Revalidation of Canadian physicians

The Canadian Medical Association has long recognized the need for physicians to engage in lifelong learning to maintain the quality of clinical care. Although Wendy Levinson is to be commended for endorsing the principle of lifelong learning, the Canadian Medical Association cannot agree with her suggestions on how best to achieve it.1

The editorial largely ignores the peer-review process that the provincial licensing bodies have been running for a quarter century. Ontario was a pioneer and its work has been cited in the world literature as such; Alberta has added a number of innovations, including interviews with staff, colleagues and patients. Under these programs it is mandatory that physicians allow physician assessors into their practice to review their charts and question their approaches to diagnosis and the management of patient care. The process is designed to educate rather than punish.

Most physicians would agree that the acquisition of continuing medical education credits and participation in peer-review programs are important to ensuring competence. There is, however, little if any research to prove that examinations assess practitioners appropriately. The article by Tamblyn and colleagues2 cited by Levinson is often referred to precisely because there is almost no other such evidence, certainly not enough for the type of systematic review we would demand if a clinical intervention were to become recommended practice. There is a wealth of research showing good continuing medical education to be effective in enhancing quality of care.

A simple focus on a recertification process that is based on passing a test misses the key issue. The real challenge is to show that new knowledge gained by physicians is leading to positive changes in practices and better patient care. Self-reported measures are currently the only cost-effective way to demonstrate such changes; the cost of external audits would be prohibitive.

Bringing about change in practice is the final frontier. To ensure that better training leads to better patient outcomes, we need a concerted collaboration between physician organizations and governments to make the best possible learning opportunities available to physicians.