By Paul Levy

First Posted at Not Running a Hospital on 10/19/2012

Paul Levy, Host of (Not) Running a Hospital

The BBC reports:

The UK’s 220,000 doctors will have annual appraisals, with a decision taken every five years on whether they are fit to continue working.

Worth it? Probably, although I wonder what this reappraisal will look like. It seems to be directed at the 0.7% of doctors whose skills have become substandard. It must be hard to design a system that will be able to detect those defects that could be harmful. It’s even harder to design an appraisal system that remediates previous defects in medical training, you know, the ones that lead to excessive levels of patient harm in hospitals.

This made me wonder what we do in the US. Here’s a summary from a few years ago from an internist who suggested that the US system is not very useful.

I’m due to recertify in Internal Medicine soon, so a recent perspective from the New England Journal of Medicine caught my eye. Of the many criticisms of the Maintenance of Certification Exam, one that stands out is whether the format and questions were relevant to modern clinical practice.

It’s not.

Two contrasting opinions were written, and I’m inclined to agree with the dissenting commentary. There is little data correlating those who recertify and improved medical outcomes. The major reason is that the format of the exam is antiquated, consisting of hundreds of multiple choice questions that relies on a physician’s recall of obscure facts, largely irrelevant to clinical practice.

When we think about the holes in medical education the first time through, it is any wonder that the recertification curriculum would also be inadequate?  Remember this summary?

The Lucian Leape Institute at the National Patient Safety Foundation released today a report that finds that U.S. “medical schools are not doing an adequate job of facilitating student understanding of basic knowledge and the development of skills required for the provision of safe patient care.”