Best Practice & Research Clinical Obstetrics & Gynaecology
10Recertification and continuing professional development: The way ahead
Introduction
The arguments in favour of Recertification have been made cogently.1 Doctors in the UK on the whole continue to enjoy the trust and respect of their patients and general public, but the Shipman enquiry led by Dame Janet Smith questioned the validity of the existing system.2 Following a lengthy discussion, the Chief Medical Officer of England published his proposal for professional regulation: Trust, assurance and safety – the regulation of health professionals in the 21st century1 was published in February 2007.3 This document laid out the principles of revalidation for all doctors practising in the United Kingdom. The purpose of revalidation is principally to ensure that doctors update their knowledge, skills, and fitness to practise. This mechanism of revalidation will ensure that health professionals are able to demonstrate their continued fitness to practise by collecting supporting data. Medical revalidation has two components: relicensure and specialist recertification. With effect from 16 November 2009 all doctors are expected to have a licence to practise which will enable them to remain on the medical register, and this licence must be renewed every year. This process will be managed by the General Medical Council (GMC). Recertification will apply to all specialist doctors, including general practitioners, requiring them to demonstrate that they meet the standards that apply to their particular medical specialty. The Royal Colleges have been delegated to set these standards, and approved by the GMC. Recertification will take place every five years. This article describes the approach adopted by the Royal College of Obstetricians and Gynaecologists (RCOG) to support the recertification of obstetricians and gynaecologists.
Section snippets
Current system of postgraduate training in the United Kingdom
Under the auspices of the Postgraduate Medical Education and Training Board (PMETB), radical changes have led to the streamlining of training, regular on-site assessments, and the development of special skills for certification as a specialist. During these years of training, doctors have to demonstrate that they have acquired the necessary skills and competences which are judged by using workplace-based assessments, 360 degree feedback, and their annual review of competence progression (ARCP).
Why do we need recertification?
Although our current system of training doctors to be specialists is now heavily regulated, this is not matched by the current systematic assessments of performance during the course of specialists’ careers. All obstetricians and gynaecologists practising in the UK are expected to take part in continuing professional development (CPD) activities. However, concerns have been expressed about the effectiveness of various types of learning supporting the CPD activities.4 It has also been suggested
Professional benefits of revalidation
Research evidence from the USA supports the notion that specialist certification has a positive impact on patients’ health outcomes. Three decades ago, the majority of participants in a voluntary recertification programme in obstetrics and gynaecology in the United States found it to be an educational experience which was worth their time and effort provided the procedures did not become too cumbersome.10 In surgery, certification had a higher correlation with reduced mortality.11 In patients
International models of certification
There are existing models of recertification in obstetrics and gynaecology in other countries. For two decades, the certificates issued by the American Board of Obstetricians and Gynaecologists for obstetrics and gynaecology and for the sub-specialties of maternal-fetal medicine, reproductive medicine, and oncology have been time-limited, and since 2001 recertification has been required every six years. This recertification can be obtained in one of three ways: either an oral or a written
What should be assessed?
A review of the literature essentially supports a strong commitment from the clinicians that their practice is up to date by providing evidence of “good quality care supported by clinical outcome indicators”, that they are up to date with current knowledge, and that their CPD activity is relevant to their day-to-day clinical work. The public wants an assurance from the regulators that the doctors are judgement safe. Although recertification by examination has been found to be useful, it is now
The contribution of the RCOG to setting standards of care and performance monitoring
The RCOG’s commitment to setting standards as its core activity is captured by its strapline, “Setting standards to improve women’s health”. The RCOG was the first College to instigate a CME/CPD programme in 1994. It has a long tradition of disseminating best practice guidance in clinical and professional arenas through its green-top and national evidence-based guidelines and the clinical governance series. The zenith of this commitment to the development and maintenance of national standards
How to assess a practitioner’s competence for a recertification programme
There is considerable interest in doctors’ performance and the tools required to assess this. Dame Janet Smith’s review2 found that among the high risk organisations of the aviation, nuclear, and offshore oil industries, the assessment of competence was carried out against defined standards of competence, that the interval between assessments ranged from six months to three years, and that repeated failures were an exception rather than the rule. Costs are high in the aviation industry, with
Various tools and mechanisms to assess competence
A wide variety of tools and mechanisms could potentially be employed in recertification, and some of these tools are discussed below. It is important to establish some guiding principles at the outset as these will determine which of the array of options is adopted. These simple but important principles will constitute the reference point for evaluating the proposed recertification programme as it goes through the process of consultation. Broadly speaking, these tools should support the
Knowledge-based assessment
The American experience shows that organising examinations for all specialists could be quite expensive and would require huge investment in setting up an infrastructure in the UK. There is a clear understanding that consultants’ job plans in the NHS evolve during their working life. A majority of newly appointed consultants usually start as generalists but gradually move into areas of subspecialisation. Currently the RCOG trains the future generation of subspecialists in four sub-specialty
Multi-source feedback (MSF)
Multi-source feedback, also known as 360 degree feedback, is a process whereby an individual (the recipient or assessee) is rated on their performance by people who know something about their work (the raters or assessors).The MSF is considered as a means of collecting information regarding a doctor’s performance. The assessment tool consists of questions which ask the assessor to evaluate the assessee’s performance against a number of attributes, such as the ability to work well in a team.
Continuing professional development
The RCOG has one of the most firmly established programmes of Continuing Professional Development (CPD) in Europe, and for a long time it has regarded CPD as fundamental to revalidation.23 The CPD programme has been revised to meet the challenges of recertification, to ensure that clinicians stay up to date in their current areas of practice and develop in the areas they wish to progress. Clinicians need to bring their CPD activities into line with their job plans and professional aspirations,
How the revalidation system will work in practice for the RCOG?
It has been acknowledged that the implementation of the revalidation process will be incremental in order to deliver a robust and quality-assured system. It will be based on evidence drawn from local practice, with robust systems of clinical governance to support it.
Revalidation has two components: relicensure and recertification (Fig. 4).
Quality assurance of the programme in the UK
In the United Kingdom, every doctor will have a “responsible officer” - the responsible officer will be a senior doctor in a health care organisation, normally but not always the Medical Director, who takes personal responsibility for local governance processes. Every region in the United Kingdom will have a “GMC affiliate” who will provide a link between national and local workplace regulation. The responsible officer and the GMC affiliate will also liaise with the Royal Colleges and
Potential pitfalls and challenges
The revalidation process has been introduced with a great deal of enthusiasm in response to public demand for the transparency and accountability of practising doctors. The process demands that the doctors should collect the necessary supporting data about their day-to-day activities. Currently not all of the NHS organisations have established clinical governance and audit systems in place for measuring clinical outcome measures and patient feedback related to their experiences. Therefore a
Conclusion
The recertification of specialists presents a huge challenge to the Royal Medical Colleges. The Colleges’ Royal Charters allow them to set standards of good clinical care. However, regulatory responsibility rests with the General Medical Council. The RCOG’s framework for recertification has been subjected to wide consultation with all relevant stakeholders and has been approved by the General Medical Council for it to be piloted and tested. Multimodal assessment will be used to generate a
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2022, Research in Social and Administrative PharmacyCitation Excerpt :These discussions suggest that an emphasis on continuous professional development42,43 is important to ensure that practitioners remain competent and responsible. The notion of ensuring accountability through continued competence has led regulators in the UK to move to revalidation and recertification of professional requirements.44,45 However, these revalidation and recertification approaches represent the imposition of professionalism from above to achieve some kind of ‘enforceable trust’.46
Regulation and registration as drivers of continuous professional competence for Irish pre-hospital practitioners: a discussion paper
2016, Irish Journal of Medical ScienceContinuous professional development for GPs: Experience from Denmark
2014, Postgraduate Medical JournalIntroducing multi-source feedback of trainees
2012, Zdravstveno Varstvo