Policy brief: do lifelong learning and revalidation ensure that physicians are fit to practise?
Année de publication: 2008
In some countries, pressure is growing to demonstrate that practising physicians
continue to meet acceptable standards, driven in part by concerns that the
knowledge obtained during basic training may rapidly become out of date. This
takes various forms, from expectations – in some cases backed by various
sanctions – that physicians will engage in continuing medical education and
continuing professional development to requiring that they demonstrate that
their skills are up to date as a condition of remaining in practice. The latter
approach is exemplified by the proposals for a system of revalidation in the
United Kingdom.
Lifelong learning is a process involving assessing practice, identifying relevant
learning objectives, acquiring skills and knowledge and carrying out
assessment. The two main components are the process of keeping up to date
through continuing medical education and continuing professional
development and then assessing whether this has been successful through
various assessment and feedback mechanisms. Continuing medical education
and continuing professional development can enhance physicians’ knowledge,
attitudes and skills, but the quality can vary. Audit and feedback can also
improve professional practice within a supportive context. Recertification can be
awarded when the required components are successfully completed, and
recertification systems can identify the few physicians who seriously
underperform (experience is limited to the United States). Revalidation is an
encompassing term that includes all methods used to ensure physician
competence.
Relevant to their own context and requirements, countries also need to
consider which body should be responsible for regulating physicians. There
seems to be a consensus that self-regulation is more willingly accepted than
government regulation, reducing incentives for opportunistic behaviour and
non-compliance. Some commentators argue that overzealous regulation could
actually erode rather than increase trust in professionals and public services.
Perhaps reflecting increased awareness of these issues, forms of co-regulation
or partnership regulation between professional and statutory bodies or payers
are increasingly being explored.