Certification, Fellowship, and lifelong learning: Recognizing achievement in a special discipline

Commitment to a defined program of lifelong learning is a core requirement for receiving and maintaining membership (MCFP), Certification (CCFP), and Fellowship (FCFP) in the College of Family Physicians of Canada (CFPC). As mandated through federal government charter, the CFPC establishes accreditation standards and accredits continuing medical education and professional development (CME/CPD) programs for family physicians in Canada. The CFPC also conducts examinations and has the authority to confer Certification upon family doctors who demonstrate special competence in our discipline and Fellowship upon Certificants who meet commitments to lifelong learning. As of January 2005, approximately two thirds of Canada’s actively practising family physicians were CFPC members, and 80% were Certificants or Fellows of our College. Although the requirements for Certification and Fellowship in family medicine (and the rigour of the CFPC’s Certification examination) are equivalent to the requirements for Certification and Fellowship in the specialties of the Royal College of Physicians and Surgeons of Canada (RCPSC), until now, holding CCFP and FCFP have not carried equivalent value or prestige in many of our medical schools, regulatory bodies, hospitals, and public policy settings. Government and medical association fee negotiators have also consistently undervalued the work carried out by family doctors who are as expert in their special field as “specialist” physicians are in any other discipline. This has been the case, despite the fact that, since 1992-1993, the Federation of Medical Regulatory Authorities of Canada (FMRAC) agreed that, to have a full portable licence to practise in Canada, new graduates must successfully complete the licensing examination of the Medical Council of Canada (LMCC) and must attain Certification from either the CFPC (family doctors) or the RCPSC (other specialists). Many family physicians, Royal College specialists, medical students, medical school and regulatory or licensing authorities, and others have been recommending that the CFPC should more strongly promote the meaning and value of Certification and Fellowship in family medicine in Canada. Medical students, in fact, identify lack of prestige for CCFP credentials as one of the reasons that more of them do not select family medicine as a first-choice career. The CFPC Board has heard this challenge clearly and has approved our exploring options for increasing recognition for family physicians who have demonstrated special competence and commitment to our discipline (see our position paper, Family Medicine in Canada; Vision for the Future, available on http://www.cfpc.ca). While the College’s effort will focus on the importance of Certification and Fellowship, it will look wider as well. It will seek ways to acknowledge family physicians who have been in practice for many years before Certification became firmly ensconced in Canada and who have never achieved CCFP or FCFP status. Although our College has maintained a practice-eligible path to Certification for those not residency trained, many physicians who have been away from academic environments for many years have indicated that preparing for and passing examinations is impractical and unattainable for them. This does not mean that these physicians are unskilled, lacking in knowledge, or unwilling to participate in accredited CME/CPD programs. It also does not mean that they are opposed to providing evidence of their skills, knowledge, and CME/CPD activities. The CFPC will, therefore, try to meet this challenge and offer all family physicians the opportunity to become part of what we represent. Our ultimate goal is to augment the image and value of the discipline of family medicine and the thousands of outstanding family physicians across Canada who are committed to both their patients and lifelong learning. With the explosion of new knowledge, CME/CPD programs are expanding rapidly. The CFPC is one of several medical organizations leading development of CME/CPD standards both in Canada and abroad. Research in CME/CPD is essential to determine the best learning strategies and their effect on physicians’ competence and performance in practice. In the next few years, the CFPC will increase its role in carrying out such studies. Emerging evidence already shows the value of practice-focused, evidence-based, reflective learning, which is the basis of the CFPC’s Mainpro-C program, including the “linking learning to practice” activities. In the past year, the CFPC Board of Directors approved having Fellowship join Certification as one of the important milestones of lifelong learning, with Mainpro-C requirements central to earning and maintaining Fellowship. Medical regulatory bodies, health authorities, and hospitals in Canada and around the world are now considering introducing explicit requirements for maintenance or revalidation of licences and privileges. Physicians in many nations and all specialties are being asked to provide evidence of high-quality practice (through audits, peer and patient surveys, etc) and of their ongoing commitment to CME/CPD. The CFPC is prepared to be the voice of family medicine in these deliberations, ensuring that the standards and requirements developed by the regulatory bodies and institutions for revalidation of licences and privileges for family physicians are appropriate. We are also prepared to support all family doctors by recommending that the credits they earn in our CME/CPD programs be fully recognized by licensing and other authorities, and we are prepared to provide evidence of physicians’ participation in our programs. We hope this will help reduce anxiety, duplication of effort, and costs for family practitioners across Canada.

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