Revalidation of Canadian physicians

We thank Wendy Levinson for promoting the principle that physicians individually and the medical profession collectively must be accountable for sustaining and enhancing physicians' knowledge, skills, attitudes and competencies over a lifetime of practice and that these processes must be transparent.1 In 2005, the Council of the Royal College of Physicians and Surgeons of Canada established lifelong learning as the professional ethic for all fellows. The Maintenance of Certification program has promoted and supported this mandate by establishing high standards for group learning, self-learning and practice and performance assessment strategies and by requiring fellows to plan, implement, document and defend, where required, their process of learning and the outcomes achieved that contributed to the quality of their professional practice. Participation in continuing professional development activities alone is an inadequate marker of learning, and learning divorced from improvements in competence, performance and health outcomes is an inadequate metric for any continuing professional development system committed to improving the quality of professional practice.

We disagree with Levinson about the foundation upon which accountability should be based. Rather than promoting the development of a testing culture that is based on summative examinations, the Royal College of Physicians and Surgeons of Canada is advocating for the creation of a learning culture characterized by practice reflection, inquiry, peer review and rigorous formative assessments of knowledge (through self-assessment programs), competence (through simulations) and performance (through practice reviews) that reflect the entire spectrum of roles and competencies associated with the CanMEDS framework. Because recertification examinations cannot realistically be tailored to an individual specialist's scope of practice and provide limited feedback to promote learning and improvement, we have rejected the inclusion of recertification examinations as a mandatory requirement of the Maintenance of Certification program. We applaud the Federation of Medical Regulatory Authorities of Canada's inclusion of “formative” as 1 of the 5 principles of revalidation.2

We are in the midst of an exciting but challenging cultural shift in continuing professional development. At the Royal College of Physicians and Surgeons of Canada, we remain committed to enhancing the rigour, accountability and transparency of our continuing professional development system to promote lifelong learning and to enhance the quality and safety of care, thereby contributing to the health of Canadians.