The IOM targets doctors

A new Institute of Medicine report calls for more-stringent licensing and recredentialing criteria.

By Gail Garfinkel Weiss
Senior Editor

Medical school and residency programs don't prepare health professionals to give patients the best and safest care possible, and CME, recredentialing, and other oversight processes don't do a very good job of monitoring proficiency. Therefore, rank-and-file physicians should face new and more rigorous recertification requirements.

That's one of the core findings of "Health Professions Education: A Bridge to Quality," an Institute of Medicine report released in April. The report has already run into resistance from physicians who worry that the new requirements could add to their workload and stress and from some in organized medicine, who say many of its recommendations have already been implemented.

Specifically, the report recommends that physicians and other providers should possess five "core competencies." They should (1) provide patient-centered care; (2) work in interdisciplinary teams to ensure that care is continuous and reliable; (3) employ evidence-based practice; (4) identify errors and hazards in care and implement basic safety design principles; and (5) utilize information technology to communicate, manage knowledge, mitigate error, and support decision-making.

To integrate these core competencies into health curricula and monitoring systems, the IOM recommends that:

• State medical boards require licensed health professionals to periodically demonstrate their ability to deliver patient care through direct measures of technical competence, patient assessment, and evaluation of patient outcomes.

• Certification bodies require physicians to periodically demonstrate their ability to deliver patient care that reflects the five competencies.

• The Agency for Healthcare Research and Quality (AHRQ) work with health care leaders to implement the core competencies, set national goals, and issue a report evaluating progress.

• Beginning in 2004, a biennial summit be held to review progress and set new goals.