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August 21, 1991, Vol 266, No. 7 >
ARTICLE | August 21, 1991

Medical Competence and Performance Assessment: Title and subTitle BreakA New Era FREE

Donald G. Langsley, MD
[+] Author Affiliations

The opinions expressed herein are those of the author and not necessarily those of the American Board of Medical Specialties or any of the other organizations cited.

Reprint requests to American Board of Medical Specialties, One Rotary Center, Suite 805, Evanston, IL 60201 (Dr Langsley).


JAMA. 1991;266(7):977-980. doi:10.1001/jama.1991.03470070107013
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References

Historically, the competence of physicians has been based on peer review of their performance. Formal assessment at the time of licensure and certification has been done by cognitive testing, a relatively easy method that is supported by a science of psychometrics. The assessment of actual performance has been less scientific, but that is changing.

The National Board of Medical Examiners (NBME) and the Educational Commission for Foreign Medical Graduates (ECFMG) are developing tests of clinical skills using standardized patients for live or electronic simulations. Specialty boards are seeking standardized evaluations of residency performance as part of the certification process. Licensure boards propose to develop a final step of their examinations that will test the cognitive processes used by experienced clinicians. As recertification moves toward an evaluation of practice, there is a call for competence evaluations that will also examine practice performance. These may use a battery of techniques such as

REFERENCES

1 +
Liaison Committee for Medical Education. Functions and Structures of a Medical School . Chicago, Ill: American Medical Association; 1991;.
2 +
Accreditation Council for Graduate Medical Education. General Requirements for the Approval of Graduate Medical Education Programs . Chicago, Ill: Accreditation Council for Graduate Medical Education; 1991;.
3 +
Clyman SG, Orr NA.  Status report on the NBME's computer-based testing. Acad Med . 1990;;65:235-241.
4 +
Deckert GH. Will certifying exams predict performance? Presented at the annual meeting of the Federation of State Medical Boards; April 25,1991; Seattle, Wash.
5 +
Schmidt HG, Norman GR, Boshuizen HPA.  A cognitive perspective on medical expertise: theory and implications. Acad Med . 1990;;65:611-621.
6 +
Harden RM, Gleeson FA.  Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ . 1979;;13:41-54.
7 +
Barrows HS, Williams RG, Moy RH.  A comprehensive performance-based assessment of fourth-year students' clinical skills. J Med Educ . 1987;;62:805-809.
8 +
Stillman PL, Regan MB, Swanson DB, et al.  An assessment of the clinical skills of fourth-year students at four New England medical schools. Acad Med . 1990;;65:320-326.
9 +
Conn HL, Cody RP.  Results of the second clinical skills assessment examination of the ECFMG. Acad Med . 1989;;64:448-453.
10 +
Van der Vleuten CPM, Swanson DB.  Assessment of clinical skills with standardized patients: the state of the art. Teach Learn Med . 1990;;2:58-76.
11 +
Petrusa ER, Blackwell TA, Ainsworth MA.  Reliability and validity of an objective structured clinical examination for assessing the clinical performance of residents. Arch Intern Med . 1990;;150:573-577.
12 +
Hart IR.  Correlation of performance in the OSCE with later clinical performance. Ann Rev Coll Phys Surg Can . 1983;;16:356-360.
13 +
Newble DI.  The assessment of clinical competence: a perspective from 'down under.'  In: Hart IR, Harden RM, Walton HJ, eds. Newer Developments in Assessing Clinical Competence . Montreal, Quebec: Heal Publications; 1986;:40-45.
14 +
Barrows HS. Newer Approaches to the Assessment of Clinical Performance . Springfield, Ill: Southern Illinois University Press; 1985;.
15 +
Harless WG, Duncan RC, Zier MA, Ayers WR, Berman JR, Pohl HS.  A field test of the TIME patient simulation model. Acad Med . 1990;;65:327-332.
16 +
Carline JD, Wenrich M, Ramsey PG.  Characteristics of ratings of physician competence by professional associates. Eval Health Prof 1989;;12:409-423.
17 +
Physician Review Program (PREP) . Hamilton, Ontario: College of Physicians & Surgeons of Ontario; 1988;.
18 +
Borgiel AEM, Williams JI, Anderson GM, et al.  Assessing the quality of care in family physicians' practices. Can Fam Phys . 1985;;31:853-862.
19 +
Norman GR.  Reliability and construct validity of some cognitive measures of clinical reasoning. Teach Learn Med . 1989;;1:194-199.
20 +
Meyer TC.  The role of remedial CME. Fed Bull . 1990;;77:182-187.
21 +
Breaden DG.  Markers and indicators of physician performance and fitness: an overview. Fed Bull . 1988;;75:67-73.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Liaison Committee for Medical Education. Functions and Structures of a Medical School . Chicago, Ill: American Medical Association; 1991;.
2 +
Accreditation Council for Graduate Medical Education. General Requirements for the Approval of Graduate Medical Education Programs . Chicago, Ill: Accreditation Council for Graduate Medical Education; 1991;.
3 +
Clyman SG, Orr NA.  Status report on the NBME's computer-based testing. Acad Med . 1990;;65:235-241.
4 +
Deckert GH. Will certifying exams predict performance? Presented at the annual meeting of the Federation of State Medical Boards; April 25,1991; Seattle, Wash.
5 +
Schmidt HG, Norman GR, Boshuizen HPA.  A cognitive perspective on medical expertise: theory and implications. Acad Med . 1990;;65:611-621.
6 +
Harden RM, Gleeson FA.  Assessment of clinical competence using an objective structured clinical examination (OSCE). Med Educ . 1979;;13:41-54.
7 +
Barrows HS, Williams RG, Moy RH.  A comprehensive performance-based assessment of fourth-year students' clinical skills. J Med Educ . 1987;;62:805-809.
8 +
Stillman PL, Regan MB, Swanson DB, et al.  An assessment of the clinical skills of fourth-year students at four New England medical schools. Acad Med . 1990;;65:320-326.
9 +
Conn HL, Cody RP.  Results of the second clinical skills assessment examination of the ECFMG. Acad Med . 1989;;64:448-453.
10 +
Van der Vleuten CPM, Swanson DB.  Assessment of clinical skills with standardized patients: the state of the art. Teach Learn Med . 1990;;2:58-76.
11 +
Petrusa ER, Blackwell TA, Ainsworth MA.  Reliability and validity of an objective structured clinical examination for assessing the clinical performance of residents. Arch Intern Med . 1990;;150:573-577.
12 +
Hart IR.  Correlation of performance in the OSCE with later clinical performance. Ann Rev Coll Phys Surg Can . 1983;;16:356-360.
13 +
Newble DI.  The assessment of clinical competence: a perspective from 'down under.'  In: Hart IR, Harden RM, Walton HJ, eds. Newer Developments in Assessing Clinical Competence . Montreal, Quebec: Heal Publications; 1986;:40-45.
14 +
Barrows HS. Newer Approaches to the Assessment of Clinical Performance . Springfield, Ill: Southern Illinois University Press; 1985;.
15 +
Harless WG, Duncan RC, Zier MA, Ayers WR, Berman JR, Pohl HS.  A field test of the TIME patient simulation model. Acad Med . 1990;;65:327-332.
16 +
Carline JD, Wenrich M, Ramsey PG.  Characteristics of ratings of physician competence by professional associates. Eval Health Prof 1989;;12:409-423.
17 +
Physician Review Program (PREP) . Hamilton, Ontario: College of Physicians & Surgeons of Ontario; 1988;.
18 +
Borgiel AEM, Williams JI, Anderson GM, et al.  Assessing the quality of care in family physicians' practices. Can Fam Phys . 1985;;31:853-862.
19 +
Norman GR.  Reliability and construct validity of some cognitive measures of clinical reasoning. Teach Learn Med . 1989;;1:194-199.
20 +
Meyer TC.  The role of remedial CME. Fed Bull . 1990;;77:182-187.
21 +
Breaden DG.  Markers and indicators of physician performance and fitness: an overview. Fed Bull . 1988;;75:67-73.

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