Why are we lacking certification standards for Colombia’s doctors? An initial approach to describing the problem

Abstract

Background: Standardization of medical knowledge is crucial to set minimum standards that can serve as the basis for enhancing high-quality healthcare delivery. Colombia’s medical education system lacks regulation, which has contributed to unequitable variation in the quality, knowledge, and skill of students from different medical schools and a general lack of trust towards general practitioners. The aim of this study was to first qualitatively describe stakeholders’ perceptions of the need for a national certification process for general practitioners in Colombia and then to quantify these perceptions with a novel survey instrument.

Methods: This report uses a mixed-methods exploratory sequential study design, with 9 semi-structured interviews of key stakeholders in Colombia. Attitudes and perceptions qualitatively reported from the interviews and corresponding literature review were used to inform our development of a novel survey instrument that was distributed to doctors in Bogotá, Colombia.

Results: Our main qualitative findings from semi-structured interviews revealed that students and faculties wanted a new set of common standards for clinical practice established before an exam was in place and that an accountable entity is needed for supervision of standardization in Colombia. The small sample of respondents to our survey (n=80) were approximately representative of doctors nationally in Colombia (76% GP in the population vs 66.25% in our sample). Our main quantitative findings from the survey revealed that a substantial majority of respondents perceived an exam as beneficial for student training (77%) but simultaneously questioned its acceptance in the clinical field (38%). Lastly, a certification exam was perceived to likely increase general practitioners proficiency, specifically a pathway to effective delivery of clinical services (76.25%) and a positive change in the perceptions of doctors by patients (46%).

Conclusion: A set of educational standards is first needed in Colombia prior to implementation of a standardized, certification exam. Standardization can help address the lack of trust in general practitioners and possibly better link societal expectations and physician performance. Rigorous oversight from a new or existing institution or bureaucracy is of paramount importance to enforce accountability throughout certification process.