Process Improvement of the Certification of Medical Specialists in Mexico: A Case Study of Otorhinolaryngology

Mejora del proceso de certificación de médicos especialistas en México: un estudio de caso en otorrinolaringología
Melchor Sánchez-Mendiolaa*, Daniel Bross-Sorianob, Arturo Ramírez-Garcíab y Laura Delgado-Maldonadoc

aDivisión de Estudios de Posgrado, Facultad de Medicina de la UNAM, Ciudad de México, México.
bConsejo Mexicano de Otorrinolaringología y Cirugía de Cabeza y Cuello, Ciudad de México, México.
cInstituto Nacional para la Evaluación de la Educación. Ciudad de México, México.

*Autor para correspondencia: Melchor Sánchez-Mendiola. Facultad de Medicina, UNAM, División de Estudios de Posgrado, Ave. Universidad 3000, C.U. México, Cd. Mx. 04510. Tel.: (5255) 5622-1059 Correo electrónico: melchorsm@gmail.com, melchorsm@unam.mx

Recibido: el 6 de enero-2018; Aceptado el 19 de marzo de 2018.

Palabras Clave

Consejos de especialidades médicas; exámenes de certificación; evaluación sumativa; mejoría de calidad; países en desarrollo; diseminación de innovaciones; otorrinolaringología; México.

Keywords

Medical specialty board; certification exam; summative assessment; quality improvement; developing countries; dissemination of innovations; otolaryngology; Mexico


Abstract

Background: The certification of medical specialists is a fundamental task to protect society and document the achievement of competences in a specific field. The medical certifying process has advanced and disseminated globally, becoming more evidence-based, sophisticated and complex. Formal physicians’ certification in Mexico started in 1963, but the quality and validity of the process is heterogeneous due to a variety of reasons. The Mexican Board of Otorhinolaryngology and Head and Neck Surgery (MBO) was created in 1970. Recently the Board implemented an initiative to diagnose and improve its test development and analysis processes. The objective of this study is to describe the quality improvement process of a medical specialty certification exam in Mexico.

Methods: Single descriptive instrumental case study. Review of the MBO normative documents and previous exams’ reports. Interviews with the Board’s main stakeholders and information obtained during the test development and analysis activities. Implementation of a two-year change process for improvement of the MBO certifying examination, using Downing’s model for test development and Greenhalgh’s model for dissemination of innovations.

Results:A two-year agenda of academic and administrative activities was designed (strategic planning, diagnosis and analysis of the test development and implementation processes, faculty development workshops). Implementation strategies and validity sources for the test were developed. Areas of opportunity were identified and improved. The whole process of test development and analysis was revamped.

Conclusions: Specialty board certification exams in developing countries need to be developed with rigorous methodology. Political, technical, financial and human resource issues that emerged must be addressed. Lessons for the dissemination of sound medical specialty certification strategies are discussed.