Biomedical subjects

R Drop

Publications and source records attributed to R Drop.

10 recordsLinked to original sources

PubMed1991

Does competence of general practitioners predict their performance? Comparison between examination setting and actual practice.

OBJECTIVE: To study the differences and the relation between what a doctor actually does in daily practice (performance) and what he or she is capable of doing (competence) by using national standards for general practice. DESIGN: General practitioners were consulted by four standardised (simulated) patients portraying four different cases during normal surgery hours. Later the doctors participated in a controlled practice test, for which they were asked to perform to the best of their ability. In the test they saw exactly the same standardised cases but in different patients. The patients reported on the consultations. SETTING: Province of Limburg, the Netherlands. SUBJECTS: 442 general practitioners invited by a letter. 137 (31%) agreed to participate, of whom 36 were selected and visited. MAIN OUTCOME MEASURES: Number of actions taken during the consultations across complaints and for each category of complaint: the competence and performance total scores. Combination of scores with duration of consultations (efficiency-time score). Correlation between scores in the competence and performance part. RESULTS: Mean (SD) total score across complaints for competence was 49% higher than in the performance test (81.8 (11) compared with 54.7 (10.1), p less than 0.0001). The Pearson correlation across complaints between the competence total score and the performance total score of the participating physicians was -0.04 (not significant). When efficiency and consultation time of the consultations were taken into account, the correlation was 0.45 (p less than 0.01). CONCLUSIONS: Assessment of competence under examination circumstances can have predictive value for performance in actual practice only when factors such as efficiency and consultation time are taken into account. Below standard performance of physicians does not necessarily reflect a lack of competence. Performance and competence should be considered as distinct constructs.

Clinical Competence↗

PubMed1991

A method for introducing standardized (simulated) patients into general practice consultations.

A study has been undertaken to determine whether it is possible for a set of standardized (simulated) patients to visit general practitioners, without being detected, in a health care system where doctors have fixed patient lists. Since sending standardized patients into doctors' offices is a new way to assess the performance of general practitioners; this paper describes in detail the methodology that has been used for visits. The paper looks first at the general preparation for visits and secondly at the specific preparation concerning the fine detail of the individual visit. The method was tested in 156 consultations with 39 general practitioners and in no cases were the standardized patients detected. None of the doctors visited felt offended and all were prepared to cooperate in future studies with standardized patients. It is concluded that the standardized patient method, following the step-by-step procedure described, is feasible in actual practice.

Clinical Competence↗

PubMed1991

Assessment of the performance of general practitioners by the use of standardized (simulated) patients.

A study was undertaken whereby a set of standardized (simulated) patients visited general practitioners without being detected, in a health care system where doctors had fixed patient lists. Thirty nine general practitioners were each visited during normal surgery hours by four standardized patients who were designed to be indistinguishable from real patients. The objective of the study was to see whether the actual performance of general practitioners, as assessed by standardized patients, met predetermined consensus standards of care for actual practice. The patients presented standardized accounts of headache, diarrhoea, shoulder pain and diabetes. The mean group scores of the doctors on the predefined standards of care for the different complaints ranged from 33 to 68%. The results show that standardized patients may be the method of choice in the assessment of the quality of actual care of doctors. It is hypothesized that the substandard scores of the doctors do not reflect inadequate competence, but are a result of the difference between competence and performance.

Clinical Competence↗

PubMed1990

Competence and performance: two different concepts in the assessment of quality of medical care.

In the debate about 'what is a competent general practitioner?' little attention has been paid ot the actual practice situation of general practitioners. This paper, based on the 18 most important studies in the literature about medical competence, tries to re-initiate this debate by proposing a clear distinction between 'competence', (what a physician is capable of doing) and 'performance' (what a physician does in his day-to-day practice). With this distinction we looked at whether studies defined both competence and performance, how they dealt with these concepts, what measurement instruments were used and what the conclusions of the studies were. Although it is the common reasoning that competence is a good predictor of performance this concept could not be affirmed. This survey shows that the majority of studies use wrong concepts and come to invalid conclusions. With the empirical distinction between competence and performance however, this paper proposes new directions for the quality assessment of general practitioners.

Clinical Competence↗

PubMed1978