Competence, Confidence, and Certification: Observations from Both Sides of the Aisle

Excerpt

Most definitions of a profession include the tenet that members set standards of service and hold themselves accountable to meet them. This includes requirements for rigorous specialized training with a formal qualification process and for ongoing reassessment. Although these principles seem foundational for the profession of medicine, we are currently witnessing two somewhat contradictory concerns playing out: one is about a perceived lack of competence among our new practitioners, while the other worries that the standards we have tried to use to reassess their skills are onerous and without meaning. I have had the opportunity to view these issues from two very different angles—as a chief medical officer, I oversee credentialing, privileging, and recredentialing for my hospital, and, at the same time, I have served on the American Board of Surgery and more recently the Accreditation Council for Graduate Medical Education (ACGME) Board, where I have participated in the development of some of these national standards. This perspective seems an appropriate place for some random observations on these topics, focusing primarily on general surgery, although I believe they have relevance to other specialties. …