Evaluation of a High Stakes Physician Competency Assessment: Lessons for Assessor Training, Program Accountability, and Continuous Improvement.

Introduction: There is a dearth of evidence evaluating postlicensure high-stakes physician competency assessment programs. Our purpose was to contribute to this evidence by evaluating a high-stakes assessment for assessor inter-rater reliability and the relationship between performance on individual assessment components and overall performance. We did so to determine if the assessment tools identify specific competency needs of the assessed physicians and contribute to our understanding of physician dyscompetence more broadly.

Method: Four assessors independently reviewed 102 video-recorded assessments and scored physicians on seven assessment components and overall performance. Inter-rater reliability was measured using intraclass correlation coefficients using a multiple rater, consistency, two-way random effect model. Analysis of variance with least-significant difference post-hoc analyses examined if the mean component scores differed significantly by quartile ranges of overall performance. Linear regression analysis determined the extent to which each component score was associated with overall performance.

Results: Intraclass correlation coefficients ranged between 0.756 and 0.876 for all components scored and was highest for overall performance. Regression indicated that individual component scores were positively associated with overall performance. Levels of variation in component scores were significantly different across quartile ranges with higher variability in poorer performers.

Discussion: High-stake assessments can be conducted reliably and identify performance gaps of potentially dyscompetent physicians. Physicians who performed well tended to do so in all aspects evaluated, whereas those who performed poorly demonstrated areas of strength and weakness. Understanding that dyscompetence rarely means a complete or catastrophic lapse competence is vital to understanding how educational needs change through a physician's career.