EDITORIAL

The competent pediatrician

Which of your colleagues is competent? How do you know? Is your concept of competency the same as your patients' or insurance companies'? If you had to recommend a pediatrician for your grandchild in a distant city, how would you select from the list in the phone book? Is certification by the American Board of Pediatrics enough?

The Accreditation Council for Graduate Medical Education (ACGME), which accredits residency training programs in all specialties, has recently determined that periodic review of rotations, faculty, and institutional support is not sufficient to assure the competence of residency program graduates. The next iteration of requirements for program accreditation will include a system for evaluating residents for specialty-specific competence in six areas: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The American Board of Medical Specialties agrees that assessment of knowledge through periodic examinations is not an adequate way to assure continued competency. Its 24 member boards, of which the American Board of Pediatrics is one, have agreed to begin evaluating their candidates and existing diplomates using the same list of competencies.

These efforts are intended to assure the public that physicians who complete our residency programs and are certified by specialty boards are more than knowledgeable. Under the new standards these physicians will also be assessed for their ability to communicate effectively with patients and colleagues, reevaluate their practice based on their own experience and on new information, be able to use their knowledge to make appropriate judgments in patient management, and provide their patients with care that is efficient, prompt, and comprehensive.

Periodic assessment of knowledge will continue to be a part of the recertification process, but the specialty boards will also assess professional standing (for example, by peer review and by verifying maintenance of state license), documentation of continuing education, and practice performance. For pediatricians, it is anticipated that the American Academy of Pediatrics will cooperate with the American Board of Pediatrics to develop a method for assuring continuing education and for assessing practice performance.

Nineteen years ago, pediatrician and Nobel laureate Frederick C. Robbins asserted in a lecture at the University of North Carolina that expecting physicians to document continuing education seemed "an extraordinary requirement for a learned profession." Current expectations of the public and of payers have taken us a long way from a time when being part of a "learned profession" was enough. Besides, we're talking about your grandchild.

Julia A. McMillan, MD, Editor-in-chief of Contemporary Pediatrics, is Vice Chair, Pediatric Education, and Director, Residency Training, Johns Hopkins University School of Medicine, Baltimore.

 

Julia McMillan. Editorial: The competent pediatrician. Contemporary Pediatrics 2000;9:9.