Email this article 
Post a Comment 
Hide
Show all
Editorial
This issue, I would like to present a guest editorial from my colleague at Medical Physics, Dr. William R. Hendee. Bill graciously responded to my invitation to discuss the maintenance of certification issue, which I believe is the most important issue facing our profession. Thanks, Bill; we all appreciate what you have to say.
Michael D. Mills, PhD
Performance and accountability in medical physics: A point of view
William R. Hendee, PhD
In the United States, we seem to be enamored by the
idea that professionals should perform as expected and that they
should be accountable for their performance by verification against
measurable and quantifiable standards. In part, this idea has grown
out of the so-called decline of deference in which the veneer of
invincibility of teachers, ministers, doctors, auditors, and other
professionals in our society has eroded over the past few decades.
It is also a reaction to recent revelations of questionable ethical
values and behaviors of business, industry, religious, and political
leaders. But underneath these reactions lies a fundamental truth:
professionals should perform as they are educated and trained to
function, and they should be held account-able for their performance
because, fundamentally, they are entrusted with the public's
welfare.
Certainly professional
performance and accountability are essential in medicine; no field
surpasses health care in the depth and breadth of its impact on the
lives and well-being of people. Good performance in health care can
save lives and reduce suffering-and poor per-formance can cost lives
and increase suffering. Health-care professionals are entrusted by
patients and families with the expectation of good performance, and
health-care professionals owe patients and families their
willingness to be transparent, ethical, and accountable in the
appli-cation of their skills and knowledge to the patients' benefit.
This social contract between those who provide care and those who
receive it is beyond question. What remains questionable, however,
is how to document performance and how to assure accountability.
These questions are pertinent to every field of health care,
including medical
physics.
Licensure by a
quasi-governmental agency has traditionally been one approach to
verifica-tion of the credentials of health-care professionals. This
approach suggests that the individuals should be able to perform
competently in their roles within a health-care setting. Only four
states (Texas, Florida, Hawaii, and New York) license medical
physicists. In most states, medi-cal physics licensure does not
exist because there has been insufficient interest to mount the
lobbying effort required to move a licensing bill through the state
legislature. Licensure does not ensure that medical physicists
perform their duties as expected, and it does little for
ac-countability of medical physicists to the public that they serve.
But it does set a threshold for the credentials of medical
physicists that serves to weed out those whose qualifications fall
short of what is considered
essential.
Certification by a
process established by peers is a second and more widespread
approach to documentation that professionals possess the knowledge
and experience to practice in a disci-pline. Medical physicists can
be certified in diagnostic radiological physics, therapeutic
radiological physics, and medical nuclear physics by the American
Board of Radiology profes-sional duties. Certification merely
documents that individuals at one particular point in time possessed
the knowledge and experience considered necessary to practice a
particular
profession.
Accreditation is
another mechanism occasionally referenced as a way to ensure that
the performance and accountability of professionals meet accepted
standards. This interpretation is misguided because accreditation
does not apply to individuals; it applies to programs of education
and training; that is, professionals can graduate from accredited
educational pro-grams, but they cannot become accredited as
individuals. In medical physics, accreditation of graduate and
residency education and training programs is provided by the
Commission on Accreditation of Medical Physics Educational Programs
(www.campep.org), an organization sponsored by the American
Association of Physicists in Medicine, American College of Medi-cal
Physics, American College of Radiology, and the Canadian College of
Physicists in Medicine. Accreditation ensures that a graduate or
residency program in medical physics satisfies certain
peer-determined standards for educational content and clinical
experience. It provides no di-rect assurance that individuals
graduating from accredited programs will perform competently and
with accountability to the
public.
So even with licensure,
certification, and accreditation, the questions of how to document
performance and how to assure accountability in medical physics
remain unanswered. Yet, medical physicists, like other health-care
professionals, are expected to answer these ques-tions. This
expectation reflects in part society's demand for heightened
accountability of health-care professionals, and in part a
self-imposed desire of health-care professionals to measure up to a
high level of accountability over their course of practice. An
effort to meet this expectation has yielded the evolving process of
maintenance of certification (MOC) now con-fronting medical
physicists (and radiologists and radiation oncologists) who have
time-limited certificates issued by the American Board of Radiology
(ABR). Physicists with lifetime certifi-cates from the ABR are also
encouraged to engage in the MOC process as a testament to their
dedication to professional performance and accountability. The MOC
process is designed to document that medical physicists perform
their professional duties at a level deemed accept-able to their
peers, and to provide greater transparency in the performance of
those duties in an effort to be more accountable to patients,
families, and the public in general.
Maintenance of ABR certification has four components: professional standing
- lifelong learning and self-assessment
- cognitive expertise, and
- assessment of performance in practice
For each of these components, six competencies should be demonstrated:
- medical knowledge
- patient care
- interpersonal and communication skills
- professionalism
- practice-based learning and improvement, and
- systems-based practice
Medical physicists are experts who perform their professional responsibilities with diligence and dedication, and who are actively engaged in continuing education demanded by their involvement in a rapidly evolving specialty. They are all busy people, and insertion of the MOC process into their already complex schedules makes their lives even more complicated. But MOC is happening, and it needs to happen so that physicists can demonstrate performance at a level consistent with their education and training, and accountability for that performance in the service of patients, families, and the public.
Journal of Applied Clinical Medical Physics
.
|
|
| Editor-in-Chief | Michael D. Mills |
| Deputy Editor-in-Chief | Timothy D. Solberg |
| Associate Editor-at-Large | Richard Stark |
|
|
| Radiation Oncology Physics | Nzhde Agazaryan, B. Gino Fallone, |
| John Gibbons, Michael Herman, | |
| Edwin McCullough, Janelle Molloy, | |
| Matthew Podgorsak, Nikos Papanikolaou, | |
| Mehrdad Sarfaraz, Lu Wang | |
| Medical Imaging | Walter Huda, William Pavlicek |
| Radiation Measurements | Larry DeWerd |
| Radiation Protection & Regulations | James Deye |
| Nonionizing Topics | Bhudatt Paliwal |
| Other Topics | Timothy Solberg |
| Book/Media Reviews | James Smathers |
| Editorials | John Horton |
|
|
| Manuscript Manager | Patricia Walker |
| Copy Editor | Betty R. Robinson |
| Layout Editor | Melanie Marques |
| Proofreader | Heather Shand |