Problems in General Surgery

All around us, in this age of consumerism, are expressions of public expectations regarding the quality of medical care. Among the responses of the medical profession to this growing public demand has been a cre­ scendo of interest in continuing education. Continuing education is not a new concern for the physician. Most major professional organizations were founded to increase the exchange of information among members. But something new is in the wind. Both inside and outside the profes­ sion, the question is becoming more and more insistent: What does at­ tendance at meetings or exposure to other types of prepared materials have to do with the quality of care that is provided? Recertification, reexamination, and peer review of outcomes of practice-subjects only recently unmentionable-have become common issues before specialty boards, legislatures, hospital boards, insurance carriers, and even medical societies. As of October of 1979, all 22 of the member boards of the American Board of Medical Specialties had made commitments to the principle of periodic recertification of their members. Most boards have explicitly acknowledged that the cognitive skills measured in the objective examination do not assure clinical competence. An assumption behind information-assessing recertification efforts is that, though mastery of the current knowledge upon which clinical decisions should be made does not guarantee competent practice, the lack of it probably impairs competent practice.