DEFENSIBLE ASSESSMENT OF THE COMPETENCE OF THE PRACTICING PHYSICIAN

When a physician's licence to practice is at stake, professional accep tance and legal challenge are concerns for an organization undertaking competency assessments for practicing physicians. In 1995 the Physici an Review and Enhancement Program (PREP), a program of McMaster Univer sity sponsored by the College of Physicians and Surgeons of Ontario, u nderwent an external review by evaluation experts. As a results, one o f the four assessment tools, the Structured Office Oral, was dropped, as it was insufficiently structured to be reliable and because it did not add significantly to the other tools. The content of all assessmen t tools was revised based on a PREP-developed blueprint for family pra ctice. The multiple-choice questions (MCQs) were upgraded through coll aboration with Canada's physician-accrediting body, the Medical Counci l of Canada (MCC), by the physician assessors, who chose MCQs accordin g to the blueprint from the MCC question bank. The standardized-patien t assessment was also refined by these physicians, who developed scena rios of standardized clinical cases with predefined performance criter ia. Finally, through collaboration with the American Board of Emergenc y Medicine, a chart-stimulated recall test, in which the physician's o wn patient records are used to assess the physician's practice behavio r, was restructured to ensure objectivity in standardization and inter pretation. The result of these changes in the assessment tools is a mo re standardized and structured program of assessing physicians' compet encies.