Toward Meeting the Challenge of Physician Competence Assessment: The University of California, San Diego Physician Assessment and Clinical Education (PACE) Program

Abstract

Physician competence and performance problems contribute to medical errors and substandard health care quality. Assessment of the clinical competence of practicing physicians, however, is challenging. Although physician competence assessment undoubtedly does take place at the local level (e.g., hospital, medical group), it is difficult to objectively assess a partner, colleague, or friend. Moreover, the methodologies used and the outcomes are necessarily veiled by peer review statutes. Consequently, there is a need for regional or national assessment centers with the knowledge, skill, and experience to perform clinical competence assessments on individual physicians and provide or direct remediation, when appropriate. The University of California, San Diego (UCSD) Physician Assessment and Clinical Education (PACE) Program was founded at the UCSD School of Medicine in 1996 for this purpose. From inception in 1996 through the first quarter of 2009, 867 physicians have participated in the UCSD PACE Program. The PACE Program is divided into two components. Phase I includes two days of multilevel, multimodal testing, and Phase II is a five-day, preceptor-based formative assessment program taking place in the residency program of the physician's specialty. From July 2002 through December 2005, a study of 298 physician participants of the UCSD PACE Program was conducted.The future of the comprehensive assessment of practicing physicians depends on (1) development and standardization of instruments, techniques, and procedures for measuring competence and performance, including in-practice measures, (2) collaborative networking of assessment programs, (3) cost control, and (4) continued development of remedial measures that correspond to assessment findings.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs

“…Effective medical relationships have unique boundaries, however, demanding a skillful balance of empathic intimacy and mindful objectivity [3]. When the challenging task of regulating these boundaries goes awry and boundary violations occur, health care providers are often referred to specialized assessment and remediation programs [4][5][6][7][8][9][10]. To assist boundary-challenged health care providers (professionals who have been disciplined because of professional boundary violations), improve the quality of remedial boundary programs and inform preventive education and provider wellness, it is important to understand risk factors for boundary violations.…”

“…The current study aimed to explore the relationships between childhood trauma, attachment and maladaptive beliefs in a group of 100 health care professionals (89% physicians) referred to the UCSD Physician Assessment and Clinical Education (PACE) Program Professional Boundaries Program [8]. The current study aimed to explore the relationships between childhood trauma, attachment and maladaptive beliefs in a group of 100 health care professionals (89% physicians) referred to the UCSD Physician Assessment and Clinical Education (PACE) Program Professional Boundaries Program [8].…”

Practice policies for older anesthesiologists in academic departments: a national survey of academic departmental chairpersons

“…At the same time, many in the media and patient advocacy groups have questioned whether age-related physical changes affect the clinical performance of older physicians. 1 Organizations such as the National Patient Safety Foundation and some specialty boards have called for systematic ways to measure physician competency and cognitive function [2,3].…”

“…2 By 2009, the percentage had increased to 28%, and by March 2011 to 31.5%. 3 In 2009, according to AMA data, the mean ages of U.S. anesthesiologists by activity were: administration, 59.8 years; research, 58.3 years; teaching 58.5 years; and patient care, 48.7 years [4].…”

Predictors of Physician Performance on Competence Assessment

“…[6][7][8] Although other published data about physicians who present for competence assessment in the United States and Canada are limited, this body of work is growing. 3,6,[9][10][11][12] In this study, we examine CPEP program data to identify the predictors of performance on CPEP competency assessment. More specifically, we seek to identify factors that are associated with performance on competence assessment that deem the physician unsafe to practice.…”