1
|
Dubowitz H, Belanger R, Magder L, Palinkas LA, Kim H, Muralidharan V. Comparing Two Training Modalities Supporting the Adoption of the SEEK Approach in Pediatric Primary Care 6/30/24. Acad Pediatr 2024:S1876-2859(24)00270-5. [PMID: 39004298 DOI: 10.1016/j.acap.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/01/2024] [Accepted: 07/07/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To compare the impact of two common continuing medical education training modalities - independent online training (IND) and a Maintenance of Certification-4 activity (MOC) - on primary care professionals' (PCPs') thinking and practice behavior regarding the Safe Environment for Every Kid (SEEK) approach. This was part of an implementation science study scaling up the evidence-based practice, SEEK. METHODS This is a longitudinal, multi-site, mixed methods, cluster randomized controlled trial comparing 21 pediatric primary care practices across the U.S. randomized to one of two training modalities. Two hundred and ten PCPs completed surveys up to 4 times over a two-year period to assess their thinking and practice regarding SEEK; a subset was interviewed up to 3 times. RESULTS Training led to significant and sustained improvements in PCPs' thinking and behavior related to SEEK, with no significant differences between the IND and MOC groups. PCPs mostly viewed their training positively, but several described shortcomings. PCP characteristics, such as age and sex, did not moderate the impact of the training, nor did the presence of a behavioral health professional. CONCLUSIONS The lack of significant differences between the training modalities favors the simpler IND modality. This was despite the MOC training employing key principles of adult education. Of note, MOC-4 credits are required for pediatric board certification. More research is needed to optimize continuing medical education and to tailor approaches for different learners.
Collapse
Affiliation(s)
- Howard Dubowitz
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Rose Belanger
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Laurence Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Lawrence A Palinkas
- Herbert Wertheim School of Public Health and Longevity Science University of California, San Diego
| | - Hannah Kim
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Vyas Muralidharan
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
| |
Collapse
|
2
|
Burke AE, Sklansky DJ, Haftel HM, Mitchell A, Mann KJ. Competency-based medical education and the education continuum: Establishing a framework for lifelong learning. Curr Probl Pediatr Adolesc Health Care 2024:101642. [PMID: 38851971 DOI: 10.1016/j.cppeds.2024.101642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2024]
Affiliation(s)
- Ann E Burke
- Wright State University Boonshoft School of Medicine and Dayton Children's Hospital.
| | - Daniel J Sklansky
- University of Wisconsin School of Medicine and Public Health and American Family Children's Hospital
| | - Hilary M Haftel
- American Academy of Pediatrics, Senior Vice President, Education
| | - Andrew Mitchell
- Wright State University Boonshoft School of Medicine and Dayton Children's Hospital
| | - Keith J Mann
- American Board of Pediatrics, Vice President for Continuing Certification
| |
Collapse
|
3
|
Caretta-Weyer HA, Smirnova A, Barone MA, Frank JR, Hernandez-Boussard T, Levinson D, Lombarts KMJMH, Lomis KD, Martini A, Schumacher DJ, Turner DA, Schuh A. The Next Era of Assessment: Building a Trustworthy Assessment System. PERSPECTIVES ON MEDICAL EDUCATION 2024; 13:12-23. [PMID: 38274558 PMCID: PMC10809864 DOI: 10.5334/pme.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Assessment in medical education has evolved through a sequence of eras each centering on distinct views and values. These eras include measurement (e.g., knowledge exams, objective structured clinical examinations), then judgments (e.g., workplace-based assessments, entrustable professional activities), and most recently systems or programmatic assessment, where over time multiple types and sources of data are collected and combined by competency committees to ensure individual learners are ready to progress to the next stage in their training. Significantly less attention has been paid to the social context of assessment, which has led to an overall erosion of trust in assessment by a variety of stakeholders including learners and frontline assessors. To meaningfully move forward, the authors assert that the reestablishment of trust should be foundational to the next era of assessment. In our actions and interventions, it is imperative that medical education leaders address and build trust in assessment at a systems level. To that end, the authors first review tenets on the social contextualization of assessment and its linkage to trust and discuss consequences should the current state of low trust continue. The authors then posit that trusting and trustworthy relationships can exist at individual as well as organizational and systems levels. Finally, the authors propose a framework to build trust at multiple levels in a future assessment system; one that invites and supports professional and human growth and has the potential to position assessment as a fundamental component of renegotiating the social contract between medical education and the health of the public.
Collapse
Affiliation(s)
- Holly A. Caretta-Weyer
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Alina Smirnova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
- Kern Institute for the Transformation of Medical Education, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael A. Barone
- NBME, Philadelphia, Pennsylvania, USA
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jason R. Frank
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, CA
| | | | - Dana Levinson
- Josiah Macy Jr Foundation, Philadelphia, Pennsylvania, USA
| | - Kiki M. J. M. H. Lombarts
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, NL
- Amsterdam Public Health research institute, Amsterdam, NL
| | - Kimberly D. Lomis
- Undergraduate Medical Education Innovations, American Medical Association, Chicago, Illinois, USA
| | - Abigail Martini
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Daniel J. Schumacher
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - David A. Turner
- American Board of Pediatrics, Chapel Hill, North Carolina, USA
| | - Abigail Schuh
- Division of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
4
|
Leslie K, Bourgeault IL, Carlton AL, Balasubramanian M, Mirshahi R, Short SD, Carè J, Cometto G, Lin V. Design, delivery and effectiveness of health practitioner regulation systems: an integrative review. HUMAN RESOURCES FOR HEALTH 2023; 21:72. [PMID: 37667368 PMCID: PMC10478314 DOI: 10.1186/s12960-023-00848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/23/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. METHODS We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. FINDINGS This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. CONCLUSION We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
Collapse
Affiliation(s)
- Kathleen Leslie
- Athabasca University, Athabasca, Canada.
- Canadian Health Workforce Network, Ottawa, Canada.
| | - Ivy Lynn Bourgeault
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | - Anne-Louise Carlton
- Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia
| | - Madhan Balasubramanian
- College of Business, Government and Law, Flinders University, Adelaide, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Raha Mirshahi
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | | | - Jenny Carè
- University of Technology Sydney, Sydney, Australia
| | | | - Vivian Lin
- University of Hong Kong, Hong Kong, China
| |
Collapse
|
5
|
Price DW, Wang T, O'Neill TR, Bazemore A, Newton WP. Differences in Physician Performance and Self-rated Confidence on High- and Low-Stakes Knowledge Assessments in Board Certification. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:2-10. [PMID: 36877811 DOI: 10.1097/ceh.0000000000000487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 11/15/2022] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Evidence links assessment to optimal learning, affirming that physicians are more likely to study, learn, and practice skills when some form of consequence ("stakes") may result from an assessment. We lack evidence, however, on how physicians' confidence in their knowledge relates to performance on assessments, and whether this varies based on the stakes of the assessment. METHODS Our retrospective repeated-measures design compared differences in patterns of physician answer accuracy and answer confidence among physicians participating in both a high-stakes and a low-stakes longitudinal assessment of the American Board of Family Medicine. RESULTS After 1 and 2 years, participants were more often correct but less confident in their accuracy on a higher-stakes longitudinal knowledge assessment compared with a lower-stakes assessment. There were no differences in question difficulty between the two platforms. Variation existed between platforms in time spent answering questions, use of resources to answer questions, and perceived question relevance to practice. DISCUSSION This novel study of physician certification suggests that the accuracy of physician performance increases with higher stakes, even as self-reported confidence in their knowledge declines. It suggests that physicians may be more engaged in higher-stakes compared with lower-stakes assessments. With medical knowledge growing exponentially, these analyses provide an example of the complementary roles of higher- and lower-stakes knowledge assessment in supporting physician learning during continuing specialty board certification.
Collapse
Affiliation(s)
- David W Price
- Dr. Price : American Board of Family Medicine, Lexington, KY, and the University of Colorado Anschutz School of Medicine, Aurora, CO; Dr. Wang: American Board of Family Medicine, Lexington, KY; Dr. O'Neill: American Board of Family Medicine, Lexington, KY; Dr. Bazemore: American Board of Family Medicine, Lexington, KY; and Dr. Newton: American Board of Family Medicine, Lexington, KY, and the University of North Carolina, Chapel Hill, NC
| | | | | | | | | |
Collapse
|
6
|
Sheth BP, Schnabel SD, Comber BA, Martin B, McGowan M, Bartley GB. Relationship Between the American Board of Ophthalmology Maintenance of Certification Program and Actions Against the Medical License. Am J Ophthalmol 2023; 247:1-8. [PMID: 36370838 DOI: 10.1016/j.ajo.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the likelihood of disciplinary actions against medical licenses of ophthalmologists who maintained board certification through successful completion of the American Board of Ophthalmology Maintenance of Certification program compared with ophthalmologists who did not maintain certification. METHODS This was a retrospective cohort study of ophthalmologists certified by the American Board of Ophthalmology from 1992 to 2012 with time-limited certificates. Rates and severity of disciplinary actions against medical licenses were analyzed among ophthalmologists who did and did not maintain certification. RESULTS Of 9111 ophthalmologists who earned initial board certification between 1992 and 2012, 8073 (88.6%) maintained their certification and 1038 (11.4%) did not maintain their certification. A total of 234 license actions were identified in the study group. Among ophthalmologists who did not maintain board certification, the risk of a license action was more than 2 times that of those who maintained board certification (hazard ratio = 2.34, 95% CI=1.73-3.18). License actions were significantly higher in men than in women (hazard ratio = 2.02, 95% CI=1.43-2.86). Ophthalmologists who had a lapse in their certification had a higher severity of disciplinary actions (χ2 = 9.21, p <.01) than ophthalmologists who maintained their certification. CONCLUSIONS This study supports prior literature in other specialties demonstrating a higher risk of disciplinary licensure actions in physicians who did not maintain board certification as compared with those who did. Physicians who did not maintain certification were also more likely to have actions against their license reflecting a higher severity violation. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
Collapse
Affiliation(s)
- Bhavna P Sheth
- From the Department of Ophthalmology & Visual Sciences (B.P.S), Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Sarah D Schnabel
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Beth Ann Comber
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Brian Martin
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - Meghan McGowan
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| | - George B Bartley
- American Board of Ophthalmology (S.D.S., B.A.C., B.M., M.M., G.B.B .); Department of Ophthalmology (G.B.B.), Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
7
|
Kim JG, Mazotti L, McDonald KM, Holmboe E, Kanter MH. Rowing Together: Publicly Reported Quality of Care Measures, US Graduate Medical Education Accountability, and Patient Outcomes. Jt Comm J Qual Patient Saf 2023; 49:174-178. [PMID: 36653211 DOI: 10.1016/j.jcjq.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
|
8
|
Toews H, Pearce J, Tavares W. Recasting Assessment in Continuing Professional Development as a Person-Focused Activity. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 43:S35-S40. [PMID: 38054490 DOI: 10.1097/ceh.0000000000000538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
ABSTRACT In this article, we examine assessment as conceptualized and enacted in continuing professional development (CPD). Assessment is pervasive throughout the life of an individual health professional, serving many different purposes compounded by varied and unique contexts, each with their own drivers and consequences, usually casting the person as the object of assessment. Assessment is often assumed as an included part in CPD development conceptualization. Research on assessment in CPD is often focused on systems, utility, and quality instead of intentionally examining the link between assessment and the person. We present an alternative view of assessment in CPD as person-centered, practice-informed, situated and bound by capability, and enacted in social and material contexts. With this lens of assessment as an inherently personal experience, we introduce the concept of subjectification, as described by educationalist Gert Biesta. We propose that subjectification may be a fruitful way of examining assessment in a CPD context. Although the CPD community, researchers, and educators consider this further, we offer some early implications of adopting a subjectification lens on the design and enactment of assessment in CPD.
Collapse
Affiliation(s)
- Helen Toews
- Toews: Registered Dietitian, The Wilson Centre, University of Toronto, Toronto, Ontario, Canada. Dr. Pearce: Principal Research Fellow, Specialist and Professional Assessment, Tertiary Education, Australian Council for Educational, Research, Camberwell, Australia. Dr. Tavares: Scientist|Assistant Professor, Department of Health and Society, The Wilson Centre, Department of Medicine, University of Toronto, Scarborough, Ontario, Canada
| | | | | |
Collapse
|
9
|
Wiese A, Galvin E, Korotchikova I, Bennett D. Doctors' attitudes to maintenance of professional competence: A scoping review. MEDICAL EDUCATION 2022; 56:374-386. [PMID: 34652830 DOI: 10.1111/medu.14678] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/05/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
CONTEXT Recent decades have seen the international implementation of programmes aimed at assuring the continuing competence of doctors. Maintenance of Professional Competence (MPC) programmes aim to encourage doctors' lifelong learning and ensure high-quality, safe patient care; however, programme requirements can be perceived as bureaucratic and irrelevant to practice, leading to disengagement. Doctors' attitudes and beliefs about MPC are critical to translating regulatory requirements into committed and effective lifelong learning. We aimed to summarise knowledge about doctors' attitudes to MPC to inform the development of MPC programmes and identify under-researched areas. METHODS We undertook a scoping review following Arksey and O'Malley, including sources of evidence about doctors' attitudes to MPC in the United States, the United Kingdom, Canada, Australia, New Zealand and Ireland, and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) as a guide. RESULTS One hundred and twenty-five sources of evidence were included in the review. One hundred and two were peer-reviewed publications, and 23 were reports. Most were from the United Kingdom or the United States and used quantitative or mixed methods. There was agreement across jurisdictions that MPC is a good idea in theory but doubt that it achieves its objectives in practice. Attitudes to the processes of MPC, and their impact on learning and practice were mixed. The lack of connection between MPC and practice was a recurrent theme. Barriers to participation were lack of time and resources, complexity of the requirements and a lack of flexibility in addressing doctors' personal and professional circumstances. CONCLUSIONS Overall, the picture that emerged is that doctors are supportive of the concept of MPC but have mixed views on its processes. We highlight implications for research and practice arising from these findings.
Collapse
Affiliation(s)
- Anél Wiese
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Emer Galvin
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Irina Korotchikova
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| |
Collapse
|
10
|
Griffis CA, Dishman D, Giron SE, Ward RC, McMullan SP. Concept analysis of longitudinal assessment for professional continued certification. Nurs Forum 2021; 57:311-317. [PMID: 34862793 DOI: 10.1111/nuf.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/25/2021] [Accepted: 11/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND This concept analysis presents a scholarly epistemological approach to defining the attributes, empirical referents, antecedents, and consequences of a knowledge maintenance approach-known as longitudinal assessment-to professional certification. AIM The analysis reports on the efforts of the National Board of Certification and Recertification for Nurse Anesthetists to explore this educational method as an approach to meet requirements for continued professional certification. METHOD Using the classical approach to concept analysis, the authors explore the structure and function of longitudinal assessment and define the characteristics of the concept in a way that is meaningful to the continued certification of nursing and medical professionals. CONCLUSION This analysis establishes a link between the goal and outcome of the continued certification process, including continuing education in nursing and medical practice, and the desirable characteristics of longitudinal assessment, which include proven principles of educational psychology. Through exploring model and borderline cases, the authors seek to demonstrate that longitudinal assessment is the best approach to foster lifelong learning of continuously evolving scientific, theoretical, and clinical knowledge in support of safe care for patients.
Collapse
Affiliation(s)
- Charles A Griffis
- Program of Nurse Anesthesiology, University of Southern California, Los Angeles, California, USA
| | - Deniz Dishman
- Department of Research Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sarah E Giron
- Kaiser Permanente School of Anesthesia, Pasadena, California, USA
| | - Robyn C Ward
- Harris College of Nursing and Health Sciences, Texas Christian University, Fort Worth, Texas, USA
| | - Susan P McMullan
- Department of Acute, Chronic and Continuing Care, University of Alabama at Birmingham (UAB) School of Nursing, Birmingham, Alabama, USA
| |
Collapse
|
11
|
LaVigne C, Foulkes G, Kane S. The Estimated Cost of Maintenance of Certification. J Bone Joint Surg Am 2021; 103:e58. [PMID: 34357893 DOI: 10.2106/jbjs.20.00632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Maintenance of Certification (MOC) is a controversial topic in medicine for many different reasons. Studies have suggested that there may be associations between fewer negative outcomes and participation in MOC. However, MOC still remains controversial because of its cost. We sought to determine the estimated cost of MOC to the average orthopaedic surgeon, including fees and time cost, defined as the market value of the physician's time. METHODS We calculated the total cost of MOC to be the sum of the fees required for applications, examinations, and other miscellaneous fees as well as the time cost to the physician and staff. Costs were calculated for the oral, written, and American Board of Orthopaedic Surgery Web-based Longitudinal Assessment (ABOS WLA) MOC pathways based on the responses of 33 orthopaedic surgeons to a survey sent to a state orthopaedic society. RESULTS We calculated the average orthopaedic surgeon's total cost in time and fees over the decade-long period to be $71,440.61 ($7,144.06 per year) for the oral examination MOC pathway and $80,391.55 ($8,039.16 per year) for the written examination pathway. We calculated the cost of the American Board of Orthopaedic Surgery web-based examination pathway to be $69,721.04 ($6,972.10 per year). CONCLUSIONS The actual cost of MOC is much higher than just the fees paid to organizations providing services. The majority of the cost comes in the form of time cost to the physician. The ABOS WLA was implemented to alleviate the anxiety of a high-stakes examination and to encourage efficient longitudinal learning. We found that the ABOS WLA pathway does save time and money when compared with the written examination pathway when review courses and study periods are taken. We believe that future policy changes should focus on decreasing physician time spent completing MOC requirements, and decreasing the cost of these requirements, while preserving the model of continued evidence-based medical education.
Collapse
Affiliation(s)
- Caleb LaVigne
- Mercer University School of Medicine, Macon, Georgia
| | - Guy Foulkes
- Department of Surgery, Mercer University School of Medicine, Macon, Georgia.,OrthoGA, Macon, Georgia
| | - Steve Kane
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, Georgia
| |
Collapse
|
12
|
Lenschow C, Rinschen S, Lindner K, Colombo-Benkmann M. Current practice of thyroid surgery in Germany: a nationwide survey. Minerva Surg 2021; 77:205-213. [PMID: 34338458 DOI: 10.23736/s2724-5691.21.08898-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Due to the lack of perioperative standards in thyroid surgery, this study aimed to evaluate the perioperative management and wound closure techniques used in a nationwide survey. MATERIAL AND METHODS A questionnaire evaluating preferred technique in thyroid resection, postoperative management, and the occurrence of complications was sent to all hospitals in Germany performing more than 50 thyroid operations p.a. (n=362, response rate 78% (n=283)). Subsequently, hospitals were subdivided into university and maximum care hospitals (Category A, n=54) and tertiary hospitals and basic care hospitals (Category B, n=229). RESULTS 10.6% of the hospitals were certified as a center for thyroid surgery, with a significantly higher percentage in Category A (20.4% vs. 8.3%; p<0.01). Concerning the surgical techniques, Kocher´s incision was the favored cervical approach in 96% of the hospitals. A minimally invasive approach was performed in 30.1%, with a significantly more common description in category A. 97.8% of all clinics stated that they perform a platysma muscle suture, primarily as a single stitch interrupted. Skin closure was predominantly performed via intracutaneous suture in 84.5% using absorbable suture material in 63.1%. There was no difference in the technology used in terms of hospital size. The mean in-hospital stay was significantly shorter in Category A hospitals (p=0.035). CONCLUSIONS The suture technique used in thyroid surgery in Germany is a simple interrupted suture technique for platysma and a continuous suture with absorbable skin closure material. Maximum care hospitals are characterized by shorter in-hospital stays and improved quality assurance.
Collapse
Affiliation(s)
- Christina Lenschow
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Wuerzburg, Germany -
| | - Stephan Rinschen
- Department of Internal Medicine, Evangelisches Krankenhaus Münster, Münster, Germany
| | - Kirsten Lindner
- LAKUMED, Department of Endocrine Surgery, Vilsbiburg, Germany
| | | |
Collapse
|
13
|
Samuel A, Cervero RM, Durning SJ, Maggio LA. Effect of Continuing Professional Development on Health Professionals' Performance and Patient Outcomes: A Scoping Review of Knowledge Syntheses. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:913-923. [PMID: 33332905 DOI: 10.1097/acm.0000000000003899] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Continuing professional development (CPD) programs, which aim to enhance health professionals' practice and improve patient outcomes, are offered to practitioners across the spectrum of health professions through both formal and informal learning activities. Various knowledge syntheses (or reviews) have attempted to summarize the CPD literature; however, these have primarily focused on continuing medical education or formal learning activities. Through this scoping review, the authors seek to answer the question, What is the current landscape of knowledge syntheses focused on the impact of CPD on health professionals' performance, defined as behavior change and/or patient outcomes? METHOD In September 2019, the authors searched PubMed, Embase, CINAHL, Scopus, ERIC, and PsycINFO for knowledge syntheses published between 2008 and 2019 that focused on independently practicing health professionals and reported outcomes at Kirkpatrick's level 3 and/or 4. RESULTS Of the 7,157 citations retrieved from databases, 63 satisfied the inclusion criteria. Of these 63 syntheses, 38 (60%) included multicomponent approaches, and 29 (46%) incorporated eLearning interventions-either standalone or in combination with other interventions. While a majority of syntheses (n = 42 [67%]) reported outcomes affecting health care practitioners' behavior change and/or patient outcomes, most of the findings reported at Kirkpatrick level 4 were not statistically significant. Ten of the syntheses (16%) mentioned the cost of interventions though this was not their primary focus. CONCLUSIONS Across health professions, CPD is an umbrella term incorporating formal and informal approaches in a multicomponent approach. eLearning is increasing in popularity but remains an emerging technology. Several of the knowledge syntheses highlighted concerns regarding both the financial and human costs of CPD offerings, and such costs are being increasingly addressed in the CPD literature.
Collapse
Affiliation(s)
- Anita Samuel
- A. Samuel is assistant professor, Department of Medicine and Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0001-9488-9565
| | - Ronald M Cervero
- R.M. Cervero is professor, Department of Medicine, and deputy director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Steven J Durning
- S.J. Durning is professor, Department of Medicine, and director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Lauren A Maggio
- L.A. Maggio is associate professor, Department of Medicine, and associate director, Center for Health Professions Education, Uniformed Services University of the Health Sciences, Bethesda, Maryland; ORCID: https://orcid.org/0000-0002-2997-6133
| |
Collapse
|
14
|
Radiologist Opinions of a Quality Assurance Program: The Interaction Between Error, Emotion, and Preventative Action. Acad Radiol 2021; 28:e54-e61. [PMID: 32139303 DOI: 10.1016/j.acra.2020.01.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 01/24/2020] [Accepted: 01/26/2020] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate inter-relationships between radiologist opinions of a quality assurance (QA) program, QA Committee communications, negative emotions, self-identified risk factors, and preventive actions taken following major errors. MATERIALS AND METHODS A 48 question electronic survey was distributed to all 431 radiologists within the same teleradiology organization between June 15 and July 3, 2018. Two reminders were sent during the survey time period. Descriptive statistics were generated, and comparisons were made with Fisher exact test. Significance level was set at p < 0.05. RESULTS Response rate was 67.5% (291/431), and 72.5% of respondents completed all survey questions. A total of 64.3% of respondents were male, and the highest proportion of radiologists (28.9%, 187/291) had been in practice >20 years. Preventative actions following an error were positively correlated to a higher opinion of the QA process, self-identification of personal risk factors for error, and greater negative emotions following an error (all p < 0.05). A higher opinion of communications with the QA committee was associated with a positive opinion of the QA process (p < 0.001). An inverse relationship existed between negative emotion and opinion of QA committee communications (p < 0.05) and negative emotion and opinion of the QA process (p < 0.05). Radiologist gender and full time versus part time status had a significant effect on perception of the QA process (p < 0.05). CONCLUSION Radiologist opinions of their institutional QA process was related to the number of negative emotions experienced and preventative actions taken following major errors. Nurturing trust and incorporating more positive feedback in the QA process may improve interactions with QA Committees and mitigate future errors.
Collapse
|
15
|
Alyesh D, Gambhir A, Waase M, Remo B, Singh A, Green J, Kittleson M, Estes NM, Heist EK. A Blueprint for Productive Maintenance of Certification, But Is the American Board of Internal Medicine up to the Challenge? Circ Cardiovasc Qual Outcomes 2020; 13:e006696. [DOI: 10.1161/circoutcomes.120.006696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The future of the American Board of Internal Medicine Maintenance of Certification (MOC) program is at a crossroads. The current MOC program lacks a clear visible mission, adds to modern health care’s onerous bureaucracy, and thus pulls physicians from the most important humanistic aspects of their profession. The aim of the MOC program should be to promote the best patient care by ensuring certified physicians maintain core skills through continuous education and evaluation. The program should focus on education and be designed with the rigorous obligations of practicing physicians in mind. Moving forward, the American Board of Internal Medicine should cocreate MOC with the physician community and apply innovative adult education techniques. Over time, data-driven methods and member feedback should be used to provide continuous program improvement. This review describes the origins of the current state of MOC, explores its evidence base, provides examples of model programs for the maintenance of complex professional skills, and outlines guiding principles for the future of MOC.
Collapse
Affiliation(s)
- Daniel Alyesh
- South Denver Cardiology Associates, Littleton, CO (D.A.)
| | - Alok Gambhir
- The Heart Center of Northeast Georgia Medical Center, Gainesville (A.G.)
| | - Marc Waase
- Columbia University Medical Center, New York, NY (M.W.)
| | - Benjamin Remo
- University of Maryland Medical Center, Baltimore (B.R.)
| | | | | | - Michelle Kittleson
- Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA (M.K.)
| | | | | |
Collapse
|
16
|
Affiliation(s)
- Suzanne M Norby
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
| |
Collapse
|
17
|
Price D, Campbell C, Van Hoof TJ, ElChamaa R, Jeong D, Chappell K, Moore D, Olson C, Danilovich N, Kitto S. Definitions of Physician Certification Used in the North American Literature: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2020; 40:147-157. [PMID: 32898116 DOI: 10.1097/ceh.0000000000000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION The authors sought to identify how physician specialty certification is defined in the North American literature. METHODS A rigorous, established six-stage scoping review framework was used to identify the North American certification literature published between January 2006 and May 2016 relating to physician specialty certification. Data were abstracted using a charting form developed by the study team. Quantitative summary data and qualitative thematic analysis of the purpose of certification were derived from the extracted data. RESULTS A two stage screening process identified 88 articles that met predefined criteria. Only 14 of the 88 articles (16%) contained a referenced purpose of certification. Eighteen definitions were identified from these articles. Definitional concepts included lifelong learning and continuous professional development, assessment of competence and performance, performance improvement, public accountability, and professional standing. DISCUSSION Most articles identified in this scoping review did not define certification or describe its purpose or intent. Future studies should provide a definition of certification to further scholarly examination of its intent and effects and inform its further evolution.
Collapse
Affiliation(s)
- David Price
- Dr. Price: The University of CO School of Medicine and Senior Advisor to the President, American Board of Family Medicine, Lexington, KY; Dr. Campbell: Associate Professor at the Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Dr. Thomas Van Hoof: Associate Professor at the School of Nursing and School of Medicine, University of Connecticut, Mansfield, CT; Dr. Chappell: Senior Vice President of the Accreditation Program and Institute for Credentialing Research, American Nurses Credentialing Center, Silver Spring, MD; Dr. Moore: Director at the Division of Continuing Medical Education and Director of Evaluation and Education, Office of Graduate Medical Education, Vanderbilt University, Nashville, TN; and Professor of Medical Education and Administration, Vanderbilt University, Nashville, TN; Dr. Olson: Assistant Professor at the Geisel School of Medicine, Dartmouth College, Hanover, NH; Ms. ElChamaa: Research Associate at the Department of Innovation in Medical Education, and the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Ms. Jeong: Research Associate at the Department of Innovation in Medical Education, and the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Dr. Danilovich: Research Associate at the Department of Innovation in Medical Education, and the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa, Ottawa, Canada; and Dr. Kitto: Professor at the Department of Innovation in Medical Education and the Faculty of Education, and Director of Research at the Office of Continuing Professional Development, Faculty of Medicine, University of Ottawa; and Assistant Professor at the Department of Surgery, University of Toronto, Canada
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Chesluk BJ, Eden AR, Hansen ER, Johnson ML, Reddy SG, Bernabeo EC, Gray BM. How Physicians Prepare for Maintenance of Certification Exams: A Qualitative Study. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2019; 94:1931-1938. [PMID: 31192798 DOI: 10.1097/acm.0000000000002829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Little is known about how board-certified physicians prepare for their periodic maintenance of certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current. METHOD Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam. They analyzed transcripts and notes from these interviews looking for patterns and emergent themes, using the constant comparative method and a social practice theory perspective. RESULTS Most interviewees studied for their MOC exams by varying from their routines for staying current with medical knowledge, both by engaging with a different scope of information and by adopting different study methods. Physicians described exam preparation as returning to a student/testing mindset, which some welcomed and others experienced negatively or with ambivalence. CONCLUSIONS What physicians choose to study bounds what they can learn from the MOC exam process and, therefore, also bounds potential improvements to their patient care. Knowing how physicians actually prepare, and how these activities compare with what they do when not preparing for an exam, can inform debates over the value of requiring such exams, as well as conversations about how certification boards and other key stakeholders in physicians' continuing professional development could improve the MOC process.
Collapse
Affiliation(s)
- Benjamin J Chesluk
- B.J. Chesluk is senior researcher for ethnographic research, American Board of Internal Medicine, Philadelphia, Pennsylvania. A.R. Eden is medical anthropologist and qualitative researcher, American Board of Family Medicine, Lexington, Kentucky. E.R. Hansen was qualitative research assistant, American Board of Family Medicine, Lexington, Kentucky. The author is currently a first-year student, University of Kentucky College of Medicine, Lexington, Kentucky. M.L. Johnson is research program manager, American Board of Internal Medicine, Philadelphia, Pennsylvania. S.G. Reddy is senior research associate, Assessment and Research Division, American Board of Internal Medicine, Philadelphia, Pennsylvania. E.C. Bernabeo is research consultant, Accreditation Council for Graduate Medical Education, Chicago, Illinois. B.M. Gray is senior health services researcher, American Board of Internal Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | | | | |
Collapse
|
19
|
The Association Between Maintaining American Board of Emergency Medicine Certification and State Medical Board Disciplinary Actions. J Emerg Med 2019; 57:772-779. [DOI: 10.1016/j.jemermed.2019.08.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/02/2019] [Accepted: 08/12/2019] [Indexed: 11/22/2022]
|
20
|
Sehlbach C, Govaerts MJB, Mitchell S, Teunissen TGJ, Smeenk FWJM, Driessen EW, Rohde GGU. Perceptions of people with respiratory problems on physician performance evaluation-A qualitative study. Health Expect 2019; 23:247-255. [PMID: 31747110 PMCID: PMC6978864 DOI: 10.1111/hex.12999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite increasing calls for patient and public involvement in health-care quality improvement, the question of how patient evaluations can contribute to physician learning and performance assessment has received scant attention. OBJECTIVE The objective of this study was to explore, amid calls for patient involvement in quality assurance, patients' perspectives on their role in the evaluation of physician performance and to support physicians' learning and decision making on professional competence. DESIGN A qualitative study based on semi-structured interviews. SETTING AND PARTICIPANTS The study took place in a secondary care setting in the Netherlands. The authors selected 25 patients from two Dutch hospitals and through the Dutch Lung Foundation, using purposive sampling. METHODS Data were analysed according to the principles of template analysis, based on an a priori coding framework developed from the literature about patient empowerment, feedback and performance assessment. RESULTS The analysis unearthed three predominant patient perspectives: the proactive perspective, the restrained perspective and the outsider perspective. These perspectives differed in terms of perceived power dynamics within the doctor-patient relationship, patients' perceived ability, and willingness to provide feedback and evaluate their physician's performance. Patients' perspectives thus affected the role patients envisaged for themselves in evaluating physician performance. DISCUSSION AND CONCLUSION Although not all patients are equally suitable or willing to be involved, patients can play a role in evaluating physician performance and continuing training through formative approaches. To involve patients successfully, it is imperative to distinguish between different patient perspectives and empower patients by ensuring a safe environment for feedback.
Collapse
Affiliation(s)
- Carolin Sehlbach
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Truus G J Teunissen
- Patient Contributor, and Researcher at the Department of Medical Humanities, Amsterdam Public Health research institute (APH), Amsterdam UMC Free University Medical Centre, Amsterdam, The Netherlands
| | - Frank W J M Smeenk
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.,Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gernot G U Rohde
- Department of Respiratory Medicine, University Hospital, Goethe University, Frankfurt, Germany
| |
Collapse
|
21
|
Wiese A, Galvin E, Merrett C, Korotchikova I, Slattery D, Prihodova L, Hoey H, O’Shaughnessy A, Cotter J, O’Farrell J, Horgan M, Bennett D. Doctors' attitudes to, beliefs about, and experiences of the regulation of professional competence: a scoping review protocol. Syst Rev 2019; 8:213. [PMID: 31439022 PMCID: PMC6706919 DOI: 10.1186/s13643-019-1132-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/13/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Historically, individual doctors were responsible for maintaining their own professional competence. More recently, changing patient expectations, debate about the appropriateness of professional self-regulation, and high-profile cases of malpractice have led to a move towards formal regulation of professional competence (RPC). Such programmes require doctors to demonstrate that they are fit to practice, through a variety of means. Participation in RPC is now part of many doctors' professional lives, yet it remains a highly contested area. Cost, limited evidence of impact, and lack of relevance to practice are amongst the criticisms cited. Doctors' attitudes towards RPC, their beliefs about its objectives and effectiveness, and their experiences of trying to meet its requirements can impact engagement with the process. We aim to conduct a scoping review to map the empirical literature in this area, to summarise the key findings, and to identify gaps for future research. METHODS We will conduct our review following the six phases outlined by Arksey and O'Malley, and Levac. We will search seven electronic databases: Academic Search Complete, Business Source Complete, CINAHL, PsycINFO, PubMed, Social Sciences Full Text, and SocINDEX for relevant publications, and the websites of medical regulatory and educational organisations for documents. We will undertake backward and forward citation tracking of selected studies and will consult with international experts regarding key publications. Two researchers will independently screen papers for inclusion and extract data using a piloted data extraction tool. Data will be collated to provide a descriptive summary of the literature. A thematic analysis of the key findings will be presented as a narrative summary of the literature. DISCUSSION We believe that this review will be of value to those tasked with the design and implementation of RPC programmes, helping them to maximise doctors' commitment and engagement, and to researchers, pointing to areas that would benefit from further enquiry. This research is timely; internationally existing programmes are evolving, new programmes are being initiated, and many jurisdictions do not yet have programmes in place. There is an opportunity for learning across different programmes and from the experiences of established programmes. Our review will support that learning. SYSTEMATIC REVIEW REGISTRATION PROSPERO does not register scoping reviews.
Collapse
Affiliation(s)
- Anél Wiese
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Emer Galvin
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Charlotte Merrett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | - Irina Korotchikova
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| | | | | | - Hilary Hoey
- Royal College of Physicians of Ireland, Dublin, Ireland
| | | | | | | | - Mary Horgan
- Royal College of Physicians of Ireland, Dublin, Ireland
| | - Deirdre Bennett
- Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
| |
Collapse
|
22
|
McMahon GT. Inspiring Curiosity and Restoring Humility: The Evolution of Competency-Based Continuing Medical Education. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:1757-1759. [PMID: 29952769 DOI: 10.1097/acm.0000000000002339] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Dr. David Price and his colleagues, in their article in this issue of Academic Medicine, summarize the findings from recent studies regarding the association of Maintenance of Certification and physicians' learning and improvements in care. Their evaluation demonstrates that physicians often changed their practice because of these educational interventions. In this Invited Commentary, the author argues that, although this finding is reassuring, it may be the right answer to the wrong question. The critical questions the profession faces are whether physicians have the humility to routinely submit themselves to the judgment of their peers, whether they will accept responsibility for managing their professional competence and that of their colleagues, and whether they are willing to create a process for identifying and remediating underperforming clinicians.If certifying boards assume responsibility for this system of accountability, then each would need to set the competency expectations for physicians in its specialty areas, allow clinicians to self-identify their core scope of practice, assume responsibility for summative assessment, provide formative feedback to participants, and link physicians to recommended professional development activities. Continuing certification must be sensitive to the burdens it puts on physicians and recognize engagement in a spectrum of learning activities that are integrated with daily practice, including continuing medical education. By assuming responsibility for their own continuing competency and that of their colleagues, physicians can manifest their commitment to their patients and their profession.
Collapse
Affiliation(s)
- Graham T McMahon
- G.T. McMahon is president and chief executive officer, Accreditation Council for Continuing Medical Education, Chicago, Illinois
| |
Collapse
|