Every year, more than 51 million patients in the U.S. undergo inpatient surgery, with the risks mitigated by the skill and expertise of their healthcare providers. These patients trust that their surgical team has the right training and skills to perform any procedure safely.
Yet too often patients have no knowledge of the professionalism standards and expertise they should expect from their care teams. This is especially true for those physicians, such as anesthesiologists, with whom patients often have little interaction. Therefore, it is critically important that hospitals, professional societies and insurers consider board certification and maintenance of certification as the benchmark from which standards of professionalism and excellence in practice are derived.
In the past year, a fierce debate over maintenance of certification erupted as physicians pushed back against program components they felt were time-consuming and expensive, but irrelevant to everyday practice. Yet, increasingly only physicians who are board-certified can obtain hospital privileges or employment in hospital group practices. This dynamic, coupled with the fact that physicians are being buffeted by the implementation of new quality grading systems from insurers, hospitals and outside services, adds urgency to the discussion over how to make maintenance of certification more meaningful.
Since 1938, the American Board of Anesthesiology has set standards for board certification for the specialty. The process is rigorous and the bar is set high. In fact, we believe it is the gold standard for physician quality. When we decided to re-design our Maintenance of Certification in Anesthesiology program a few years ago, the ABA sought ways to strengthen the process, knowing it is the best way for hospitals, insurers and, most important, patients to be assured of an anesthesiologist's knowledge and skills. Board certification demonstrates we as physicians are meeting the highest standards of our profession. Through maintenance of certification, we can attest that anesthesiologists continue to be well-equipped to provide exceptional patient care.
Like much of medical practice today, certification is evolving. Historically, the ABA required physicians to re-test every 10 years to prove they are continuing to meet certification standards. This year, it launched its redesigned maintenance of certification program and is piloting a new online tool that incorporates technology and learning science to provide continuous assessment over the course of physicians' careers.
The ABA requires anesthesiologists to answer—at their convenience—30 questions online every quarter. This new assessment tool is built on the tenets of adult learning theory, namely spaced repetition, retrieval and feedback, all of which drive the retention of clinical information. Research has shown that asking physicians to demonstrate their knowledge of concepts repeatedly over time supports our ability to retain and retrieve information long-term more effectively than a decennial exam.
With the online assessment tool, each time an anesthesiologist answers a question, whether answered correctly or not, the physician is given the correct answer and links to additional learning resources related to the topic. Physicians will see questions on the same concepts repeated over time to ensure they are retaining information they already know and to re-assess them on topics they previously answered incorrectly.
The practice of medicine is dynamic and requires that physicians constantly expand their knowledge base to provide the most up-to-date and effective care. Initial certification continues to set physicians apart, but re-testing them once every 10 years is not enough anymore. We now need to keep pace with ever-evolving medical science, practice guidelines and regulations that change more rapidly than ever before. Without taking action to retain knowledge and learn new information, we as physicians put our ability to deliver high-quality care at risk.
Intensive ongoing assessment provides physicians with opportunities to demonstrate that they are keeping their medical knowledge current and assures patients that they will get high-quality care. This approach to lifelong learning and assessment can be applied across the spectrum of medical specialties, where it should be embraced by physicians.
Now is the time—as healthcare institutions grapple with implementing effective quality measures—to look for new approaches to maintenance of certification that support improving quality standards while reducing the burden of compliance on physicians, all for the benefit of patients.
Dr. James Rathmell is secretary of the American Board of Anesthesiology.
