'Reregistration systems poorly adapted to daily practice'

Encouraging patient involvement when reregistering healthcare professionals

Informal learning in daily practice is not taken adequately into account when reregistering physicians, and patients still have too little say. This is the conclusion that Carolin Sehlbach of Maastricht UMC+ reaches in her doctoral dissertation. Sehlbach compared the reregistration systems for physicians in various countries and makes recommendations for improving the Dutch system.

Healthcare is complex and in constant flux. Throughout their careers, physicians must constantly keep abreast of the latest developments. To guarantee the quality of care, and to evaluate physicians' abilities, the Netherlands has put a variety of reregistration systems in place. To continue practising, physicians must reregister under the Individual Health Care Professions Register Act (BIG) every five years. One of the aims of reregistration is to encourage healthcare professionals to continue learning throughout their working lives. However, the formal nature of the system can backfire.

Accreditation and references
As part of the Dutch reregistration system, physicians must amass a set number of accreditation points. They can accrue points by attending meetings and conferences. They must also have at least sixteen hours of patient contact each week, they must have subjected their performance to a quality review, and they must participate in a system in which their peers and patients assess their work. Healthcare professionals lead busy lives and they may experience reregistration as extra pressure and an administrative burden. On top of that, although learning is interwoven into their daily work, it counts for little in the reregistration process. 'Most of what doctors learn, they learn by doing, for example in the consulting room,' says Sehlbach. 'They learn every day and often in an informal setting. Every patient has something to teach them, and they may be able to use whatever that is to help another patient.'

Encouraging lifelong learning
Sehlbach believes that physicians can be encouraged to learn on the job, for example by talking to their peers regularly about their experiences. To do this, they need to create a shared culture of lifelong learning and peer sharing. Patients can play an important role in this context. 'Patient involvement should only increase in the years ahead,' Sehlbach says. 'For example, practices could encourage them to share their experiences with their physicians and make it easier for them to do so. Of course, it's important to set up a system that is safe and constructive for both patient and physician.' She has based her recommendations on literature reviews, observations during consultations, and interviews with physicians and patients.

Carolin Sehlbach will defend her dissertation at Maastricht University on Friday 21 February at 10 a.m. Her dissertation is entitled 'To be continued... Supporting physicians' lifelong learning'.