Medical competence and performance assessment: a new era

Article Abstract:

Physicians are licensed on the basis of their performance on written examinations; the validity and fairness of written examinations are based on years of experience as well as research by psychometric experts. However, the evaluation of actual performance in the treatment of patients is far more problematical. Traditionally, the only evaluation of physician performance has been on the basis of reviews by other physicians. Most commonly, this review takes place only in the early years of a physician's career. Now, new emphasis is being placed on the assessment of medical competence; this new emphasis requires the development of new methods of assessment. New test protocols are being developed which can test medical competence in an organized fashion. Several such tests involve the establishment of a series of test stations; at each station the physician performs a set task under the observation of a rater. These tasks include such items as taking a medical history, performing a specific physical examination, or reviewing laboratory results. In most cases, the patients for these tasks are simulated, and the role of patient many in some cases be played by the rater himself. Other tests are being developed which make use of modern computer technology. These tests are taken by interacting with a computer terminal which requires a videodisc. The details of the test case are contained in video sequences on the disc and provide authenticity which cannot be matched by the traditional written examination. These videodisc tasks also have the advantage of uniformity among all taking the examination. While the assessment of competence in the day-to-day practice of medicine is difficult, some progress is being made. A few certification boards, such as the American Board of Obstetrics and Gynecology, require a list of procedures performed in the six months prior to a recertification request. Physicians whose practice seems to be below standards may then be invited in for an oral examination which focusses on the apparent weaknesses. The assessment of clinical practice is important to assure the public that the level of medical competence is the highest practical. However, the tests need to be sufficiently accurate and objective that they are seen by physicians as an excellent means of maintaining quality, and not as an intrusion of ''Big Brother.'' (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Medical students, Residents (Medicine), Clinical competence, Medical education

---

Competency assessment of primary care physicians as part of a peer review program

Article Abstract:

The Physician Review Program (PREP) is a statistically reliable and valid component of the peer review process. PREP was developed at the request of the College of Physicians and Surgeons of Ontario. Physicians are referred to PREP if a review of their medical records indicates continuing deficiencies six months after an initial evaluation or through patient complaints. The reliability and validity of the testing instruments was assessed on three groups of a total of 83 physicians. The doctors took a multiple choice examination, were questioned about selected patient charts from their practices, met with standardized patients and took oral exams that assessed their problem solving abilities. The objective structured clinical examination component was dropped from the program because it was found to be an unreliable indicator of a doctor's abilities. The other tests were found to be very reliable and to indicate that age, solo practice, years since graduation and certification status were all correlated with competence.

Peer review

---

Similar abstracts:

• Abstracts: Improved detection and referral of patients with diabetic retinopathy by primary care physicians: effectiveness of education
• Abstracts: Continuous quality improvement: concepts and applications for physician care. Periodic physician recredentialing
• Abstracts: Minimal access general surgery: the dawn of a new era. Results of laparoscopic cholecystectomy in a university hospital
• Abstracts: Do life events or depression exacerbate inflammatory bowel disease? A prospective study. Risk factors for a positive tuberculin skin test among employees of an urban, midwestern teaching hospital
• Abstracts: Prenatal records: a national survey of content. Should physicians infected with human immunodeficiency virus be allowed to perform surgery?

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.