Accreditation, certification, and licensure: How six general competencies are influencing medical education and patient care

Journal of Medical Licensure and Discipline  The article below was recently published in the Journal of Medical Licensure and Discipline. This is the journal of the Federation of State Medical Boards. Copies of the article may be ordered from the journal Web site.

Mazmanian PE, Galbraith R, Miller SH, Schyve PM, Kopelow M, Thompson JN, Aparicio A, Davis DA, Kahn NB Jr. Accreditation, certification, and licensure: How six general competencies are influencing medical education and patient careJournal of Medical Licensure and Discipline 2008; 94(1):8-14.

Abstract: Lifelong learning and self-assessment are tenets of medical education and health care improvement; patient safety and quality care are essential to the accreditation of organizations providing either continuing medical education (CME) or patient care. Accredited CME providers must assess the learning needs of physicians. Accredited health care organizations must document physician participation in education that relates to the nature of care, treatment and services provided by the hospi tal. The credentialing and privileging of medical staff requires ongoing focused professional practice evaluation based on six general competencies, including compassionate care, medical knowledge, practice-based learning and improvement, effective communication, demonstrated professionalism and coordinated systems-based practice.

As those charged with assessment and program evaluation are challenged to produce valid and reliable results to improve education and health care, United States licensing authorities are defining good medical practice and considering competency-based maintenance of licenses. The present paper offers a framework to advance the discussion of relative value credits for gains assessed in knowledge, competence and performance of physicians. A more synchronized and aligned consortium of medical licensing boards, specialty boards and organizations granting practice privileges is recommended to inform the design of education and physician assessment to assure patient safety and quality improvement.

From the same issue:
What’s That Knocking?
Medical licensing boards, if they existed in a state, were unable to measure physician competence because there was no agreement on the core knowledge or skills required to be a competent physician . Medical practice has seen some profound transitions during the past few decades …

State Medical Board Responses To An Inquiry On Physician Researcher Misconduct
Misconduct in clinical research jeopardizes the integrity of medical science. Physician researcher misconduct that produces flawed results has consequences, including the subsequent inability of other physicians who rely on erroneous data to provide informed consent and/or accurate assessment of pharmaceutical and medical device efficacy and safety. This deviation from acceptable medical practice can directly harm patients. How state medical boards address this clinical problem is uncertain. To examine this issue, we asked 51 U.S. medical boards to search their databases for disciplinary action in response to physician researcher misconduct (PRM) from 1996 thru early 2007. We compared their responses with data from federal agencies responsible for disciplinary actions against clinical researchers. Our results demonstrated:
 i) a high percentage (45 percent) of U.S. medical boards indicated that they did not have or could not provide access to data adequate to address whether or not disciplinary action for PRM had been levied in their states and
 ii) of respondents able to make relevant information available, we identified only 13 cases of physician disciplinary action for PRM. In contrast, several dozen examples of disciplinary action against physicians for serious clinical research misconduct could be readily documented in publicly accessible data from federal regulatory agencies.

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