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Does competence of general practitioners predict their performance? Comparison between examination setting and actual
J J Rethans1, F Sturmans, R Drop
1Centre for Quality Assurance in Research in General Practice, University of Nijmegen, The Netherlands.
BMJ (Clinical Research Ed.)
|November 30, 1991
Summary
Physician competence, what doctors can do, differs significantly from their actual performance in practice. Actual practice performance is only predictable when efficiency and time are considered, showing competence and performance are distinct.
Area of Science:
- Medical Education
- General Practice
- Healthcare Quality Assessment
Background:
- Distinguishing physician competence from actual practice performance is crucial for healthcare quality.
- National standards provide a benchmark for assessing general practitioners' capabilities.
Purpose of the Study:
- To investigate the relationship between general practitioners' competence and their daily practice performance.
- To determine if competence assessment predicts real-world performance.
Main Methods:
- Four standardized patient cases were used to assess 36 general practitioners' competence and performance.
- Simulated patients evaluated consultations during normal surgery hours and a controlled test.
- Competence and performance scores were correlated, considering efficiency and consultation time.
Main Results:
- Physician competence scores were 49% higher than performance scores (p < 0.0001).
- No significant correlation was found between competence and performance initially.
- A significant positive correlation (0.45, p < 0.01) emerged when efficiency and time were included.
Conclusions:
- Physician competence assessment predicts practice performance only when efficiency and time are factored in.
- Substandard performance does not automatically indicate a lack of competence.
- Competence and performance represent distinct, though related, constructs in medical practice.