to compare the quality of literature reviews conducted by the ChatGPT-4 model with those conducted by human researchers, focusing on the relational dynamics between physicians and patients.

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Lessons learned from a retrospective analysis of medico-legal risks for physicians treating adolescents and young adults with medical complexity

This article explore patient safety issues and identifies medico-legal risks for physicians treating adolescent and young adult patients with chronic conditions and special healthcare needs.

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Strengthening the chain: A continuing medical education program for Test Results Follow-up

This study evaluates the impact of CTC-TRFU program on test results follow-up systems to enhance patient safety within physicians’ practice.

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The problem with ‘never events’

This article calls for efforts to build a shared understanding around what a ‘never event’ entails.

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Exploring the dynamics of physician-patient relationships: Factors affecting patient satisfaction and complaints

This review identifies the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints.

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Medico-legal risks of point-of-care ultrasound: a closed case analysis of Canadian Medical Protective Association medico-legal cases

This research paper analyzes CMPA data to identify medico-legal cases arising from the use of point-of-care ultrasound (POCUS).

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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.

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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.

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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.

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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.

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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.

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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.

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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

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.

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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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Emergency medicine


Published articles

HiQuiPs: Test Result Follow-up in the Emergency Department

This blogpost provides information about Test result follow-up, which can be especially challenging in the Emergency Department (ED) due to its multiplicity of moving parts.

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Resource issues in the emergency department

This blogpost provides information about how physicians can minimize their medico-legal risk when providing care in under-resourced emergency departments.

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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.

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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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Obstetrics


Published articles

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.

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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

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.

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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

Assessing adverse outcomes and learning needs in Canadian psychiatric independent medical examinations

This review addresses the deficit of literature on the risks of independent medical examinations (IMEs) and the learning needs of psychiatrists in this area.

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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.

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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.

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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.

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Lessons learned from examination of Canadian medico-legal cases related to interventional therapies for chronic pain management

This research paper investigates patient safety incidents from injection therapies used to treat chronic pain, identifying themes that could be used to improve patient safety.

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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.

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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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