Maintaining Competency and Physician Responsibility

Santen et al wrote a viewpoint in JAMA and propose the following 5 considerations to address competency decline with age and with introduction of new technology and/or procedures.

1. Lifelong learning and mechanisms to ensure maintenance of certification.
2. Responsibility to keep training.
3. Choosing practices that involve less exposure to procedures or content for which physicians are no longer expert
4. Self-assessment and reflection.
5. Responsibility of the health care system to ensure competency of physicians and surgeons for performing procedures.

These proposals are common sense or a no-brainer. However, the devil is always in the details. For example, how to assess lifelong learning? What is the evidence behind certain methods of lifelong learning? Is it possible that the physicians who self-reflect and self-assess are the ones who need it the least? If so, how to encourage physicians to self-reflect? One can go on and on but I hope I made the point. But I want to make a larger point. Medical education obsessively teaches evidence-based medicine, however, very few, if any, medical education methods have even a weak evidence to support them (as long as we do not include expert advice into evidence). It will be rare to see any medical education methodology that has been rigorously studied like we study medical interventions. No wonder we have increasing burnout among medical students, residents, and physicians; it is time we face the fact that our prescriptions for teaching medicine lack scientific evidence.