Credentialing - or modules, as some call them - in postgraduate medical education and training has been frequently debated in recent years.
The definitions and arguments surrounding it are numerous, wide and varied, but one working definition is the recognition of competences attained in a defined area of practice at a level that would allow the holder of the credential to work with a limited level of direct supervision in that area of practice.
Those in favour of it see it as a positive, affirmative step which will support doctors’ professional development, help address the changing needs of the service, and reinforce confidence from patients and employers in the capabilities of doctors including those in postgraduate training.
Some schools of thought suggest credentialing may be the first step towards a more flexible, accommodating approach to training.
Others see it as an unnecessary ‘slicing’ of the CCT training programme, or as the first unfortunate step towards a ‘sub-consultant’ grade, or a situation where some are officially recognised in pay and status as better than others.
Credentialing has potential relevance to a much wider debate about the level at which a postgraduate specialty qualification should be awarded. As it stands the award of a CCT indicates that a doctor is ready to go on to the specialist/GP register and can compete to become a principal GP or consultant.
As the debate continues, plans to consider and clarify credentialing are really beginning to take shape.
A definition of credentialing
Credentialing refers to the accreditation of a doctor’s competence and capabilities at given points in their career.
• Credentialing would provide a way of giving formal recognition to the additional training undertaken and qualifications acquired by doctors.
• The recording of that additional training would make the expertise of specialists more easily recognised and the register more transparent.
• Specialist credentials would enable the recognition of specialist competences in fields of practice for which it is not possible to obtain a CCT and where regulation has been identified as weak.
• Credentialing offers a more agile means of responding to developments in medicine than is possible through the recognition of CCT specialties.
• It should be possible in principle to extend the principle of credentialing to apply to general practitioners with special interests.
Progression of the debate
The credentialing debate was raised as a key area for address in Lord Darzi’s A High Quality Workforce: NHS Next Stage Review.
In this report, Lord Darzi recognised the need for a new flexibility in training and to introduce “the formal accreditation of capabilities at defined points within the medical career pathway that takes into account knowledge, capabilities, behaviour, attitudes and experience.”
Much as in the way the AS level may be a stepping stone to an A level, Darzi asserted that credentialing could provide a stepping stone within a programme; reassurance to patients, trainees and the service that training in a particular area and to a particular level of competence, has been accomplished.
In addition, it gives those undertaking training the potential to move in and out of training programmes without losing recognition for the skills they have acquired.
In autumn 2008, a stakeholder group was formed, chaired by Professor David Sowden.
It comprised representatives from the Academy of Medical Royal Colleges, COPMeD, the GMC and PMETB, and concluded that combining credentialing with existing curricula at pre-CCT level would be more complex than had been originally thought. It was agreed that the work on credentialing should be taken forward in two stages and implemented over a time frame of ten years.
The Department of Health subsequently approached PMETB to lead discussions which would facilitate the coherent development of proposals for credentialing across all stages of doctors’ careers, including identified work streams.
Modernising Medical Careers
Meanwhile, the government’s response to the Health Select Committee’s report on MMC, in May 2008, raised two issues about credentialing. It called for the reform of education and training for the SAS grade doctors and suggested responsibility for regulating the training should sit with PMETB and should be considered as part of a wider review of clinical career structures, helping to remove any remaining stigma associated with the grade.
The wider review should also aim to improve access to specialist registration via the Certificate of Eligibility of Specialist Registration (CESR) route, which, “alongside modularised credentialing as outlined in the NHS Next Stage Review will be of help to those in SAS posts.”
In the second instance the government response recommended the introduction of a hierarchy within the consultant grade similar to that used in clinical academia.
PMETB-led review: 2009 onwards
PMETB agreed to review the curricula and assessment systems for all specialty training programmes commencing in the autumn of 2009, to take account of the full set of standards for specialty training.
In May 2009, PMETB and GMC jointly organised a forum, where it was agreed that a steering group should be formed, to lead and plan actions that would take initial consideration of credentialing through to development of proposals, which could potentially address subsequent work in feasibility checking, piloting, milestones and a timetable for possible implementation.
The Credentialing Steering Group met for the first time in May this year. The purpose of the CSG is to facilitate the coherent development of proposals for credentialing across all stages of doctors’ careers, including identified work streams.
Three core issues were identified:
1. Credentialing can support revalidation which will identify specific areas of practice for each doctor.
2. There are potential benefits of articulating the level of practice of doctors during training and in continued practice.
3. There are areas of practice that lack public and professional recognition and credentialing could provide a means of acknowledging these.
However significant concerns surrounding credentialing continued to be expressed by the group. It was agreed by all that the work should be developmental in nature and should aim to consider the outcomes of any initial exploratory work by the end of 2009.
Extracted from an article in The State of Postgraduate Medical Education 2009: Laying foundations for the future.
Read the whole report.
Read trainees’ views on the move towards credentialing.
Tags: Credentialing, Training
