Abstract
Periodic review ofprofessional competence or performance is on the public agenda as a response to rising malpractice suits, iatrogenic morbidity, and mortality resulting directly from professional incompetence, and the inadequacy of current licensing and discipline systems. This article reviews several continuing competency programs, such as mandatory education, as well as recent experiments in selective performance evaluation. The evaluation literature suggests that mandatory continuing education and most peer review programs are not sufficiently related to improvement ofperformance. An Ontario experiment provides useful data and insight about a positive reinforcement (nonpunitive) independent peer review process. Policymakers should consider, as an alternative to mandatory continuing education, directing professional associations, professional schools, and regulatory boards to design cost effective review procedures which selectively monitor performance.
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