Recertification: Mandatory or voluntary? Teaching old docs new tricks☆☆☆

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Abstract 

Am Heart J 2002; 143:945.

See related Editorials on pages 943 and 946.

In an age of heightened accountability in all aspects of professional life, at a time of scientific advances occurring at a dizzying pace, within a discipline featuring a bewildering array of diagnostic and therapeutic options, continuing education is an absolute imperative. Nothing new here, you say? True, but some truths, at the risk of becoming clichés, bear emphasis and repetition: (1) Cardiology is a field in which the rapidity and volume of basic and clinical advances outstrip any individual clinician's ability to keep fully apprised of the latest facts and study results, let alone to integrate these facts and results into clinical practice. (2) Busy clinicians tend to garner their continuing education most commonly and reliably from colleagues on a case-by-case basis. (3) This practice- and case-based approach to continuing education is probably effective but difficult to document and fraught with local political and personal conflicts of interest. (4) A structured approach to self-directed and self-paced continuing education is the option most likely to be palatable to most clinicians. (5) Such an approach will be most credible if developed by a respected external entity, preferably one with experience and a reputation in both education and educational testing. We believe that the American Board of Internal Medicine's (ABIM) Continuous Professional Development initiative meets criteria 4 and 5 and, therefore, is a most reasonable approach to the problems enunciated above.

We comprise a study team working our way through the ABIM recertification process in cardiology. We are an odd couple of cardiologists: one younger, full-time clinician in private practice who bears a time-limited certificate, pursuing mandatory recertification, and one older, part-time clinician and full-time administrator with a time-unlimited certificate, pursuing voluntary recertification. As different as our day-to-day practice experiences may be, we have found it helpful and mutually reinforcing to work together through the “modules” of the ABIM system. As predicted by the ABIM, we have both found the modules challenging and have typically had to turn to multiple sources (journals, texts, other colleagues, and each other) to get through the sometimes daunting questions. Are some questions seemingly irrelevant to daily practice? Of course. Are some answers arguable? Definitely. Nonetheless, in general we both believe we are growing professionally by the experience, to some extent by retreading old, partially forgotten ground, and in part by exposure to newer concepts, particularly in the sciences underlying modern cardiology practice. This professional growth is gratifying and is a positive feedback mechanism, motivating us to continue along the path to complete the entire rigorous process.

It is clear why the team member bearing a time-limited certificate is pursuing this recertification: this is a mandatory exercise. Why would the other clinician pursue voluntary recertification? The desire to be recognized as keeping abreast of some of the myriad advances made since original certification? Professional insecurity regarding late-breaking studies and findings? The exhortations of professional societies? Increasing public calls and other calls for accountability regarding one's skills? The answer, unlike most of the ABIM multiple-choice questions is “all of the above.” Whatever the dominant reason, it seems appropriate to pursue this odyssey periodically.

In his opinion piece, Brush¹ argues convincingly that “a good interventional cardiologist should be a cardiologist first and foremost …”, an assertion with which we strongly agree. It is difficult to identify another medical subspecialty discipline with more varied subdisciplines than cardiology: electrophysiology, echocardiography, nuclear cardiology, other noninvasive imaging methods, diagnostic catheterization, interventional catheterization, heart failure, cardiac transplantation, adult congenital heart disease, and others. No matter the subdiscipline, no matter the practice circumstance, no matter the age of the clinician or the certificate, we endorse the rationale and method of the cardiology recertification process and urge our colleagues to do likewise.

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References 

1. Brush JE. An interventional cardiologist: a cardiologist who intervenes. Am Heart J. 2002;6:943–944
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