Kyran:
I have evaluating and working over the past 8-9 years with physicians who
have questionable practice patterns and who cannot or will not keep current.
I work with state licensing boards (in the US physicians are licensed by
individual states, there is no national license), hospital boards,
professional organizations, local physician health committees, etc. across
the country.
It has been my experience that when physician's performance rises (?) to a
level that competence is questioned, simple audits are insufficient. We
conduct a significant evaluation process that includes medical knowledge
assessment, chart reviews, simulated patient testing, comprehensive
psychological and physical examinations, significant psychometric
instruments, etc.
Our collective wisdom suggests that these physicians do not have a deficit
in a single area of medical performance but rather exhibit a general
depression of skills, abilities and attitudes across a wide range of areas.
The problem is to identify those physicians who may derive benefit from
targeted remediation, design, implement and monitor appropriate intervention
programs, and then conduct follow-up to assess the impact of the programs.
Our interventions have range from educational programming to proctored
surgical observations.
There are two such active programs in the US, one here in Syracuse, NY and
one in Colorado. Both programs are self-funded. Physicians are charged for
the assessments and for monitoring and other services related to
interventions. Would be pleased to discuss our program in detail with
anyone.
You are correct. This is a complex issue that requires complex
approaches.
Don't know if this addresses your question/comment. If you would like to
continue to explore this, please let me know.
Bill
William D. Grant, Ed.D.
Executive Vice Chair, Research Professor
Director, Center for Evidence Based Practice
Department of Family Medicine
SUNY Upstate Medical University
475 Irving Ave., #200
Syracuse, NY 13210
315.464.6997
315.464.6982 (f)
>>> <[log in to unmask]> 01/13 6:08 AM >>>
Clinicians need answers but can be unaware of an appropriate methodology
to
pursue the qustion.
One of my partners is part of the Performance Review Quartet for the
county
which visits family doctors who have been the subject of complaints or
about
whom others have raised doubts.
The tools for performance are those used to assess practices for training
status
and are all simple process measures eg cytology/ immunisation rates and
have
any audits been done. I get the impression that the real work is done with
informal
global ratings.
Having just read through Health Scales Measurement ( Streiner and Norman)
myself, I begin to get a feel for the sheer complexity of this type of
assessment.
I wonder if anyone out there has been asked as an academic to provide help
in
this area. In these days of increasing openness and clinical governance
such
assessments will be made whether well or badly. It only seems right that
we
should have valid and reliable measures when so much is at stake for
patients
and professionals careers too.
Kyran Farrell
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