Journal of Continuing Education in the Health Professions



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CURRENT ISSUE BACK ISSUES SUBSCRIBE ADVERTISE ABOUT JCEHP FOR AUTHORS JCEHP AWARD SEARCH (Members only) FULL-TEXT		Volume 26 (3) Volume 26, Issue 3, Summer 2006 J Contin Educ Health Prof 2006; 26(3):173-191 RESEARCH ARTICLE The prevalence and special educational requirements of dyscompetent physicians Betsy W. Williams A b s t r a c t Underperformance among physicians is not well studied or defined; yet, the identification and remediation of physicians who are not performing up to acceptable standards is central to quality care and patient safety. Methods for estimating the prevalence of dyscompetence include evaluating available data on medical errors, malpractice claims, disciplinary actions, quality control studies, medical record review studies, and in-stream assessments of physician performance. These data provide a range of estimates from 0.6% to 50%, depending on the method. A reasonable estimate of dyscompetence appears to be 6% to 12%. Agerelated cognitive decline, impairment due to substance use disorders, and other psychiatric illness can contribute to underperformance, diminishing physicians’ insight into their level of performance as well as their ability to benefit from an educational experience. Currently, dyscompetent physicians in the United States are identified through either the legal system or peer review. The primary method of resolving issues of underperformance in physicians is through continuing medical education (CME). Although a number of specialized assessment and education programs exist in the United States, these programs are largely underutilized. Similar programs exist in Canada and have provided evidence of the efficacy of a more specialized and individualized educational approach for underperforming physicians. Current specialty programs focused on this population employ individual assessments of knowledge and performance, individually designed educational programs, longterm plans for maintenance of educational activity, and repeated assessment of performance level. Noting that few CME programs offer these requirements, a number of changes to current medical quality assurance programs that might foster such educational requirements for underperforming physicians are provided. Lessons for Practice Although an operational definition of physician dyscompetence does not exist, a reasonable general estimate for its prevalence is 6% to 12% Aging, mental or physical illness or both, and substance use can influence physician dyscompetence Specialized comprehensive assessment and individualized remedial training are required to address the unique needs of dyscompetent physicians Abilities, traits, goals, and motivations contribute to an individual’s ability to participate in and benefit from an educational endeavor In the United States, there is no proactive method for identifying physician dyscompetence; they are primarily identified through peer review or regulatory processes Key Words: physician dyscompetence, prevalence, underperformance, continuing medical education, undergraduate, remediation assessment, continuing professional development
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