Identification of Alternative Physician Assistant Recertification Models

An Analysis of the Landscape and Evidence Surrounding Approaches to Recertification in the Health Professions

by Rachel O. Reid, Erin L. Duffy, Catherine C. Cohen, Mark W. Friedberg

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Research Questions

  1. What is the current landscape of recertification requirements for physician assistants, advanced practice nurses, and physicians in the United States and other countries?
  2. What does current literature say about the impact of recertification requirements, including high-stakes exams, on health professionals and patients?
  3. What are the rationales and experiences of certifying organizations implementing recertification requirements that may not require a high-stakes exam?

Health professional recertification is intended to be a mechanism for demonstration and fostering of professional knowledge and competence. Recertification requirements vary among health professions and are evolving over time. RAND Corporation researchers assessed the landscape of recertification requirements for physician assistants (PAs), advanced practice nurses (APNs), and physicians in the United States and other countries through an environmental scan, reviewed the literature regarding the impact of recertification requirements on patients and health professionals, and conducted semi-structured interviews with certifying organization representatives.

Recertification requirements vary, including continuing education, exams or assessments, and other activities. Closed-book exams are most common in the United States. PA recertification currently requires a high-stakes closed-book exam; a pilot of a longitudinal assessment with smaller, regularly spaced batches of questions is planned. Many allopathic physician specialty boards are transitioning from recertification exams to longitudinal assessments; most osteopathic specialty boards require recertification exams. An exam is required for certified registered nurse anesthetist recertification, but not for other APNs. Evidence regarding the effects of recertification requirements on health professionals and patients for PAs, APNs, and professionals outside the United States is limited. The evidence mainly focuses on U.S. allopathic physicians. Physicians have mixed opinions about trade-offs between burden and professional benefit, and some, but not all, studies find associations between recertification and indicators of better care. Major themes reflected in interviews with certifying organizations included a desire to balance evaluative and educational goals, the tension felt between public responsibility and health professional preferences, and burden and applicability to practice.

Key Findings

The environmental scan revealed a broad array of recertification requirements for health professionals across countries, professions, and organizations

  • Certifying organizations in the United States and other countries varied in their recertification requirements.
  • Recertification exams were most common in, but not exclusive to, the United States.
  • Alternatives to high-stakes exams were being considered or implemented by the U.S. PA certifying organization and several U.S. physician certifying organizations; these primarily included longitudinal assessments with smaller, regularly spaced batches of questions.
  • Most APN organizations had not required exams for recertification.

The literature review found limited evidence on how recertification requirements for U.S. PAs, U.S. APNs, and U.S. osteopathic physicians affect patients and health professionals

  • There was no empirical evidence concerning the effects of PA recertification (including high-stakes exams) on patient care.
  • The review found more evidence regarding U.S. allopathic physician recertification; some (but not all) studies found associations between recertification and indicators of better care.
  • The evidence regarding the impact of recertification requirements in other countries was more limited in size and scope than for U.S. allopathic physicians.

Interviews with health professional certifying organization representatives provided context about how organizations conceptualize their recertification and assessment requirements

  • Emphasis on formative and summative goals of recertification requirements varied.
  • Common themes emerged regarding attention to the relevance of requirements to health professionals' practice, as well as a perceived tension between a responsibility to assure the public of the health professionals' competence and a desire to account for the burdens on and preferences of health professionals.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Assessment of the Landscape of Recertification Requirements

  • Chapter Three

    Review of the Literature Surrounding Recertification Requirements

  • Chapter Four

    Interviews with Health Professional Certifying Organizations

  • Chapter Five

    Conclusion

  • Appendix A

    Maintenance of Certification, Recertification, or Revalidation Requirements

  • Appendix B

    Questions from Semi-Structured Interview Guide

The research described in this report was sponsored by the American Academy of Physician Assistants (AAPA) and conducted by RAND Health.

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