U.S. jurisdictions (states, territories, and the District of Columbia) granting licenses to physicians require renewal of those licenses every 1, 2, or 3 years. Virtually all require completion and reporting of a specified number of hours of continuing medical education (CME) (12–50 hours per year) as part of license renewal. Some areas have also imposed content requirements (e.g., in geriatric medicine or palliative care) (AMA, 2006). Traditionally, CME has taken place through a lectures-at-a-conference format; however, this method has consistently been found ineffective as a means of changing clinical practice (Bero et al., 1998; Davis et al., 1999; Parochka and Paprockas, 2001). As a result, CME is being reconceptualized as “a more continuous process with more emphasis on self-assessment and continuous improvement and less on attending traditional lecture courses” (Goroll et al., 2004:908).
In addition, physicians with certification in a specialty are required to be recertified periodically. Similar to the changing conceptualization of CME, the specialty recertification process for physicians has evolved from periodic testing to a more continuous “maintenance of certification” (MOC) process (ABMS, 2006). Developed by ABMS and its Member Boards, the MOC process involves the assessment and improvement of practice performance by physicians in every specialty (Batmangelich and Adamowski, 2004; Miller, 2006). Each Member Board will be required to develop specific mechanisms for assessing evidence of diplomates’ competency in specific areas (Pugh, 2003), as shown through ABIM’s Practice Improvement Module (PIM), ABFM’s Maintenance of Certification Program for Family Physicians (MC-FP) (ABFM, 2006a), ABP’s Program for Maintenance of Certification in General Pediatrics (PMCP-G®) and in Pediatric Subspecialties (PMCP-S®) (ABP, 2006a), and ABPN’s MOC program (ABPN, 2006a). Within such programs, topics related to psychosocial health services could be incorporated in such mechanisms as self-assessment modules, used to evaluate knowledge, and performance-in-practice modules, used for peer review.
There are three major educational paths to becoming a registered nurse (RN): obtaining a 2-year associate’s degree in nursing from a community or junior college, a 3-year hospital-based diploma, or a 4-year baccalaureate degree in nursing from a college or university (IOM, 2004b). All state boards of nursing except those of North Dakota and New York accept these three educational paths as appropriate academic preparation for RN licensure (Kovner and Knickman, 2005).