Is the Public being Protected? Prevention of Suboptimalmedical Practice Through Training Programs and Credentialing Examinations

Governments have traditionally looked to the medical profession for leadership in health planning and have charged the profession with the responsibility of establishing and monitoring standards of medical practice. Training program accreditation and licensure/certification exams have been used as the primary methods of preventing unqualified individuals from entering medical practice. Despite the critical nature of the decision made at the time of licensure/certification, there is no information about the validity of these examinations for predicting subsequent practice and health outcome. In this article, the assumptions implicit in the current use of licensing/certifying examinations are identified, the relevant evidence is reviewed, and the implications of this evidence for current methods of measurement are discussed.