Resources Lesson 1: Physician Self-Regulation and Maintenance of Competence
Physician self-regulation and maintenance of competence
Maintenance of competence
In 'Maintenance of Certification and the Challenge of Professionalism' a review of the literature about maintenance of competence (MOC) states: "In summary, the preponderance of the existing literature supports the association of MOC with improved care and the importance of MOC credit as an incentive."
A paper in the BMJ by Horsley, Grimshaw and Campbell: Maintaining the competence of Europe's workforce (abstract only available) sates "we need a common set of principles for continuing professional development and a more harmonised approach to accreditation" and outlines the Rome Group summary recommendations for continuing professional development systems. This indicates that Systems should be based on values that:
- Enhance physician performance and thereby improve the health of people
- Are based on information concerning the educational needs of doctors with the ultimate aim of helping them improve health
The Rome Group outline 3 sets of responsibilities: Responsibilities of the system (accrediting bodies), Responsibilities of provider or organiser, and Responsibilities of the learner (to be fulfilled in order to claim credit) - these are:
- Participate in continuing professional development that meets their educational needs
- Ensure that the needs are relevant to their professional practice and development aimed at improving patient care and health
- Evaluate the extent to which their needs have been met, in the context of a change in knowledge, competence, or performance
- Verify that mechanisms are in place to keep educational activities free of commercial bias
Effective interaction with other people working in the health system
Of course health care is provided by more than physicians! Here are some thoughts from a paper about the broader picture and related to integrated health care in Health workforce governance: Processes, tools and actors towards a competent workforce for integrated health services delivery: "A competent health workforce is a vital resource for health services delivery, dictating the extent to which services are capable of responding to health needs. In the context of the changing health landscape, an integrated approach to service provision has taken precedence. For this, strengthening health workforce competencies is an imperative, and doing so in practice hinges on the oversight and steering function of governance." "The certification and registration of health professionals is a standard process in the initial development of the health workforce...The re-certification of health professionals at regular intervals is standard practice in the regulation of health professionals and is applied across the European Region." This is the European perspective, but similar to the regulations in other parts of the world.
- The proposed introduction of a revalidation process as part of renewal of medical registration in Australia needs wide debate.
- The revalidation process that began in the United Kingdom in 2012 is premised on a need to regain the trust of the community and to promote participation in continuing professional development. These alone are not justifiable grounds for introducing a similar process in Australia.
- There are good reasons to argue that existing processes and databases should be used to determine more accurately what the weaknesses in Australia's medical regulatory regime are and to tailor improvements to those weaknesses
The paper "No one has yet properly articulated what we are trying to achieve", summarisesRegulation "Regulation frames revalidation as a way to identify "bad apples," requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model...the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process."
Recertification:-
Not unlike the revalidation discussion above, the topic of recertification of clinicians has proponents on both sides. The is an argument for its value in ensuring senior clinicians remain current through a formal objective outcomes based process beyond CPD by introducing formalised intermittent examinations e.g. recertification boards in the USA. There is an opposing view that examination based recertification ignores the experience and work based skill sets of senior clinicians. This relevant opinion piece from the NEJM explored the issue: Ensuring physicians' competence - is maintenance of certification the answer? (Unfortunately, this is not an open access paper and you will have to register to access it in full.)
In summary, there are multiple governance tools to ensure clinicians remain current and their competencies support the highest quality care provision ensuring patient's safety is promoted. The evidence for each remains scant and this requires further quality evidence based research into the topic. There is also scant evidence about the way to teach these principles during undergraduate or professional education.
The role of Continuing Professional Development.
The paper The effectiveness of continuing medical education for specialist recertification discusses the importance of continuing medical education, as a sub-set of continuing professional education (CPD) - often used interchangeably: "Maintaining lifelong knowledge and skills is essential for safe clinical practice. Continuing medical education (CME) is an established method that can facilitate lifelong learning. It focuses on maintaining or developing knowledge, skills and relationships to ensure competent practice."
We hope that this will resonate for those who are exploring this course in the context of the continuing professional development!