Does certification improve medical standards?

Abstract

Problems in the UK In the UK routine data continue to highlight uneven quality of care compared with other countries.1–3 Good doctors, safer patients lists recent cases of exceptionally poor clinical practice or criminal conduct: Harold Shipman, Clifford Ayling, Richard Neale, William Kerr, Michael Haslam, Rodney Ledward, and the department of paediatric cardiac surgery at the Bristol Royal Infirmary.4 Although rare, such cases still occur and point to failures in underlying systems for detecting and preventing unsatisfactory performance at an early stage. Furthermore, over time the skills and knowledge of medical professionals can erode, with potentially serious consequences for quality of care. In a systematic review of the relation between experience and quality of care, over half of the studies (32 of 62; 52%) reported an association between decreasing performance and increasing years in practice for all outcomes assessed. These results suggest that older doctors and those who have been practising for many years have less factual knowledge, are less likely to adhere to appropriate standards of care, and may also have poorer patient outcomes.5