England's chief medical officer recently recommended certification of doctors to strengthen professional regulation. Specialist certification is a well established process in the United States that allows doctors to demonstrate achievements and competencies beyond the minimum acceptable standards required for licensing purposes. Certified status must be renewed every six to 10 years.
But does certification improve medical standards?
Kim Sutherland and Sheila Leatherman reviewed data on the effect of certification in the US on quality of care. A review of studies published between 1966 and 1999 found that over half showed positive and statistically significant associations between certification and superior outcomes. Since 1999, four well conducted studies have concluded that certification is associated with provision of higher quality care across a range of specialties.
Recent studies have also found that a lack of certification is associated with an increased risk of disciplinary action.
So, most of the available evidence seems to support rigorously conducted certification as a good method to improve quality of care, say the authors. Renewable certification also provides a more transparent process for assessing skills, knowledge, and competence than the opaque principles of professionalism.
Adopting certification as a key regulatory instrument in the UK will have important implications, they add. In the US much of the cost is borne by doctors themselves who are likely to benefit from the process. However, there may be an argument for some of the costs to be offset by the NHS.
As the NHS strives to improve quality of care, it is important to consider the central part played by the professions, they write. Individual professional conduct, along with collective professional values, will always provide a patient with the best quality assurance. Certification, or validation within the UK context, provides a way to strengthen and bolster that vital protection and reassurance.