S2.3
Training and credentialing
Presented by Academy of Medicine of Malaysia
Chairperson: Professor Chung-kwong Yeung
MBBS, MD, FRCSE, FRCSG, FRACS, FACS, FHKAM (Surgery),
DCH (Lond & Irel)
President, College of Surgeons of Hong Kong
Speaker: Dr Siew-kheong Lum
FRCSEd, FAMM
President, College of Surgeons,
Academy of Medicine of Malaysia
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Synopsis
Training and subsequent credentialing as a doctor and later as a specialist are
accepted norms imposed by the profession and accepted by the public. However,
there are now suggestions to take this further to credentialing of sub-specialists
and credentialing for surgical procedures. Parties championing this exercise
include the Government or regulatory body, insurance companies and specialist
societies. Each party have their own agendas though the expressed agenda is
always patient safety.
There is sparse evidence in the literature on the relationship between
credentialing and surgical errors. The limited evidence available in the literature
show that the majority of surgical errors are not made by inexperienced
surgeons or surgeons operating out of their specialty but are made by
experienced surgeons in the setting of patient factors like abnormal anatomy,
co-morbid factors, re-operations,
emergency operations and inadequate
equipment. Contrary to common belief, the majority of surgical errors involve
experienced surgeons performing routine operations rather than advanced
surgical procedures requiring special training. Furthermore, the evidence show
that advanced surgical procedures are rarely performed by inexperienced
surgeons and almost all the errors in advanced surgical procedures are made by
experienced surgeons in the subspecialty.
Excessive credentialing is therefore unlikely to make any significant impact in
patient safety but has the potential to stifle creativity and innovation, demoralize
surgeons, promote cost increase, promote turf protection and create barriers to
timely access to surgery for patients. The limited evidence show that the moral
compass of the vast majority of surgeons remain strong and they behave sensibly
and ethically in their practice. Excessive legislation and interference to control
their behaviour is unnecessary and unlikely to improve patient safety. Surgical
safety research on performance in routine operations for complex patients and
circumstances will yield better results for patient safety.
Objective
The Medical profession is now operating in an over-regulated environment on the
belief that the moral compass of doctors is doubtful and patient safety can be
enhanced by regulating doctors’ behaviour with rules and regulations. Excessive
emphasis on credentialing has the potential to deeply divide and demoralize
doctors with little contribution to patient safety. This paper cautions the profession
on this issue.