Box-ticking and Olympic high jumping – Physicians’ perceptions and acceptance of national physician validation systems

Abstract

Purpose: National physician validation systems aim to ensure lifelong learning through periodic appraisals of physicians’ competence. Their effectiveness is determined by physicians’ acceptance of and commitment to the system. This study, therefore, sought to explore physicians’ perceptions and self-reported acceptance of validation across three different physician validation systems in Europe.

Materials and methods: Using a constructivist grounded-theory approach, we conducted semi-structured interviews with 32 respiratory specialists from three countries with markedly different validation systems: Germany, which has a mandatory, credit-based system oriented to continuing professional development; Denmark, with mandatory annual dialogs and ensuing, non-compulsory activities; and the UK, with a mandatory, portfolio-based revalidation system. We analyzed interview data with a view to identifying factors influencing physicians’ perceptions and acceptance.

Results: Factors that influenced acceptance were the assessment’s authenticity and alignment of its requirements with clinical practice, physicians’ beliefs about learning, perceived autonomy, and organizational support.

Conclusions: Users’ acceptance levels determine any system’s effectiveness. To support lifelong learning effectively, national physician validation systems must be carefully designed and integrated into daily practice. Involving physicians in their design may render systems more authentic and improve alignment between individual ambitions and the systems’ goals, thereby promoting acceptance.

Glossary

National Physician Validation System: A key feature of our article, a concept also referred to as recertification, revalidation or maintenance of certification. We drew this definition from: Horsley T, Lockyer J, Cogo E, Zeiter J, Bursey F, Campbell C. 2016. National programs for validating physician competence and fitness for practice: A scoping review. BMJ Open. 6(4).

Acknowledgements

The authors wish to thank all interviewees for their contribution. Angelique van den Heuvel provided help in form of language editing, which we highly appreciated. The authors are also grateful to our two research assistants Celine Notermans and Anindita Bhattacharjee for their assistance in coding and discussing the interview transcripts.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Sharon Mitchell is a former employee of the European Respiratory Society.

Additional information

Funding

This study was funded by the European Respiratory Society. However, Carolin Sehlbach who was appointed to the research project as a PhD student at Maastricht University conducted the research independently.

Notes on contributors

Carolin Sehlbach

Carolin Sehlbach, MSc, is a PhD student at the School of Health Professions Education (SHE), Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.

Marjan J. B. Govaerts

Marjan J. B. Govaerts, MD, PhD, is an associate professor at the Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.

Sharon Mitchell

Sharon Mitchell, MSc, is an independent researcher, fraternized with the Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.

Gernot G. U. Rohde

Gernot G. U. Rohde, MD, PhD, is a Professor and respiratory specialist at the Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany, and former Education Council Chair of the European Respiratory Society.

Frank W. J. M. Smeenk

Frank W. J. M. Smeenk, MD, PhD, is a Professor at the Department of Educational Development and Research, Maastricht University, Maastricht, the Netherlands, and respiratory specialist at the Catharina Hospital, Eindhoven, The Netherlands.

Erik W. Driessen

Erik W. Driessen, PhD, is a Professor at the Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands.