The GP tests of competence assessment: which part best predicts fitness to practise decisions?

Authors:
Leila Mehdizadeh
Leila Mehdizadeh
University College London
United Kingdom
Alison Sturrock
Alison Sturrock
University College London

BMC Med Educ 2018 Jan 2;18(1). Epub 2018 Jan 2.

Research Department of Medical Education, University College London, London, UK.

Background: The General Medical Council (GMC) conducts Tests of Competence (ToC) for doctors referred for Fitness to Practise (FtP) issues. GPs take a single best answer knowledge test, an Objective Structured Clinical Examination (OSCE), and a Simulated Surgery (SimSurg) assessment which is a simulated GP consultation. The aim of this study was to examine the similarities between OSCEs and SimSurg to determine whether each assessment contributed something unique to GP ToCs.

Methods: A mixed methods approach was used. Data were collated on 153 GPs who were required to undertake a ToC as a part of being investigated for FtP issues between February 2010 and October 2016. Using correlation analysis, we examined to what degree performance on the knowledge test, OSCE, and SimSurg related to case examiner recommendations and FtP outcomes, including the unique predictive power of these three assessments. The outcome measures were case examiner recommendations (i) not fit to practise; ii) fit to practise on a limited basis; or iii) fit to practise) as well as FtP outcomes (i) erased/removed from the register; ii) having restrictions/conditions; or iii) be in good standing). For the qualitative component, 45 GP assessors were asked to rate whether they assess the same competencies and which assessment provides better feedback about candidates.

Results: There was significant overlap between OSCEs and SimSurg, p < 0.001. SimSurg had additional predictive power in the presence of OSCEs and the knowledge test (p = 0.030) in distinguishing doctors from different FtP categories, while OSCEs did not (p = 0.080). Both the OSCEs (p = 0.004) and SimSurg (p < 0.001) had significant negative correlations with case examiner recommendations when accounting for the effects of the other two assessments. Inductive thematic analysis of the responses to the questionnaire showed that assessors perceived OSCEs to be better suited to target specific knowledge and skills. SimSurg was thought to produce a more global picture as the scenarios more accurately portray a patient consultation.

Conclusion: While all three assessments are strong predictors of both case examiner recommendations and FtP outcomes, our findings suggest that the efficiency of GP ToCs can be improved by removing some of this overlapping content.

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12909-017-1111-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748949PMC
January 2018
5 Reads

Publication Analysis

Top Keywords

fit practise
12
examiner recommendations
8
case examiner
8
fitness practise
8
ftp issues
8
ftp outcomes
8
tests competence
8
osces simsurg
8
knowledge test
8
practise
5
determine assessment
4
standing qualitative
4
simsurg determine
4
simsurg case
4
tocsmethods mixed
4
mixed methods
4
good standing
4
unique tocsmethods
4
contributed unique
4
assessment contributed
4

Similar Publications

Are the General Medical Council's Tests of Competence fair to long standing doctors? A retrospective cohort study.

BMC Med Educ 2015 Apr 21;15:80. Epub 2015 Apr 21.

Royal College of Physicians, London, UK.

Background: The General Medical Council's Fitness to Practise investigations may involve a test of competence for doctors with performance concerns. Concern has been raised about the suitability of the test format for doctors who qualified before the introduction of Single Best Answer and Objective Structured Clinical Examination assessments, both of which form the test of competence. This study explored whether the examination formats used in the tests of competence are fair to long standing doctors who have undergone fitness to practise investigation. Read More

View Article
April 2015

Doctors who pilot the GMC's Tests of Competence: who volunteers and why?

Postgrad Med J 2014 Dec 14;90(1070):675-9. Epub 2014 Oct 14.

Division of University College London Medical School, University College London, London, UK.

Background: Doctors who are investigated by the General Medical Council for performance concerns may be required to take a Test of Competence (ToC). The tests are piloted on volunteer doctors before they are used in Fitness to Practise (FtP) investigations.

Objectives: To find out who volunteers to take a pilot ToC and why. Read More

View Article
December 2014

Evaluation of outcomes of a formative objective structured clinical examination for second-year UK medical students.

Int J Med Educ 2015 Jun 21;6:76-83. Epub 2015 Jun 21.

GKT School of Medical Education, Faculty of Life Sciences and Medicine, King's College London,UK.

Objective: To explore how formative OSCEs influence student performance and perception when undertaking summative OSCEs.

Methods: We introduced formative OSCEs for second-year medical students at a large London medical school. Examination data from both formative and subsequent summative OSCEs were analysed to determine the effect on summative OSCE performance. Read More

View Article
June 2015

The value of best-practice guidelines for OSCEs in a postgraduate program in an Australian remote area setting.

Rural Remote Health 2014 27;14(3):2469. Epub 2014 Jul 27.

University of Queensland, Brisbane, Queensland, Australia.

Introduction: Nurses in remote areas of Australia are the primary healthcare professionals, who need to be able to deliver comprehensive and culturally sensitive care to clients, many of whom are Indigenous Australians. Adequate and specific preparation for practice is crucial to the quality of care delivered by remote area nurses (RANs). Objective structured clinical examinations (OSCE) provide an excellent opportunity for student practice in a simulated environment that is safe, authentic, fair and valid when well constructed. Read More

View Article
May 2015