Credentialing Based on Demonstrated Skill and Knowledge

E. Antonio Mangubat, M.D.
La Belle Vie
Suite 101, 16400 Southcenter Parkway
Tukwila, WA 98188
tony(at)mangubat.com

 

Few cosmetic surgeons and cosmetic physicians receive in-depth aesthetic training in their primary residencies. Most take post graduate fellowships offered by American Academy of Cosmetic Surgery (AACS), American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS), American Society of Plastic Surgery (ASPS), American Society of Dermatologic Surgery (ASDS) and others. The post graduate training is not uniform but the hope is that at the end of the fellowship, the candidate has enough experience to provide safe and competent care to deliver excellent results. The new P3 intends to address this shortcoming by providing structured procedure training pairing experienced mentors with young cosmetic surgeons wishing to acquire new skills with the necessary education, training, and experience to provide effective care, minimizing complications and maximizing patient safety and satisfaction.

 

The P3 intends to establish a performance standard that will serve 3 stakeholders: the public, the cosmetic surgeon/physician, and industry. The ultimate goal of P3 is to protect the public, the primary stakeholder in this initiative. P3 hopes to provide the public with the confidence that the surgeon holding the P3 certificate has demonstrated the education, training, experience to perform the requested procedure safely. By offering the educational pathway to acquire specific skills and proficiency, we also serve the conscientious physicians who are striving to add new skills to their offerings; thus we serve the physician, a second stakeholder in the P3 initiative. Lastly, by providing procedure specific training and documentation, we also serve industry, a third and important stakeholder in the P3. Theoretically, there should be fewer malpractice claims, fewer “device failures” due to inexperience, and a host of other cost saving measures that saves everyone money. All stakeholders in this model would benefit and there are no downsides to the safety measures we propose.

 

At the end of the process, P3 intends to provide an answer to the question: does the surgeon I am consulting have the education, training, experience, and current competency to safely and successfully perform the requested procedure? Currently no form of credentialing can answer this.   Based on current standards, no patient can be confident of any surgeon because no surgeon has ever been required to demonstrate proficiency before being licensed. Even board certification is not required for licensure in any state. Furthermore board certification by any specialty does not actually require any demonstration of procedure proficiency skills; they only require passing written and oral examinations to receive their board certificate. All ABMS boards assume that successful completion of residency training provides sufficient proficiency and does not require a performance standard to achieve these credentials.

 

Exactly what is required for P3 to be successful is still evolving; however, I believe many of the standards already in place in other industries may lead to the correct formula. The most promising are the FAA standards for pilot training which requires acquisition and demonstration of skill skills for a given aircraft. Similarly, P3 will strive to develop programs creating a pathway to acquisition, demonstration and documentation of surgical skills to increase and patient safety.