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  • Review Article
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Assessment of specialists in cardiovascular practice

Nature Reviews Cardiology volume 6, pages 659–667 (2009)Cite this article

Abstract

Assessment of medical specialists was introduced to ensure patient safety and to maintain professional knowledge. Cardiovascular specialist assessment is challenging, as the ongoing development of new technologies is associated with increased requirements for up-to-date training and acquisition of new skills. The cardiovascular specialties include cardiology, vascular interventional radiology, cardiac surgery and vascular surgery. Assessment within these disciplines involves evaluation of knowledge in addition to technical and nontechnical skills, a process that is termed recertification or maintenance of certification. Increasingly, there is a demand for professional accountability through recertification because of concerns about professional negligence and increased awareness of medical errors. In this article we describe the process of recertification in different geographical regions and discuss the role of current tools used to recertify cardiovascular specialists and, in particular, how their use can contribute to the requirements of patient care.

Key Points

  • Recertification is a process of self-regulation within the medical profession that aims to protect patients from specialists who perform poorly

  • Continuing medical education, to ensure up-to-date knowledge and skills, is a key element of recertification

  • Objective assessment and continuing medical education should be closely associated with each other during the process of recertification

  • Further research is required to identify and develop tools with the highest level of validity and reliability for education and assessment

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Figure 1
Figure 2: Overview of recertification or maintenance of certification across various regions.
Figure 3: ACGME and GMP components of competence.7,8,14
Figure 4
Figure 5: Miller's pyramid.
Figure 6: Structural and organizational issues related to implementation of recertification process.

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References

  1. Bajona, P. Hybrid cardiac surgery: a resident's perspective. Arch. Surg. 144, 207–208 (2009).

    Article  Google Scholar 

  2. DeMaria, A. N. The morphing of cardiovascular specialists. J. Am. Coll. Cardiol. 45, 960–961 (2005).

    Article  Google Scholar 

  3. Sanderson, R. G. Ethical and legal concerns in relationships with cardiologists. Ann. Thorac. Surg. 72, 3–5 (2001).

    Article  CAS  Google Scholar 

  4. Cohen, M. S. et al. Mentorship, learning curves, and balance. Cardiol. Young (17 Suppl. 2), 164–174 (2007).

    Article  Google Scholar 

  5. Batmangelich, S. & Adamowski, S. Maintenance of certification in the United States: a progress report. J. Contin. Educ. Health Prof. 24, 134–138 (2004).

    Article  Google Scholar 

  6. Buyske, J. For the protection of the public and the good of the specialty: maintenance of certification. Arch. Surg. 144, 101–103 (2009).

    Article  Google Scholar 

  7. Academy of Medical Royal Colleges. Revalidation. Academy of Medical Royal Colleges [online], (2009).

  8. American Board of Medical Specialties. ABMS Maintenance of Certification. The American Board of Medical Specialties [online], (2009).

  9. Levinson, W. Revalidation of physicians in Canada: are we passing the test? CMAJ 179, 979–980 (2008).

    Article  Google Scholar 

  10. Darzi, A. High quality care for all: NHS Next Stage Review final report. Department of Health [online], (2008).

    Google Scholar 

  11. Bridgewater, B. et al. Has the publication of cardiac surgery outcome data been associated with changes in practice in northwest England: an analysis of 25,730 patients undergoing CABG surgery under 30 surgeons over eight years. Heart 93, 744–748 (2007).

    Article  Google Scholar 

  12. Learning from Bristol: the report of the public inquiry into children's heart surgery at the Bristol Royal Infirmary 1984–1995. The Bristol Royal Infirmary Inquiry [online], London: Stationery Office (2001).

  13. Kohn, L. T., Corrigan, J. M. & Donaldson, M. S. (Eds) To Err is Human: Building a Safer Health System (Institute of Medicine, National Academy Press, Washington DC, 1999).

    Google Scholar 

  14. General Medical Council. Good Medical Practice (2006). General Medical Council [online], (2006).

  15. Dauphinee, W. D. Self regulation must be made to work. BMJ 330, 1385–1387 (2005).

    Article  Google Scholar 

  16. European Commission Health & Consumer Protection Directorate-General. Report on the work of the High Level Group in 2006. European Commission [online], (2006).

  17. Merkur, S., Mossialos, E., Long, M. & McKee, M. Physician revalidation in Europe. Clin. Med. 8, 371–376 (2008).

    Article  Google Scholar 

  18. Archer, J., Norcini, J., Southgate, L., Heard, S. & Davies, H. Mini-PAT (peer assessment tool): a valid component of a national assessment programme in the UK? Adv. Health Sci. Educ. Theory Pract. 13, 181–192 (2008).

    Article  Google Scholar 

  19. Davies, H. A. & Archer, J. C. Multi source feedback using Sheffield Peer Review Assessment Tool (SPRAT)—development and practical aspects. Clin. Teacher 2, 77–81 (2005).

    Article  Google Scholar 

  20. Crossley, J. et al. Can a district hospital assess its doctors for re-licensure? Med. Educ. 42, 359–363 (2008).

    Article  Google Scholar 

  21. Lockyer, J. M. & Violato, C. An examination of the appropriateness of using a common peer assessment instrument to assess physician skills across specialties. Acad. Med. 79, S5–S8 (2004).

    Article  Google Scholar 

  22. Ramsey, P. G. et al. Use of peer ratings to evaluate physician performance. JAMA 269, 1655–1660 (1993).

    Article  CAS  Google Scholar 

  23. Vogt, V. Y., Givens, V. M., Keathley, C. A., Lipscomb, G. H. & Summitt, R. L. Jr Is a resident's score on a videotaped objective structured assessment of technical skills affected by revealing the resident's identity? Am. J. Obstet. Gynecol. 189, 688–691 (2003).

    Article  Google Scholar 

  24. Hance, J. et al. Objective assessment of technical skills in cardiac surgery. Eur. J. Cardiothorac. Surg. 28, 157–162 (2005).

    Article  Google Scholar 

  25. Southgate, L. & Pringle, M. Revalidation in the United Kingdom: general principles based on experience in general practice. BMJ 319, 1180–1183 (1999).

    Article  CAS  Google Scholar 

  26. Davies, H. et al. Specialty-specific multi-source feedback: assuring validity, informing training. Med. Educ. 42, 1014–1020 (2008).

    Article  Google Scholar 

  27. Spencer, F. Teaching and measuring surgical techniques: the technical evaluation of competence. Bull. Am. Coll. Surg. 63, 9–12 (1978).

    Google Scholar 

  28. Maisonneuve, H. et al. Continuing medical education and professional revalidation in Europe: five case examples. J. Contin. Educ. Health Prof. 29, 58–62 (2009).

    Article  Google Scholar 

  29. van der Vleuten, C. P. M. The assessment of professional competence: developments, research and practical implications. Adv. Health Sci. Educ. Theory Pract. 1, 41–67 (1996).

    Article  CAS  Google Scholar 

  30. Choudhry, N. K., Fletcher, R. H. & Soumerai, S. B. Systematic review: the relationship between clinical experience and quality of health care. Ann. Intern. Med. 142, 260–273 (2005).

    Article  Google Scholar 

  31. Durso, F. T. & Sethumadhavan, A. Situation awareness: understanding dynamic environments. Hum. Factors 50, 442–448 (2008).

    Article  Google Scholar 

  32. Fletcher, G. et al. Anaesthetists' non-technical skills (ANTS): evaluation of a behavioural marker system. Br. J. Anaesth. 90, 580–588 (2003).

    Article  CAS  Google Scholar 

  33. Undre, S., Sevdalis, N., Healey, A. N., Darzi, A. & Vincent, C. A. Observational teamwork assessment for surgery (OTAS): refinement and application in urological surgery. World J. Surg. 31, 1373–1381 (2007).

    Article  Google Scholar 

  34. Sevdalis, N. et al. Reliability of a revised NOTECHS scale for use in surgical teams. Am. J. Surg. 196, 184–190 (2008).

    Article  Google Scholar 

  35. Flin, R. et al. Teaching surgeons about non-technical skills. Surgeon 5, 86–89 (2007).

    Article  CAS  Google Scholar 

  36. Miller, G. E. The assessment of clinical skills/competence/performance. Acad. Med. 65, S63–S67 (1990).

    Article  CAS  Google Scholar 

  37. Epstein, R. M. & Hundert, E. M. Defining and assessing professional competence. JAMA 287, 226–235 (2002).

    Article  Google Scholar 

  38. Patil, N. G., Cheng, S. W. & Wong, J. Surgical competence. World J. Surg. 27, 943–947 (2003).

    Article  Google Scholar 

  39. Joice, P., Hanna, G. B. & Cuschieri, A. Errors enacted during endoscopic surgery—a human reliability analysis. Appl. Ergon. 29, 409–414 (1998).

    Article  CAS  Google Scholar 

  40. Reznick, R., Regehr, G., MacRae, H., Martin, J. & McCulloch, W. Testing technical skill via an innovative 'bench station' examination. Am. J. Surg. 173, 226–230 (1997).

    Article  CAS  Google Scholar 

  41. Beard, J. D., Choksy, S. & Khan, S. Assessment of operative competence during carotid endarterectomy. Br. J. Surg. 94, 726–730 (2007).

    Article  CAS  Google Scholar 

  42. Tang, B., Hanna, G. B., Bax, N. M. & Cuschieri, A. Analysis of technical surgical errors during initial experience of laparoscopic pyloromyotomy by a group of Dutch pediatric surgeons. Surg. Endosc. 18, 1716–1720 (2004).

    Article  CAS  Google Scholar 

  43. Tang, B., Hanna, G. B., Joice, P. & Cuschieri, A. Identification and categorization of technical errors by Observational Clinical Human Reliability Assessment (OCHRA) during laparoscopic cholecystectomy. Arch. Surg. 139, 1215–1220 (2004).

    Article  CAS  Google Scholar 

  44. Ahmed, K., Nagpal, K. & Ashrafian, H. Do we need to train assessors? Med. Educ. 43, 389 (2009).

    Article  Google Scholar 

  45. Allen, I. Doctors crossing borders: Europe's new reality. CMAJ 180, 158–161 (2009).

    Article  Google Scholar 

  46. Sharp, L. K., Bashook, P. G., Lipsky, M. S., Horowitz, S. D. & Miller, S. H. Specialty board certification and clinical outcomes: the missing link. Acad. Med. 77, 534–542 (2002).

    Article  Google Scholar 

  47. Neequaye, S. K., Aggarwal, R., Van Herzeele, I., Darzi, A. & Cheshire, N. J. Endovascular skills training and assessment. J. Vasc. Surg. 46, 1055–1064 (2007).

    Article  Google Scholar 

  48. Yule, S., Flin, R., Paterson-Brown, S., Maran, N. & Rowley, D. Development of a rating system for surgeons' non-technical skills. Med. Educ. 40, 1098–1104 (2006).

    Article  CAS  Google Scholar 

  49. Wass, V., Van der Vleuten, C., Shatzer, J. & Jones, R. Assessment of clinical competence. Lancet 357, 945–949 (2001).

    Article  CAS  Google Scholar 

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Acknowledgements

This project is funded by the General Medical Council, UK, and the Academy of Medical Royal Colleges, UK. This article reflects authors' views only, based on the research at Imperial College London, UK.

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Authors and Affiliations

  1. Department of Biosurgery and Surgical Technology, Imperial College London, London, UK

    Kamran Ahmed, Hutan Ashrafian, George B. Hanna, Ara Darzi & Thanos Athanasiou

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Correspondence to Kamran Ahmed.

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Ahmed, K., Ashrafian, H., Hanna, G. et al. Assessment of specialists in cardiovascular practice. Nat Rev Cardiol 6, 659–667 (2009). https://doi.org/10.1038/nrcardio.2009.155

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