Are your skills up to date?

Associations go for the hard sell on recertification

By Julia Cyboran

Brace yourself. No matter what province you practise in, it looks like you're going to have to revalidate your licence sooner or later. "Although it's difficult to predict, I think that we'll see some implementation of a national revalidation strategy within the next one to two years," says Dr Craig Campbell, the director of professional development at the Royal College of Physicians and Surgeons of Canada (RCPSC).

The Federation of Medical Regulatory Authorities of Canada (FMRAC) has put together a working group, which includes the provincial licensing colleges, the RCPSC and the College of Family Physicians of Canada (CFPC). The goal of this collaboration is to establish national standards for revalidation. "Each provincial licensing body has the right to determine what they will require," says Fleur-Ange Lefebvre, PhD, the executive director of the FMRAC. "All we're asking is that the provinces adhere to the five principles (see box "FMRAC's golden rules"). It will ultimately be up to the provinces to manage the revalidation process."

"Revalidation is an issue that concerns the [provincial] licensing colleges," explains Dr Bernard Marlow, the director of continuing professional development at the CFPC. The input and participation of the CFPC and the RCPSC is crucial. Both educational colleges have well-developed and well-established continuing professional development (CPD) programs that monitor credits. The plan is to make their systems available to all doctors, including non-members, in a push to make accredited CPD the standard in this country.

THE TRAILBLAZER
On March 31 the Quebec College of Physicians adopted new rules to regulate CPD. Professional development was already mandatory for Quebec MDs but with the new ruling the method changes slightly. "Physicians now have to reflect more on their CPD activities," says Dr Andre Jacques, the director of professional practice enhancement at the provincial college. "They have to ask the questions, 'how will this enhance my practice?' and 'how will this help me take better care of my patients?'."

He explains that the college is currently working on tools to help facilitate the process. He believes that the program will be up and running by July 2007. In the meantime, he adds, he has to work to sell physicians on the idea.

CPD OR ELSE...
Saskatchewan is another province pushing for mandatory continuing professional development for the purpose of revalidation. "Physicians will be required to meet either the CPD requirements of the CFPC or alternatively the requirements of the RCPSC," says Bryan Salte, the associate registrar of the College of Physicians and Surgeons of Saskatchewan (CPSS). "We basically said, if you want to practise and maintain your licence, you'll have to enrol in one of those programs."

The CPSS has presented the plan to the province's physicians. Mr Salte says that more doctors have started to enrol in the CPD programs offered by either certifying college. He believes that an official process for revalidation should be in place by January 2007.

PEER-TO-PEER
Mandatory CPD isn't the only way to ensure a physician's professional standards are up to snuff. Peer-assessment is another method some provinces are using to keep doctors in the loop. Alberta was one of the first to do this through their Peer-Assessment Review (PAR) program. "In a nutshell, all physicians receive feedback about their performance from colleagues, co-workers and patients, wherever possible, once every five years," explains Bryan Ward, deputy registrar of the College of Physicians and Surgeons of Alberta (CPSA). About 10% of docs are interviewed and a bit less than 5% of them get reviewed by their peers. Some fear peer review isn't enough, and that's why, says Mr Ward, Alberta is looking into adding a CPD component to the PAR.

Nova Scotia has a plan similar to the Alberta model. It was introduced in 2005, and currently looks at FPs. In the fall it will expand to other specialties, according to Bruce Thorne, the Nova Scotia College's communications manager.

The College of Physicians and Surgeons of Ontario (CPSO) has just finished a lengthy consultation about revalidation. They will integrate aspects of peer-assessment and CPD into their three-component plan. "The direction of component one will be done through the educational colleges," explains Dr Rocco Gerace, the registrar at the CPSO. As with the other provinces, there will be some sort of mandatory CME or CPD. The province isn't yet ready to start revalidating docs though. "We are aiming for a time frame around 2010," estimates Dr Gerace. "Right now we have to look at how to implement this."

THE EXAMINED LIFE
Ontario, like many other provinces, is waiting to see what comes out of a series of meetings to be held by the FMRAC working group before moving ahead with more comprehensive revalidation programs. The meetings begin this month and run through the summer. Dr Jacques heads this working group. He says that the Quebec plan will serve as a model and that FMRAC will work closely with the national colleges to integrate more self-reflection into their current CPD.

The key aspect remains this cycle of self-reflection. "Revalidation will be practice relevant and individualized," stresses Ms Lefebvre. "It will be educational. Not punitive."