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CLINICIAN'S CORNER
Physician Scores on a National Clinical Skills Examination as Predictors of Complaints to Medical Regulatory Authorities
Robyn Tamblyn, PhD;
Michal Abrahamowicz, PhD;
Dale Dauphinee, MD;
Elizabeth Wenghofer, PhD;
André Jacques, MD;
Daniel Klass, MD;
Sydney Smee, MSc;
David Blackmore, PhD;
Nancy Winslade, PharmD;
Nadyne Girard, MSc;
Roxane Du Berger, MSc;
Ilona Bartman, MA;
David L. Buckeridge, MD, PhD;
James A. Hanley, PhD
JAMA. 2007;298(9):993-1001.
Context Poor patient-physician communication increases the risk of patient complaints and malpractice claims. To address this problem, licensure assessment has been reformed in Canada and the United States, including a national standardized assessment of patient-physician communication and clinical history taking and examination skills.
Objective To assess whether patient-physician communication examination scores in the clinical skills examination predicted future complaints in medical practice.
Design, Setting, and Participants Cohort study of all 3424 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed up until 2005, including the first 2 to 12 years of practice.
Main Outcome Measure Patient complaints against study physicians that were filed with medical regulatory authorities in Ontario or Quebec and retained after investigation. Multivariate Poisson regression was used to estimate the relationship between complaint rate and scores on the clinical skills examination and traditional written examination. Scores are based on a standardized mean (SD) of 500 (100).
Results Overall, 1116 complaints were filed for 3424 physicians, and 696 complaints were retained after investigation. Of the physicians, 17.1% had at least 1 retained complaint, of which 81.9% were for communication or quality-of-care problems. Patient-physician communication scores for study physicians ranged from 31 to 723 (mean [SD], 510.9 [91.1]). A 2-SD decrease in communication score was associated with 1.17 more retained complaints per 100 physicians per year (relative risk [RR], 1.38; 95% confidence interval [CI], 1.18-1.61) and 1.20 more communication complaints per 100 practice-years (RR, 1.43; 95% CI, 1.15-1.77). After adjusting for the predictive ability of the clinical decision-making score in the traditional written examination, the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints (likelihood ratio test, P < .001), with scores in the bottom quartile explaining an additional 9.2% (95% CI, 4.7%-13.1%) of complaints.
Conclusion Scores achieved in patient-physician communication and clinical decision making on a national licensing examination predicted complaints to medical regulatory authorities.
Author Affiliations: Departments of Medicine (Drs Tamblyn and Dauphinee) and Epidemiology & Biostatistics (Drs Abrahamowicz, Winslade, Buckeridge, and Hanley, and Mss Girard and Du Berger), McGill University, Montreal, Quebec, Canada; Ontario College of Physicians and Surgeons, Toronto, Ontario, Canada (Drs Wenghofer and Klass); Quebec College of Physicians, Montreal (Dr Jacques); and Medical Council of Canada, Ottawa, Ontario (Dr Blackmore and Mss Smee and Bartman).
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