is the case with most other aspects of health care, each profession approaches regulation differently, using variable terminology and approaches to CE, employing different learning requirements, and developing unique regulatory processes.

Since the early 1970s, CE for health professionals has been linked directly to licensure, certification, and credentialing. The various regulatory authorities—states for licensure, specialty societies for certification, and health care organizations for credentialing—attempt to ensure that a given health professional’s background meets some minimal standard of quality.

Learning tools such as self-assessment, peer evaluation, and learning portfolios should all have a role in supporting the acquisition of knowledge and skills, reinforcing competence, and reassuring the public’s trust (Cooke et al., 2006). However, current licensing and certification systems principally assess learning only by measuring health professionals’ participation in CE. Despite some professions’ efforts to recognize achievement in knowledge, competence, and performance (Miller et al., 2008), the systems are still strongly linked to participation and not specifically focused on measures that really matter—changes in professional behavior and patient outcomes.

In many health professions, professionals are mandated by law to receive a license to practice from a state licensing board (Mazmanian et al., 1979), and health professionals may hold a license in more than one state. This requirement is arguably the strongest regulatory tool available to assess individual health professionals. However, licensure has been linked only tangentially to performance improvement (Davis et al., 2003). Moreover, while initial licensure establishes the minimum competence required for admission to a profession, it does not guarantee that a health professional will maintain competency or provide a high level of care.

Many states call for health professionals to apply for periodic relicensure, which often requires varying amounts of CE credits or hours. Requirements differ greatly by state and by health profession (see Figure 3-1). The various professional state boards are represented by national organizations, such as the Federation of State Medical Boards and the National Council of State Boards of Nursing. CE licensure requirements are generally organized around