Assessment in the context of relicensure

Abstract

In its broadest context, relicensure is a process by which an individual or public agency renews, reactivates, or reinstates an existing license to either practise a profession or execute a societal function. For this review, relicensure will be defined as the obligatory process of evaluating the professional knowledge, skills, and actions of a physician by a regulatory authority or certifying agency. The process is executed in a deliberative and recurrent manner, based on each physician’s clinical practice to offer an assessment of that physician’s suitability to practice medicine. That approach entails certain basic underlying assumptions. Licensure is a privilege granted by society through a regulatory authority as legislated by a given jurisdiction. Regulators both protect the public and guide the profession. To those ends, regulators should use current best practices in assessing the professional in a fair, reliable, and valid manner. The chapter presents the current state of relicensure assessment in the context of a continuous quality improvement system. The target audiences are the public as consumers of physician services and the profession of medicine as participants in the emerging system. The analyses of the origin and status of relicensure, from a legal and the social contractual perspective, are offered and illustrated by developments in the USA, the UK, Canada, and Australasia. Current developments in assessment of medical work and clinical practice, as judged against predetermined standards of care and practice behaviours, are outlined and reviewed against the intended outcomes. Progress in the fields of recertification, revalidation, and relicensure is identified. Optimal practices to define practice standards, to decide passing criteria, and to assess the predictive value of current processes are presented. Further, the nature of evidence and level of proof needed are explored from the perspective of a legislated relicensure system as opposed to a voluntary recertification or maintenance of competence programme. Since assessment processes have another equally important function, as implied by their use of the quality improvement framework, feedback and guidance needed to direct and inform physician remediation and improvement are outlined. The effectiveness of these components is reviewed, based on recent empirical results, and current challenges are discussed. In sum, although professional accountability will be more transparent, questions remain about the ultimate impact of relicensure assessment processes, including their quality improvement features. The state of instrument and feedback development suggests that years of documentation will be needed before they can be confirmed as effective.