Testing Doctors for Continuing Competence

When doctors finish med school and residency their heads are filled to the brim with up-to-date medical information. Over time, lessons learned are forgotten and new knowledge overtakes old. Earlier this week, I attended a lecture at which a colleague said that new knowledge is accumulating so quickly in the world of medicine that 3 year old textbooks are well out of date!

It's not surprising then, that there are serious concerns about the ongoing competence of physicians. In past episodes of White Coat, Black Art, we have tracked efforts by provincial colleges in Nova Scotia, Ontario and Alberta to assess the competence of practising physicians on an ongoing basis. None of these programs have an exam component.

Now, Dr. Wendy Levinson, Professor and Chair of the Department of Medicine at University of Toronto is calling for rigorous, sit-down examinations at least once every decade for Canada's physicians.

In an editorial in the current issue of the Canadian Medical Association Journal (CMAJ • November 4, 2008; 179 (10). doi:10.1503/cmaj.081342.), Dr. Levinson said practising physicians should have to write the same kind of high-stakes exams they took in med school and in residency. American physicians have been required to write exams every ten years for some time now. It was her recent experience writing a U.S. recertification exam in internal medicine that convinced her that Canada should follow the same example.

I am certified by the American Board of Emergency Medicine. In 2003, I wrote and passed the recertfication exam in emergency medicine. It was a gruelling yet very satisfying experience. In the months prior to the exam, I spent hundreds of hours updating my knowledge. I felt as nervous doing the exam as I did in med school. More important, I came away energized and re-invigorated in my practice. I was a better teacher of students and residents as well.

I too believe it's time to hold recertification exams in Canada. Some of my colleagues are opposed to the idea. They see it as another intrusion into their business. The same sorts of objections were raised In the U.S. Now, recertification is considered a basic requirement of all physicians there. Have no fear, colleagues. You'll get used to it. And Canadians will have even more confidence in their physicians.

Dr. Wendy Levinson's editorial

Let us know what you think.

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Previous Comments (1)

Why not... Paramedics are maintaining theirs licenses on a yearly basis thru CME, conferences and various other courses... why should Doctors and Nurse be exempt?

Keep up the good work!


Bryan, November 5, 2008 12:55 PM
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