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Competency on Certification. Do tests and examinatons really show level of competency?

Obviously, a person who seeks to practice medicine must be certified and meet certain standards. The question is whether passing a certification exam will fully help him demonstrate his true aptitude. Are the criteria objective enough to be used for evaluation of the expertise? And is the authoritative body competent enough to be able to make judgments regarding the professionalism?

These days, certification and recertification have become a common practice in medicine. Unfortunately, there is a lot of controversy and outrage expressed by many clinicians towards how the examination system works. There are too many problems in the process of certification and recertification. The number of unanswered questions towards how the examination system works is also startling. For example, how should test show the ability of the practitioner to express compassion to the patient? How the test can help demonstrate the ability to make decisions, which are in the patient’s interest? And most importantly, what answer is correct?

Apparently, there is no single valid mechanism for demonstrating competency. And that’s a shame since we lose valuable workforce the aptitude of which was successfully proven in the everyday practices. It is frustrating and disheartening when you fail your exam knowing that you answered correctly (and you know this from your experience with patients). Unfortunately, very often practitioners are supposed to give an “expected” answer. In fact, for many clinicians, the more they know, the more likely it is that they will get the answer wrong. Basically, certification questions are about giving the expected answer and not necessarily the correct real-world one.

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It would be fair to create one set of guidelines with the defined correct answers based on different sources of medical literature. Therefore, during the certification test, it will be possible to check how well the so-called correct answers were memorized. At least, the whole scheme would be transparent and won’t cause so much outcry and frustration among practitioners.

So what does the medical education system want? Most importantly, what do we want as patients? One would think that a critical thinker and a compassionate doctor is how we expect to see our practitioner. When we visit a physician, all we need is his help with our medical problem. We want to talk to a person who can exercise his best judgment based on his insights into our circumstances and his own unbiased medical knowledge and experience. But, most importantly, we would expect compassionate care, which will help us heal. We could not care less about whether he answered all exam questions the way, which was expected from him. The greatest sign of a professional physician is when we send a loved one for care to the practitioner who managed to help us in the past.

Reportedly, many practitioners who worked in their field of expertise for decades quit doing recertification for that simple reason that they consider it to be ineffective. Indeed, if we feel that it is reasonable to reject the standards we do not agree with, it might be the time to start advocating for implementing the standards that we believe to be more appropriate. It is an incredible challenge but it is truly an important one.