How Am I Doing?

The Hospitalist. 2007 December;2007(12):

December 1, 2007|The Hospitalist

How hospitalists assess their performance and hone their skills is critical to patient care. Continuing medical education (CME), relicensure, specialty recertification, and lifelong learning are all linked to hospitalists’ abilities to assess and meet their learning needs.

But the preponderance of evidence suggests physicians have limited ability to accurately assess their performance, according to a physician self-assessment literature review published in September 2006 in JAMA.1

“Self-assessment should be guided by tools designed by experts, based on standards, and aimed at filling gaps in knowledge, skills, and competencies—not simply the internally based self-rating of individual practitioners,” says C. Michael Fordis, MD, senior associate dean for con-

tinuing medical education at the Baylor College of Medicine in Houston, and one of the authors of the study.

“Hospitalists and other physicians are not doing themselves a service to rely on their own internal self-rated judgments of knowledge and performance,” Dr. Fordis says. “There’s too much to know, too much that’s changing, and too much that affects the implementation into practice of the knowledge that you have for any one person to be able to take care of patients and at the same time have some sense of whether there are gaps along that implementation pathway.”

“Guided” self-assessment represents the thinking of many experts who ask questions, consider guidelines, and suggest tools that can help physicians pursue the best ways of identifying those gaps that reflect differences in what they think they are doing and their actual performance.

Regular, consistent self-assessment is imperative for a self-regulating profession such as medicine. How well are hospitalists doing—and what mechanisms or tools do they use?

HOW TO SELF-ASSESS

Develop a more holistic continuing professional development process (learning portfolios, documentation of practice-based learning and improvement activities), creating less general and more detailed learning and practice objectives;
Reduce the variation between self- and external assessments by encouraging the internalization of objective measurements or benchmarks of performance;
Use multisource feedback evaluations especially to address more difficult improvement needs that may be difficult to assess (communication, psychosocial);
Consider using objective measures of competence and performance;
Increase the role of specialty societies by providing current evidence-based learning objectives on a regular basis to give members external markers of competence;
Make self-assessment an iterative process that particularly focuses on scope of practice; and
Use separate initiatives to identify physicians who require remediation. Although those professionals can also benefit from guided self-assessment, the process is designed primarily to support competent physicians who want to continuously improve their practice performance.—AS

Group Assessment

Hospital medicine groups are increasingly able to measure their clinical competence against other hospitals’ and hospitalist groups. SHM’s Benchmarks Committee has been working on performance assessment at a program level.

“When the JCAHO [Joint Commission on Accreditation of Healthcare Organizations] Core Measures were coming out a few years back, as a whole most docs when reflecting on their practice would say they do a fine job within these measures,” says Burke T. Kealey, MD, chairman of the Benchmarks Committee from 2006-07. “For instance, [they might say] ‘I always send people out on ACE inhibitors and beta-blockers,’ or, ‘We always start people on aspirin when they come into the ER,’ but when you looked at the data, you found that their self-assessment was not as accurate as we hoped it would be.”

A lot of hard work went into discovering why their self-assessment was inaccurate. “We found there were documentation problems that they didn’t really incorporate a lot of the contraindications when giving their answer about self-assessment,” says Dr. Kealey, who leads the hospital medicine program at Regions Hospital and HealthPartners Medical Group in St. Paul, Minn.