The old, gray doc just ain't what he used to be?

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Or so says a Harvard study I read about in the Boston Globe yesterday.

    A provocative study from Harvard Medical School suggests that, as a group, older doctors know less, provide lower-quality care, and may expose patients to greater risks than physicians recently out of medical school, a conclusion that an accompanying editorial declares should be ''a wake-up call to the medical profession."

Even though officials from the American College of Physicians and the American Board of Internal Medicine were ''initially surprised" at the study's findings, most of us are already wide awake on this one, especially those who toil on the continuing medical education front. And it's not just a matter of years since med school--as Donald Berwick, MD, president of the Institute for Healthcare Improvement in Boston says in the article, ''You store a lot of factual knowledge during school, and then...you're expected to, on your own, keep up with what is an enormous flood of facts...Someone said that if a doctor started reading one randomized trial a day, he'd be 10,000 trials behind by the end of the first year."

However physicians may feel about maintenance of certification including lifelong learning, self-assessment, self-directed learning, and the need to document improvements in practice it is becoming a reality for many board-certified specialties. And you can expect to see more specialty societies jumping on the MOC train in the near future. With 21 of the 24 boards in the American Board of Medical Specialties already adopting the MOC process, and many hospitals and insurance companies requiring board certification for employment, maintenance of certification will be nothing less than a job requirement, if not now, soon.

This could entail a sea change in the way physicians operate (sorry, bad pun!), because the MOC asks docs to lift the veil of secrecy around medical mistakes -to change the culture so that mistakes will be viewed as learning opportunities, not things that can only be discussed behind closed doors. Somehow, I don t see that happening, even though, as I pointed out in this post, being open about mistakes can actually reduce liability. But it would entail a major shift in the culture in which most docs work, and that kind of change doesn t come easy.

And honest self-assessment can be extraordinarily difficult. Not everyone knows what they don t know. In fact, a study by the American College of Cardiology that used an online tool to measure the gap between real and perceived knowledge in several core competencies, docs consistently rated themselves as knowing more than actually they did about some topics, and knowing less about others than they thought they did. And I won t even go into the problem of trying to assign AMA PRA Category 1 credit for practice-based learning, though better minds than mine are working diligently to resolve that one.

Despite these and other challenges, though, it sounds like this will be the new reality that both physicians and those who provide them continuing medical education will have to grapple with. May the Force be with us.

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