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Year : 2013  |  Volume : 29  |  Issue : 1  |  Page : 1

Recertification: Overhyped or need of the hour

Department of Urology, Unit II, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication3-Apr-2013

Correspondence Address:
Nitin S Kekre
Department of Urology, Unit II, Christian Medical College, Vellore, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-1591.109974

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How to cite this article:
Kekre NS. Recertification: Overhyped or need of the hour. Indian J Urol 2013;29:1

How to cite this URL:
Kekre NS. Recertification: Overhyped or need of the hour. Indian J Urol [serial online] 2013 [cited 2021 Jul 31];29:1. Available from:

Patient safety is the cornerstone on which modern health-care systems are based. With the increase in interest in patient safety, has come the realization that passion, interest, and enthusiasm are no longer enough to ensure optimal professional standards in urology. Mandatory "recertification" every few years has been proposed as a mechanism to ensure that minimum professional standards are met. It also reassures patients and employers that the doctor is fit to practice and it is also hoped concurrently there will be an improvement in patient safety. [1]

Many countries have already adopted recertification/revalidation in urological practice. In India, several state medical councils have made relicensing compulsory. For example, the Tamil Nadu Medical Council has made it mandatory for all physicians to attend at least 30 h of continuing medical education program to be eligible for the renewal of licensing, which is at the end of every 5 th year.

Recertification however goes beyond mere renewal of license. The frame-work should include the several domains of: (a) Knowledge and skills (b) safety and quality (c) communication, partnership and teamwork and finally (d) maintenance of trust.

While the domains are easy enough to identify, it is far more difficult to evaluate them. Clinical audit and a log book have been accepted as a fair way to evaluate safety, performance and skill of a surgeon. A recertification examination can test knowledge. The method of assessment of safe practice, team work, and communication is controversial. England uses multi source feedback for assessment of non-technical skills. This is not evidence based and has a strong subjective component. [1]

Wide spread adoption of recertification will also result in a small minority of urologists who are unable to meet the specified standard. Regulatory bodies need to have systems in place that protect interests of both urologists and patients. It is important at the outset to clearly define the protocol to be followed.

India has unique challenges. Careful record keeping, which is the foundation of surgical audit is almost non-existent. In addition, the huge financial outlay required for recertification will be difficult to generate. While recertification programs have been started in the west, not all surgeons remain convinced about its effectiveness and benefits. It is still too early to validate or objectively evaluate its benefits through audit.

Under these circumstances, it is unlikely that India will adopt such an approach now. The Medical Council of India in its present form is seriously ill-equipped to handle the additional responsibility this will imply. Perhaps it is time to have individual specialty boards for better management of education and training in the country. The quality of the initial urological training is not uniform with varying levels of supervision and hands-on training. Without an adequate structure for basic initial urological training, any talk about recertification would be premature. While the need for recertification as a tool to increase the patient safety and enhance the quality of care, remains undeniable, its application and tools to implement it remain debatable.

In this issue Priyadarshini et al have shown a genetic predisposition to prostate cancer in persons with the polymorphism of the TLR- 4 gene. Further research could perhaps one day lead to genetic markers that can identify people at risk, who then, can be subjected to more intensive screening. Srivastava et al have described their experience with vascular complications after renal transplantation; which can potentially lead to early graft loss. Khan et al have researched the origins of the ubiquitous condom.

   References Top

1.Ahmed K, Zakri R, Rowland S, Joyce A, Challacombe B, Dasgupta P, et al. What is the current status of revalidation in urology? BJU Int 2011;108:1248-53.  Back to cited text no. 1


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