Do lifelong learning and revalidation ensure that physicians are fit to practice?

Key messages

Policy issue and context

• In some countries, pressure is growing to demonstrate that practicing physicians continue to meet acceptable standards. This is driven in part by concerns that the knowledge obtained during basic training may rapidly become out of date. It is also increasingly a way of holding physicians accountable.
• Physicians may be encouraged to engage in lifelong learning to continually update their knowledge and skills. This may involve assessing practice, identifying relevant learning objectives, acquiring skills and knowledge and carrying out assessment.
• A review of selected European countries, Australia, New Zealand and the United States of America reveals diversity in approaches to ensuring physician competence. The outcome of these processes may be recertification or relicensure.
• Revalidation is an all-encompassing term that includes all the methods used to ensure that physicians remain competent and, at its simplest, involves ensuring that a physician remains fit to practise. More complex forms can also involve interventions to deal with physicians who are not fit to practise. Hence, it can also be a method of improving physician performance.

Policy measures

• Continuing medical education and continuing professional development are the most widely used approaches and can be effective in improving clinical practice and health care outcomes. Nevertheless, they do not identify the physicians who perform poorly.
• Recertification can be used to identify the physicians who perform poorly, and evidence from the United States suggests that it is effective in improving clinical outcomes and the quality of care.
• Continually assessing the performance of all physicians in all domains of competence is impractical. Evidence on the different tools for assessing physicians is inconclusive in most cases, especially in terms of patient outcomes. Cost–effectiveness data are also largely absent.
• When government leads revalidation, it can be a control mechanism for the quality and accountability of services. In contexts of professional self-regulation and co-regulation (between professional and statutory bodies), it represents the reformulation of professional autonomy.

Implementation considerations

• Different balances of incentives and penalties are likely to work best in each country. Currently the most severe penalty is revoking the licence to practise.

• Sophisticated information systems are needed to implement and evaluate revalidation.

• Many countries experience difficulty in raising the necessary resources to implement even the most basic policies on physician performance. When the pharmaceutical industry is a major funder of revalidation, the government should consider establishing an independent regulatory body to set the programme’s agenda.