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Doctors on the move: a European case study on the key characteristics of national recertification systems
  1. Carolin Sehlbach1,
  2. Marjan J Govaerts1,
  3. Sharon Mitchell2,
  4. Gernot G U Rohde3,
  5. Frank W J M Smeenk1,4,
  6. Erik W Driessen1
  1. 1 Department of Educational Development and Research, SHE, Maastricht University, Maastricht, The Netherlands
  2. 2 Department of Education, European Respiratory Society, Lausanne, Switzerland
  3. 3 Respiratory Medicine, Johann Wolfgang Goethe University Hospital, Frankfurt, Germany
  4. 4 Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
  1. Correspondence to Carolin Sehlbach; carolin.sehlbach{at}


Objectives With increased cross-border movement, ensuring safe and high-quality healthcare has gained primacy. The purpose of recertification is to ensure quality of care through periodically attesting doctors’ professional proficiency in their field. Professional migration and facilitated cross-border recognition of qualifications, however, make us question the fitness of national policies for safeguarding patient care and the international accountability of doctors.

Design and setting We performed document analyses and conducted 19 semistructured interviews to identify and describe key characteristics and effective components of 10 different European recertification systems, each representing one case (collective case study). We subsequently compared these systems to explore similarities and differences in terms of assessment criteria used to determine process quality.

Results Great variety existed between countries in terms and assessment formats used, targeting cognition, competence and performance (Miller’s assessment pyramid). Recertification procedures and requirements also varied significantly, ranging from voluntary participation in professional development modules to the mandatory collection of multiple performance data in a competency-based portfolio. Knowledge assessment was fundamental to recertification in most countries. Another difference concerned the stakeholders involved in the recertification process: while some systems exclusively relied on doctors’ self-assessment, others involved multiple stakeholders but rarely included patients in assessment of doctors’ professional competence. Differences between systems partly reflected different goals and primary purposes of recertification.

Conclusion Recertification systems differ substantially internationally with regard to the criteria they apply to assess doctors’ competence, their aims, requirements, assessment formats and patient involvement. In the light of professional mobility and associated demands for accountability, we recommend that competence assessment includes patients’ perspectives, and recertification practices be shared internationally to enhance transparency. This can help facilitate cross-border movement, while guaranteeing high-quality patient care.

  • recertification
  • continuing professional development
  • performance assessment
  • patient safety
  • quality assurance
  • professional mobility

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  • Contributors CS wrote the research plan, collected, cleaned and analysed the data, and drafted and revised the paper. She is the guarantor. All authors were involved in conceptualising the research. MJG analysed the data, and drafted and revised the paper. SM revised the paper. GGUR drafted and revised the paper. FWJMS drafted and revised the paper. EWD analysed the data, drafted and revised the draft paper.

  • Funding CS is a PhD student at Maastricht University, on a project funded by the European Respiratory Society. The European Respiratory Society was however not involved in the design or in conducting this research.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval was obtained from the Netherlands Association for Medical Education (NVMO; file number 669).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The dataset(s) supporting the conclusions of this article is available from the author on request by emailing the corresponding author.