Continuing competence in selected health care professions

Journal of Allied Health, Winter 2002 by Lundgren, Burden S, Houseman, Clare A

Core Competencies and Specialized Practice

Role and work setting diversity further complicate the development and implementation of mechanisms for competence assurance. Graduate health care practitioners enter practice settings requiring specialized skills development. Professionals practicing in different settings necessarily acquire and perfect differing competencies. Practitioners also may move from specialty to specialty acquiring new skills with each move. It is common for state regulatory boards to require nonspecified continuing education as a requirement for relicensure. Typically, voluntary certification organizations deal with specialized competencies. (Certification is a confusing term. This article addresses certification as granted by private organizations. States also may certify professionals. In this case, certification is a form of title protection.)

Certification is a voluntary process for the demonstration of the mastery of specialized skills. In 1996, the Citizen Advocacy Center reviewed the continuing competence requirements of 52 voluntary health care professional certification organizations. The uncertainties inherent in ensuring continuing competence are well reflected in the varying methodologies employed by these organizations. Most require continuing education hours or recertification examinations (written or oral) or both. There also were occasional requirements for self-assessment, peer review, medical record review, office site visits, institutional input, experience reports, and practice hours. Little agreement existed concerning the time intervals between recertification processes. Ten years is common, but so is 5 years. At least two organizations require recertification every 2 years. Degree of risk in practice did not seem to be the determining criterion for frequency of recertification. Physician specialty organizations tended to have the lengthiest interim periods whereas personal trainers had one of the shortest. With the rate of turnover of knowledge now estimated to be 4 to 7 years,49 serious questions must be raised considering the appropriate time interval for recertification processes.

The link (if any) between periodic certification and continuing competence remains to be established. Does certification ensure competence, or do competent professionals seek certification? With no regulatory requirement to be met for specialized practice, professionals who seek specialty certification may be self-selected. They have elected to take a proactive posture with regard to ensuring competence, and certification validates that posture. More basic is the question whether certification is positively associated with competence and whether competence is positively associated with better patient outcomes.

Goals and Responsibilities for Ensuring Continuing Competence

Different professional organizations have differing perspectives concerning the responsibility for continuing competence. By and large, federations of state boards see continuing competence as a regulatory responsibility. The Pew Health Professions Commission8,9 supports a regulatory model, as does the Citizen Advocacy Center.61 Professional organizations often view continuing competence as a voluntary responsibility of the practitioners in their disciplines. There are gradients, however, in voluntary continuing competence requirements. Medical specialty boards generally require recertification after a period of 7 to 10 years.24 Without such recertification, a physician may practice, but he or she cannot call himself or herself board certified. Failure to recertify may affect the ability to maintain hospital privileges and managed care contracts. The authority to administer recertification examinations extends the influence and the economic capacity of the examining board. The conflict between occupational therapy organizations illustrates the desirability of possessing recertification authority.