Reflective Self-Assessment…Emphasize Reflection

I was awake at 3:00 a.m. as I often am. I was reflecting on the differences I see in how the word “reflection” might be conceptualized by the Federation of State Medical Boards (FSMB) and by Dr. Wiley Souba, a surgeon who wrote an article entitled “The Inward Journey of Leadership” [1], web link http://geiselmed.dartmouth.edu/cfm/education/pdf/souba_inward_journey.pdf. I found out about this article from our chief resident, who is going to lead a journal club discussion about it. Now there’s a leader.

As many of my readers know, I ‘m opposed to Maintenance of Licensure (MOL) and Maintenance of Certification (MOC) as mandated by FSMB and specialty certification boards in the U.S. Despite the recognition by FSMB that state medical boards (SMBs) have the power to choose whether MOL is adopted or not, they’ve set a ten-year timetable for every state in the union to implement MOL. A primer to what MOC and MOL processes entail for physicians can be found at link, http://www.currentpsychiatry.com/article_Pages.asp?AID=11052.

I know it’s difficult to slog through many pages of literature on MOL, but I think it’s worthwhile to consider specifically what the FSMB is calling “reflective self-assessment”, and you should read pages 14 and 25 in the document about MOL implementation at link, http://www.fsmb.org/pdf/mol-implementation.pdf. You can read more about MOL at their website, FSMB | Maintenance of Licensure. If you’re not careful, you could come away believing that FSMB thinks reflective self-assessment is the same as Continuing Medical Education (CME).  Of course, the intention was to convey the expectation that physicians would become aware of their shortcomings in knowledge and practice by introspection and supposedly correct them by engaging in CME activities.

Before you decide whether FSMB’s definition of “reflection” accords with what usually occurs to you when you think about the nature of the process, have a look at Dr. Souba’s article, which describes the inward journey that he suggests physicians undertake in order to explore their motivation for assuming leadership, which is a choice, not a position, as Stephen Covey pointed out years ago.

Whether or not you see the word “reflection” itself in Souba’s article, his entire essay is about the deep, honest, introspection, the “inward journey” that can be both painful and liberating and which can be done only if the physician chooses to do so. The FSMB’s use of the term “reflection” seems to trivialize a process which can only be undertaken voluntarily by doctors, but which the FSMB propose to mandate. Not only does the FSMB mandate this spiritual journey, but they propose to make it a condition of medical licensure in every state in the next decade.

I’m not ready to accept the FSMB’s interpretation of reflection. In my opinion, I should approach reflection with respect, engage in reflection by taking the time for it, and be aware that reflection is a deeper process than CME will ever cover. When I reflect on my flaws as a human being and as a doctor, I don’t look to MOL to correct me with a package of CME activities that is analogous to a duck wearing a suit and offering me plastic fruit.DSC00893

1. Souba, W. W. (2006). “The inward journey of leadership.” J Surg Res 131(2): 159-167.

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