Setting performance standards for medical practice: a theoretical framework

• Published in: Medical education Vol. 35; no. 5; pp. 474 - 481
• Main Authors: Southgate, L, Hays, R B, Norcini, J, Mulholland, H, Ayers, B, Woolliscroft, J, Cusimano, M, McAvoy, P, Ainsworth, M, Haist, S, Campbell, M
• Format: Journal Article
• Language: English
• Published: Oxford UK Blackwell Science Ltd 01.05.2001; Wiley Subscription Services, Inc
• Subjects: Clinical competence; Clinical Competence - standards; Education, Medical; Employee Performance Appraisal - organization & administration; Evidence-Based Medicine; Humans; models, theoretical; organization; Physicians - standards; quality of health care; Quality of Health Care - organization & administration; Quality of Health Care - standards; quality of health care, organization, standards; research design; theoretical
• ISSN: 0308-0110; 1365-2923
• DOI: 10.1046/j.1365-2923.2001.00897.x

Background The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance‐based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. Methods The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. Conclusion Standards that reflect the complexity of medical practice may best be developed through an ‘expert systems’ analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three‐dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.