Medical Competence and Performance Assessment

Abstract

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