Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer?

 “Pressed by their leaders, external stakeholders, and a public troubled by lapses in the quality of care and unsustainable cost increases, physicians are facing stiffer challenges in initiatives designed to link more closely the goals of learning with the delivery of better care and measures of greater accountability… ”

So begins Ensuring Physicians’ Competence — Is Maintenance of Certification the Answer? in this week’s issue of NEJM .

While the essay focuses on US system of reaccreditation, the opening remarks could apply to any (Western) healthcare system which desires its doctors to deliver best possible healthcare to citizens with greater accountability for the medical profession.

I want to know how my leaders allowed the demise of self-regulation to occur after several hundred years of autonomy.

Why does the author of the article believe there is no chance the medical profession can return to less fettered self-regulation?

Is it really in the public’s interest for politicians and healthcare payers to control medical profession ever more tightly? Is the cost for such regulation really affordable?

It is my opinion, that the majority of doctors are self-directed learners who perform better under less scrutiny rather than more. Healthcare innovation may well be stifled by the drive to tighten regulations for physician practice.

This is apparently a global phenomenon at least in the rich countries with managed healthcare systems. National medical bodies may need to work together to fight this threat to the effective care of our patients.

The increasing threats to independent practice and the profession of medicine are contrary to the human values in healthcare that is at the heart of what we do.

Using Evernote for Continuous Professional Development – a view from General Practice in UK

Like many professional people doctors must keep track of a lot of information. From beginning of December 2012, all GMC registered doctors must engage with 5 yearly revalidation cycle.  Annual appraisal has been in place since 2004 after the Shipman scandal and its aftermath, the legal requirement for revalidation has only now been enacted.

Many different systems are available to doctors to choose from for keeping track of the required documents and learning. The Royal Medical Colleges have systems for their members (e.g. RCGP ePortfolio), the NHS has encouraged a toolkit, and some household names in medical press (eg GP, BMJ eLearning) have also jumped on the bandwagon.

However, after trying out several I have purchased the premium version of Evernote.  Evernote suits my style of learning and integrates easily with all the devices used for work and play – Windows Home PC, laptop and work PC, and android phone & tablet.  It will also work happily on iOS devices and Apple computers.

It has taken some time to get used to the powerful features of Evernote.  The Premium version allows full control of privacy settings which is clearly important for something as sensitive as professional portfolio.  Also the paid version allows up to 1GB data uploaded per month which is generous unless you are in habit of uploading videos or audio files of meetings. This data plan can be increased for another fee.  Acrobat PDF files can be read inside the programme too.  Numerous third party applications are available to expand the capability of Evernote: some are free, many are enterprise (fee paying) solutions.

I have two main folders for notebooks – Personal and Work.  One notebook is publicly shared with my patients – the link is here
My appraisal notebook can be shared with my appraiser for the current year.

Evernote provides a tool to archive twitter posts which is a boon when engaging in professional twitter chats (when you see @myEN the author is archiving post to her or his evernote notebook.  You can add an extension to Chrome or Firefox to help grab web pages or parts thereof and store in  Evernote.

Furthermore, careful use of tags will help with finding notes quickly, though Evernote does a good job with free text searching too.

Finally, the best is kept until last  – automatic adding of useful emails or social network interactions or cloud storage files. The means to do this is provided by a couple of providers which I have stumbled on.  Zapier (http://zapier.com) offers free packages for a limited number of “recipes” (5) and ifttt (http://ifttt.com) offer free packages for unlimited number of “recipes” .  Careful planning can give excellent results for busy doctors (and others).  The instructions for use are straightforward.

After nearly one year nearly 7000 notes have been collected. While not a complete and comprehensive collection of learning and interaction that some may aspire to, it is a good reflection of continuous professional development.