Search

Objectives: This study aimed to determine if national licensing examinations that measure medical knowledge (QE1) and clinical skills (QE2) predict the quality of care delivered by doctors in future practice., Methods: Cohorts of doctors who took the Medical Council of Canada Qualifying Examinations Part I (QE1) and Part II (QE2) between 1993 and 1996 and subsequently entered practice in Ontario, Canada (n = 2420) were followed for their first 7-10 years in practice. The 208 of these doctors who were randomly selected for peer assessment of quality of care were studied. Main outcome measures included quality of care (acceptable/unacceptable) as assessed by doctor peer-examiners using a structured chart review and interview. Multivariate logistic regression was used to determine if qualifying examination scores predicted the outcome of the peer assessments while controlling for age, sex, training and specialty, and if the addition of the QE2 scores provided additional prediction of quality of care., Results: Fifteen (7.2%) of the 208 doctors assessed were considered to provide unacceptable quality of care. Doctors in the bottom quartile of QE1 scores had a greater than three-fold increase in the risk of an unacceptable quality-of-care assessment outcome (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.14-10.22). Doctors in the bottom quartile of QE2 scores were also at higher risk of being assessed as providing unacceptable quality of care (OR 4.24, 95% CI 1.32-13.61). However, QE2 results provided no significant improvement in predicting peer assessment results over QE1 results (likelihood ratio test: chi(2) = 3.21, P-value((1 d.f.)) = 0.07)., Conclusions: Doctor scores on qualifying examinations are significant predictors of quality-of-care problems based on regulatory, practice-based peer assessment.

Context: Poor patient-physician communication increases the risk of patient complaints and malpractice claims. To address this problem, licensure assessment has been reformed in Canada and the United States, including a national standardized assessment of patient-physician communication and clinical history taking and examination skills., Objective: To assess whether patient-physician communication examination scores in the clinical skills examination predicted future complaints in medical practice., Design, Setting, and Participants: Cohort study of all 3424 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed up until 2005, including the first 2 to 12 years of practice., Main Outcome Measure: Patient complaints against study physicians that were filed with medical regulatory authorities in Ontario or Quebec and retained after investigation. Multivariate Poisson regression was used to estimate the relationship between complaint rate and scores on the clinical skills examination and traditional written examination. Scores are based on a standardized mean (SD) of 500 (100)., Results: Overall, 1116 complaints were filed for 3424 physicians, and 696 complaints were retained after investigation. Of the physicians, 17.1% had at least 1 retained complaint, of which 81.9% were for communication or quality-of-care problems. Patient-physician communication scores for study physicians ranged from 31 to 723 (mean [SD], 510.9 [91.1]). A 2-SD decrease in communication score was associated with 1.17 more retained complaints per 100 physicians per year (relative risk [RR], 1.38; 95% confidence interval [CI], 1.18-1.61) and 1.20 more communication complaints per 100 practice-years (RR, 1.43; 95% CI, 1.15-1.77). After adjusting for the predictive ability of the clinical decision-making score in the traditional written examination, the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints (likelihood ratio test, P < .001), with scores in the bottom quartile explaining an additional 9.2% (95% CI, 4.7%-13.1%) of complaints., Conclusion: Scores achieved in patient-physician communication and clinical decision making on a national licensing examination predicted complaints to medical regulatory authorities.

Purpose: To determine the extent to which systematic differences not related to group differences in clinical competence could be observed in the results of six administrations of the same multiple-station test of clinical skills., Method: The same 16 stations were administered as part of the Ontario International Medical Graduates Program clinical skills screening examination on three different occasions, and on each occasion in two sessions. The interval between the first (fall 1986) and second (March 1990) administrations was four years, and that between the second and third (July 1990) administrations, four months. International medical graduates were the candidates in the first two administrations; the third administration was to a combined sample of fourth-year clinical clerks and interns. A different item functioning (DIF) approach with sessions within administration as the grouping variable was used to describe the extent of differences unrelated to clinical competence in the results of the different test administrations. For the generalizability and DIF calculations the designs were balanced by sampling down to 33 cases in each session., Results: Station DIF values varied considerably from station to station. DIF effects between sessions with administrations were less than those between administrations, and were less between the two administrations separated by four months than between the two administrations separated by four years., Conclusion: Hypotheses concerning the relative magnitudes of station DIF and total-test aggregated values of DIF, as a function of the time intervals between test occasions, were substantiated, demonstrating that the greater the time interval between test administrations, the greater the magnitude of DIF.

A major impediment to the use of the objective structured clinical examination (OSCE) is that it is a labor-intensive and costly form of assessment. The cost of an OSCE is highly dependent on the particular model used, the extent to which hidden costs are reported, and the purpose of the examination. The authors detail hypothetical costs of running a four-hour OSCE for 120 medical students at one medical school. Costs are reported for four phases of this process: development, production, administration, and post-examination reporting and analysis. Costs are reported at two ends of the spectrum: the high end, where it is assumed that little is paid for by the institution and that faculty receive honoraria for work put into the examination; and the low end, where it is assumed that the sponsoring institution defrays basic costs and that faculty do not receive honoraria for their participation. The total costs reported for a first-time examination were $104,400 and $59,460 (Canadian dollars) at the high and low ends, respectively. These translate to per-student costs of $870 and $496. The cost of running an OSCE is high. However, the OSCE is uniquely capable of assessing many fundamental clinical skills that are presently not being assessed in a rigorous way in most medical schools.