Revalidation of doctors in Canada

doi:10.1136/bmj.319.7218.1188

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W Dale Dauphinee, executive director (dauphine@mcc.ca)

Medical Council of Canada, PB Box 8234, Station T, Ottawa, ON, Canada K1G 3H7

Editorial by Buckley

All approaches to revalidation ask doctors to prove their continuing competence to practise. This paper considers developments in Canada from two perspectives: what the profession and its regulatory bodies are doing to meet the challenge of maintaining doctors' performance, and the methods of assessment the regulatory bodies and agencies are using to address this issue. The two perspectives have led to two primary pathways: assessment related to practice activities but linked to an educational or enhancement feedback by the licensing bodies, and strategies emphasising the maintenance of good learning practices by the certifying bodies. The term revalidation is not widely used in Canada, but it can be defined as enforcing standards of practice in the medical workplace by direct measures of doctors' performance.

Methods

We reviewed the peer reviewed literature and publicly available documents describing either existing or proposed steps for the revalidation of medical licensure or certification and the maintenance of good medical learning practices in Canada. This generated a summary of the principal developments in policy and technical aspects, including a discussion of emerging challenges.

Overview of structures

Canada is a federation of 10 provinces and three territories. Health care is the responsibility of the provinces and territories. Though licensure of health professionals is a provincial matter, nationwide entry standards exist and are administered by national bodies: the Medical Council of Canada (basic medical qualifications) and the Royal College of Physicians and Surgeons of Canada (specialists) and the College of Family Physicians of Canada (family medicine). These are recognised by all jurisdictions but one.1 National standards for the accreditation of hospitals exist, and provinces can participate in quality control through budgetary and utilisation reviews.

Role of licensure bodies

Peer review mechanisms

The medical licensing authorities have been monitoring doctors' practices for many years For example, Canada's three most populated provinces, British Columbia, Ontario, and Quebec, …