December 1999 Bulletin

Physicians asked to prove continuing competency

Here's a scenario to ponder. You board a 747 jet. The pilot addresses the passengers, saying that 35 years ago he learned how to fly a Piper Cub. Of course this is a 747, but he tells the passengers not to worry because twice a year he and his wife attend continuing flying education seminars.

In the winter, they go to a warm climate for five or six days and he takes two or three hours of courses in the mornings and in the afternoons they play golf. In the summer, he goes to South America for four or five days and sits in on seminars for a few hours in the mornings and he skis in the afternoon. No one tests him. No one sees if there has been a change in behavior. But the pilot tells the passengers not to worry, trust him, just sit back and relax.

Stephen Miller, MD, executive vice president of the American Board of Medical Specialties (ABMS), who offers that scenario assumes that no one would want to fly with the pilot of that 747.

Dr. Miller's message is that all physician specialists must get accustomed to the idea that they will have to prove maintenance of competency throughout their careers. In addressing the Board of Councilors meeting in October, Dr. Miller said "allopathic medicine achieved ascendancy over all other types of health care providers in the late 1800s by gaining the moral level that assured the public we would assume the responsibility for education on a continuing basis.

"Now, it is almost out of our hands, the train has left the station. The public, and I mean all the publics-the HMOs, the hospitals-are looking to you to demonstrate not only that you passed an examination once in your life, but that there is a continuing level of competence. Our credibility demands that we do something."

In 1998, the ABMS formed a task force focused on how to assess competence as an end result of the recertification process. "The standard must be set by physicians or it will be set by people who don't know how to judge you," Dr. Miller said.

"We must define competence and look at competencies and measurements of competency and which will one will stand as a proxy for competence. The maintenance of certification or competency subsumes the old term recertification."

The ABMS believes it can identify reliable methods that are clinically valid and clinically relevant. There must be evidence of the following: satisfactory professional standing, life-long learning that is specialty specific, cognitive expertise that must have credibility in the eyes of the public, and evaluations of practice performance. The ABMS has developed a generic description of a competent physician:

The physician should possess the medical knowledge, judgment, clinical and communication skills, professionalism and leadership ability to provide high quality care. Patient care encompasses the diagnosis, treatment and management of medical conditions, promotion of health, prevention of disease, compassion and respect for patients and their families. Maintenance of competence should be demonstrated throughout the physician's career by evidence of life-long learning and ongoing improvement of practice.

The ABMS has developed six general competencies and they have been accepted by the Accreditation Council for Graduate Medical Education for residency programs. The competencies are: patient care; medical knowledge; practice-based learning and improvement; systems-based practice, referring to team approach; professionalism/ethics; and interpersonal skills and communication.

Dr. Miller said the ABMS member boards have approved the descriptions of the six competencies and "we expect there will be general agreement to the maintenance of certification concept and to the descriptors for the six general competencies."


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