Clinical Performance Assessment of Physician in Primary Care

目前，西方国家已经开始了用医师绩效测量来评估临床能力的研究。我们列举了专业活动，以实施评估个别医生表现的计划。在2005年的研究中，我们通过模拟病例情景的笔试，完成了对他们的一些临床绩效评估方法，如1)发现患者病情叙述的能力，2)诊断的合理评估能力，3)临床计划能力，4)临床推理能力。另一方面，在2006年的研究中，我们尝试建构其他更深刻的绩效评估方法，如沟通能力、情绪与价值观、患者心理社会问题处理方法、反思性实践等。然后，我们采用直接访谈的方法，对首次来我院医院就诊的患者，采用基于问卷的评定量表进行评估。在这个病人的调查中还有一个问题是a)你觉得你的问题被完全接受了吗？b)你在检查时对医生是否有礼貌和尊重？c)你是否欣赏医生对你病情的诊断并感到可靠？实际上，A医生（59岁，男）是一名全科医生，他的临床表现是由一名医学生作为采访者进行评估的，他接受过询问病人的培训。77名患者对A医生的临床表现进行评价，每3个问题分为3（非常好）、2（相当好）、1（较差）、0（非常差）。因此，a)、b)和c)题的平均得分分别为2.62、2.57和2.60。由于患者对专家医师的评价较好，本试验旨在作为一种适当的评价方法。通过模拟情景的笔试和基于问卷的对患者的直接访谈，可以对医生的临床表现和日常临床实践能力进行评估。少

At the present, the study for physician performance measurement to assess clinical competence has been started in the western countries. We enumerate the professional activities to implement the plans for assessing the performance of individual physicians.In the study of 2005, we accomplished the methods of some clinical performance assessment of them, such as abilities of 1) detecting patient's narration of illness, 2) reasonable assessment for diagnosis, 3) clinical planning, 4) clinical reasoning, by written tests using scenarios of simulated cases. On the other hand, in the study of 2006, we tried to make up the methods of other more profound performance assessment of them, such as abilities of 5) communication, 6) emotions and values, 7) approach for patient's psycho-social problems, 8) reflective practice. Then, we assessed these performances by a direct interview method to the patient who visited our university hospital firstly, using a rating scale based on the questionnaire. M … More ain questionnaire on this patient's survey was a) did you feel your problems being fully accepted?, b) did you feel politeness and respect to physician in examinations?, c) did you appreciate physician accounts about diagnosis of your sickness and feel reliance?. Actually, clinical performance of doctor A (59 year old, male), a veteran of the general practice, was assessed using this method by the medical student as an interviewer who was trained to ask patient. The 77 patient's evaluations of the clinical performance to doctor A was performed in each 3 questions by rating scales of 3 (very well), 2 (fairly well), 1 (rather poor), 0 (very poor). As a result, the mean score of question a), b) and c) was 2.62, 2.57 and 2.60, respectively. The assessment by the patients to an expert physician performance being excellent, this trial of theassessment for physician performance was supposed to be as an adequate method.The physician assessment for the clinical performance and competence on daily clinical practices became possible using both written test of simulated scenario and direct interview to patient about the physician performance based on the questionnaire. Less