Credentialing of Individuals in professionalism pharmacy

Licensure. The history of medical licensure varies from country to country, but the necessity for some form of license became apparent in the middle of the nineteenth century in most. There were a variety of health care providers and the public required some assurance of quality as science made modern health care more complex and therefore more difficult to regulate. The recently constituted national professional associations lobbied their respective governments to be given the privilege of setting and maintaining the standards for entry into practice and monitoring its quality. In addition, they petitioned for and were granted a monopoly over the practice of medicine. In the United Kingdom, the centralized system of registration of qualified practitioners was established by the General Medical Council. In the United States and Canada, both of whom enjoy federal systems, the various states and provinces legislated the establishment of physician-run licensing bodies.

These organizations established the criteria for eligibility for licensure, which generally include graduation from a recognized medical school, a minimum amount of postgraduate training, and passage of an examination testing skills and knowledge using validated methods. There is an impression amongst physicians that licensing bodies are a part of an ever expanding bureaucracy intruding into their daily lives. This is not true. Their mandate is to protect the public and they are a fundamental part of the process by which the profession regulates itself. They are ‘‘us’’ and individual physicians must be aware of their role and, when required, must participate in their activities. 

Relicensure and Revalidation. Until recently, in the absence of documented incompetent or unethical behavior, licensure was for life. During the past few decades, it has become apparent that a credential given to a young physician is no guarantee of continued competence and pressure has grown for a reassessment of competence on a regular basis. There has been great resistance on the part of the medical profession to this concept and as has been pointed out by Irvine, ‘‘performance based relicensure does not exist despite there being much talk about it.’’The emphasis has been on a revalidation of the continuing ability of an individual to meet contemporary standards through documented participation in a wide variety of accredited educational programs or activities, an examination of knowledge and practices, and an assessment of the opinions of patients and colleagues as to the individual’s professional competence and behavior. Extensive processes have been developed in order to gather and act upon this information and validate the processes. 

There is a strong emphasis on identifying marginal practitioners and establishing remedial educational or counseling programs. The ultimate sanction available is the temporary or permanent loss of the license to practice. Again, participation in these activities is an essential individual professional responsibility which will undoubtedly become even more important in the future as the processes become more universal, reliable, and sophisticated.

Certification. A medical license is essential to practice. Certification as it was originally conceived was voluntary and represented a credential indicating that the individual concerned had demonstrated a pre-established and verified level of competence in a specialized field of medicine.The development of specialty boards was contemplated in the United States before the First World War and the first (ophthalmology) was established in Other disciplines followed, and in 1933 the American Board of Medical Specialties was established to ensure uniform standards, a function which it still carries out. Specialty certification arrived in Canada in 1929, when the Royal College of Physicians and Surgeons was chartered and given the mandate to establish and maintain standards for all specialties. Certification in family medicine became a reality during the second half of the twentieth century in both countries. 

In the United Kingdom, for over two hundred years specialists have become credentialed when they joined one of the Royal Colleges. Credentialing in general practice developed during the latter half of the twentieth century. In general in North America, credentialing of competence in a specialty has been documented by requiring candidates to pass an exit examination after they have completed training in accredited programs. In the United Kingdom, exit exams are still not the norm, the emphasis being on satisfactory completion of training within an approved program. The growth of subspecialization has greatly expanded the number of certifying bodies and increased the variety of the credentials being presented to the general public. Although this has added to the complexity of health care systems, it is a reality of contemporary medicine and the trend will undoubtedly continue. 

Recertification. As is true of licensure, the idea that certification of competence at one stage of a practitioner’s career will guarantee that competence for the rest of that practitioner’s professional lifetime is no longer tenable. The rapid growth of knowledge and of technology require that practitioners constantly renew their knowledge and skills. There has been sufficient evidence of incompetent and unethical practice that the public now demands assurance of continued competence. This has led to demands for recertification of practitioners (see the discussions by Cassell and Nash in Chapter 8). It is now a requirement of the American Board of Medical Specialties and has been instituted by several of the examining boards. There is a time limit on the credentials granted and some form of scrutiny of practice is required for their maintenance. 

A variety of means is used to accomplish this, including assessment of knowledge by examination, documentation of practice patterns, peer review, and the solicitation of information from other health professionals and patients. Because practices vary greatly, fairness dictates that the process be tailored to the individual, taking into account what he or she actually does. The aim is to document the ‘‘maintenance of competence’’ and to issue a credential attesting to this. It can be anticipated that these methods will grow more rigorous and sophisticated in time and that the information will be made public in order to offer assurance of competence. As is true with relicensure, recertification is a professional responsibility.


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