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Better Professional Development
Published in Paul Batalden, Tina Foster, Sustainably Improving Health Care, 2022
Maren Batalden, David Leach, Paul Batalden
With its competency initiative, the ACGME opened a revolutionary conversation in health professional formation that linked undergraduate professional preparation with lifelong professional development and crossed interprofessional boundaries. In 1999, the American Board of Medical Specialties adopted the same six core competencies as a framework to guide their work with certification and maintenance of certification in the 24 medical specialties. In 2005, the nursing profession birthed the Quality and Safety Education for Nurses (QSEN) movement, which articulated a similar set of competencies for nursing professionals – patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. As with physicians, these nursing competencies widened the mandate for health professional formation and put health professional formation into an explicit relationship with patient outcomes and system performance.
Continuing Professional Development and Fitness to Practise
Published in Robin Stevenson, Learning and Behaviour in Medicine, 2022
The systems and instruments described above were created primarily to monitor physicians’ CPD, but in large part they have been hijacked for a different purpose. They have come to form the basis for deciding fitness to practise. In the 1970s, time-limited certification was introduced in the US and, since 2000, Maintenance of Certification (MOC) programmes have been adopted with a 10-yearly, four-part recertification assessment of medical knowledge, competence and communication skills. This system is not mandatory and includes an examination. Canada’s present system was launched in 2011 by the Royal College of Physicians and Surgeons of Canada with a revised MOC programme framework, credit system and ePortfolio. The UK revalidation system began in 2012 with annual appraisals requiring exhaustive documentation of activities. There is a more detailed appraisal every 5 years (including results from MSF) when decisions on revalidation are made. Comparable systems have been established worldwide. The cost has of course been enormous, both in time and money. It is too soon to know what will be the return on this investment. A recent survey of Responsible Officers in the UK revalidation system suggested that “one size fits all” was not the best model and that it should be more responsive to individual and professional contexts [7]. It was better in dealing with poor performance, but less useful for physicians who were performing well. In the US, where recertification is long-established, there is little evidence that it improves patient care [8].
Scholarship
Published in Robert S. Holzman, Anesthesia and the Classics, 2022
Educational achievement is a starter criterion for medical school and accomplishment in postgraduate medical education. One does well on Scholastic Achievement Tests (SATs) in order to enter the best college possible, Medical College Admissions Tests (MCATs) in order to enter the best medical school possible, passes National Board of Medical Examiner (NBME) exams, specialty exams, subspecialty exams to obtain board certification and so forth. Content-based knowledge is a justifiably large component of traditional medical education and practice. More recently, emphasis has been placed on the philosophy and resources necessary for continuing medical education, maintenance of certification and life-long learning, all of which are based on core principles of a continuing engagement with educational growth and development. It is, however, relatively easy in our current system of compliance with such goals to achieve benchmarks of credible public competency – having your college and medical school diploma, various subsequent postgraduate medical education certifications, and verification of acceptable credit for participation in continuing medical education. What is subtler is to continually challenge oneself with professional growth into evolving areas of uncertainty because they confront one’s sensibilities of finitude and completion. In this context, the role of the medical educator expands to educator-motivator as well as role model.
When Surgeons Are “Too Old” to Practice Surgery: Recommendations to Balance the Imperatives of Public Safety and Practical Necessity
Published in Hospital Topics, 2023
Mark Cwiek, Dan J. Vick, Krista Osterhout, Vincent Maher
Although not required by law, board certification has essentially become compulsory to contemporary practice, the granting of hospital privileges, and third-party insurance reimbursement in first world countries (Cox 2017). The medical and surgical specialty boards regulate continuing certification in the specialty. Board certification is maintained through completion of a maintenance of certification (MOC) program. Some specialty boards in surgery and anesthesiology also require clinical practice evaluation of all candidates of a certain age or older by other board-certified members of the medical specialty to promote public safety. Medical and surgical specialty boards usually manage to maneuver the fine line between public safety and adherence to age discrimination laws. Requiring all people of a certain age or older to undergo periodic clinical evaluation can help ensure that evaluation is not discriminatory (Reeves, Chilton, and Bird 2020a).
Use of neuroimaging to measure neurocognitive engagement in health professions education: a scoping review
Published in Medical Education Online, 2022
Serkan Toy, Dana D Huh, Joshua Materi, Julie Nanavati, Deborah A. Schwengel
Our review did not identify a strong literature base within the health professions education for real-time monitoring of tasks that require vigilance and sustained attention. One group examined the effect of fatigue on clinical reasoning skills across two separate pilot studies as internal medicine physicians answered and reflected on multiple-choice questions from the US medical licensing and/or maintenance of certification exams [29,32]. The results were consistent with those of other studies outside medical education, which have shown that fatigue and sleep quantity are associated with significant changes in brain activation patterns, especially in the medial and/or lateral PFC and other working memory-related areas. Although the exact nature of this relationship was not clear, these preliminary findings emphasize the importance of examining how fatigue and sleep deprivation might regulate neurocognitive engagement. The interplay among various factors such as expertise level, task, cognitive load, attention, and medical errors presents critical research opportunities for functional neuroimaging studies. Numerous studies in other fields could offer guidance for such efforts in health professions education. This type of research can have significant implications for real-time monitoring, and potentially intervention, during critical clinical tasks.
How general pediatricians learn procedures: implications for training and practice
Published in Medical Education Online, 2021
Maya S. Iyer, David P. Way, Daniel J. Schumacher, Charmaine B. Lo, Laurel K. Leslie
When asked how they would ‘relearn’ a procedure if they happened to relocate or change job types, most said that they would prefer to shadow or be observed by peers as opposed to attending training workshops. They wanted their employer or local medical center to ensure they were credentialed and/or to complete ‘check-offs’ for competency. Furthermore, most participants voiced concerns about introducing formal procedural competence assessments as a component of maintenance of certification (MOC). Participants stated that since GPeds’ scope of practice varied so broadly, governing medical bodies and boards could not fairly implement requirements. In addition, they reported that requiring procedural MOC would be costly, burdensome, and add to the ever-growing list of administrative requirements that occupy a physician’s time. Above all, GPeds believed that procedural MOC is unnecessary since not all procedures are relevant to the practice of all GPeds.