Policy brief: do lifelong learning and revalidation ensure that physicians are fit to practise?

    Publication year: 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acceptable standards, driven in part by concerns that the knowledge obtained during basic training may rapidly become out of date.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.