No doctor will deny an ethical obligation to provide competent clinical care to patients, but many have been reluctant to embrace compulsory continuing medical education (CME) or compulsory recertification of their professional competence. Such reluctance in regard to making this obligation compulsory relates to factors including scepticism that recertification will necessarily improve standards of patient care or prevent the problems created by incompetent members of the profession; awareness that the medical profession is generally very committed to CME, and to evaluation of care through clinical research and its dissemination and publication; and, lastly, sensitivity by many doctors to the accountability already required of them by the courts, health complaints mechanisms and medical boards. There has, however, emerged a more positive approach to the need to document maintenance of professional competence in the profession with formal initiatives taken by all the medical colleges. These initiatives, while eschewing examinations, are designed to reflect the realities of everyday professional life and are consistent with education and learning theory, itself still evolving. A small proportion of doctors still resent this perceived bureaucratic intrusion, but the benefits for the medical profession and the community outweigh any additional effort involved in documenting what most doctors already do.

Apart from the ethical dimension there are other influences at work in the move to document the maintenance of professional learning and competence of doctors.