CLINICAL COMPETENCE ASSESSMENT RESOURCES

Description of Assessment Modalities
The PLAS has developed diverse, state-of-the-art assessment modalities that, taken together, generate pertinent data regarding a physician's medical knowledge, clinical judgment and patient management skills in his or her current or intended area of practice. An overview of the specific assessment modalities developed by the PLAS is provided below.

These tools are offered to and utilized by collaborators to complement local, performance-based methods of assessment, such as medical record reviews, peer (preceptor) assessment and feedback, patient evaluations and case-based evaluations of physician care.

Standardized Testing

• Primum® Computer-based Case Simulations (CCS) (8 computer-simulation cases; 4 hours) A computerized patient management test developed by the NBME that utilizes a spectrum of patient cases including emergency situations, acute and chronic illness. The simulation provides information that is usually present in the patient chart. The participant manages the case through the computer by gathering data and test information, or ordering treatment. No cues are provided as to what information or diagnoses should be considered. The physician decides what treatment to begin while monitoring the patient's response throughout the case. The interactive computer format of CCS permits an assessment of patient management decision-making skills in a realistic and integrated manner. Physicians preparing for assessments that include CCS should run the CCS tutorial and practice with the sample CCS cases available at the USMLE website (http://www.usmle.org/Orientation/2009/menu.html).
• Primum CCS forms are available in:
  • Generalist 1 ambulatory care
  • Generalist 2 ambulatory care
  • Hospitalist / inpatient care
  • Urgent intervention
  • Women's health care
  • Children's health care
  • Elder care
  • Cardiovascular care

Personalized Testing

• Transaction Stimulated Recall Interview (1 hour): A structured interview based on a record of the physician-participant's actions in the Primum Computer-based Case Simulations (described above). The physician-participant's performance and management choices are evaluated based on expectations of the particular cases administered.
• Medical School Subject Examinations (100 items each; 2 hours): Participants complete a subject exam specific to his or her specialty and practice area. These multiple choice question exams (MCQs) are available in the following clinical clerkship designations:
  • Internal Medicine
  • Family Medicine
  • General Surgery
  • Obstetrics & Gynecology
  • Pediatrics
  • Psychiatry
• Modular Knowledge Tests: Participants complete a selected group of objective multiple choice question exams (MCQs) specific to his or her specialty and practice. The results are used to identify possible deficiencies regarding knowledge in clinical areas. Practice-specific tests are selected to best evaluate the physician's assessment needs.
  • Mechanisms of Disease (120 items; 2 hours)
    Designed to assess knowledge of underlying basic science principles. Subscores are profiled (for descriptive and educational planning purposes) across:
    • Behavioral science
    • Anatomic structures
    • Pathology & laboratory medicine
    • Infectious disease & immunology
    • Pathophysiology
    • Physiology & metabolism

  • Interpreting the Medical Literature (40 items; 1 hour)
    Subscores are provided in general principles and patient applications
  • Ethics and Communication (100 items or two 50-item forms; 2 hours)
    Subscores are provided in knowledge of how to say things to patients and families, the patient-physician relationship, and end-of-life care including pain management. Subscores are also provided for systems-based care, which is divided among physician-to-physician interactions and how the physician uses the health care system, including legal process and reporting channels. Other subscores include patient age, location of care, and urgency to intervene; also reacting to and managing the behavior of others, and reacting to belief systems and alternative medicine.
  • Pharmacotherapeutics with practice-friendly submodules (60 items in core, 30 items in submodules; 90 minutes total) Submodules are provided for ambulatory, in-patient, women's health, or behavior-related care. Subscores are assigned in selecting the initial drug therapy, adjusting the regimen and patient follow-up, and identifying drug-drug interactions or toxic effects; also included are use of cardiovascular drugs, patient age, location of care, and urgency to intervene.
  • Women's Health Care (90 items; 90 minutes) Subscores are provided in problems relating to obstetric, gynecologic, medical, and behavioral-care encounters; also included are patient age, location of care, and urgency to intervene. The major clinical tasks assessed include knowledge of mechanisms of disease, diagnosis and diagnostic work-up, and managing therapy and interventions.
  • Internal Medicine forms Core, Ambulatory, and Geriatrics (60 items each; 75 minutes) Subscores include the major clinical tasks: mechanisms of disease, diagnosis and diagnostic work-up, and managing therapy and interventions.
  • Family Medicine forms Core 1, Core 2, and Wellness & Health Maintenance (60 items each; 75 minutes) Subscores include the major clinical tasks: mechanisms of disease, diagnosis and diagnostic work-up, and managing therapy and interventions.