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Many new medical programs have been established during the last 20 years, and this trend seems set to continue as the health care needs of the world's populations become more complex and demand increases for more physicians to provide the necessary health care. In this paper, we address how best to establish a new medical school, based on our experiences in new ventures in several countries. Success requires a combination of boldness of vision, support from many stakeholder groups, adequate financial and human resources, educational expertise, confidence, patience, and persistence. [ABSTRACT FROM AUTHOR]

Background While much is now known about how to assess the competence of medical practitioners in a controlled environment, less is known about how to measure the performance in practice of experienced doctors working in their own environments. The performance of doctors depends increasingly on how well they function in teams and how well the health care system around them functions. Methods This paper reflects the combined experiences of a group of experienced education researchers and the results of literature searches on performance assessment methods. Conclusion Measurement of competence is different to measurement of performance. Components of performance could be re-conceptualised within a different domain structure. Assessment methods may be of a different utility to that in competence assessment and, indeed, of different utility according to the purpose of the assessment. An exploration of the utility of potential performance assessment methods suggests significant gaps that indicate priority areas for research and development. [ABSTRACT FROM AUTHOR]

Background Some doctors who perform poorly appear not to be aware of how their performance compares with accepted practice. The way that professionals maintain their existing expertise and acquire new knowledge and skills – that is, maintain their ‘currency’ of practice – requires a capacity to change. This capacity to change probably requires the individual doctor to possess insight into his or her performance as well as motivation to change. There may be a range of levels of insight in different individuals. At some point this reaches a level which is inadequate for effective self-regulation. Insight and performance may be critically related and there are instances where increasing insight in the presence of decreasing performance can also cause difficulties. Objective This paper presents an exploration into the nature of insight, its relationship to professional performance and its measurement as part of performance, reflecting the combined experiences of a group of experienced education researchers and the results of literature searches on insight and performance. Conclusion There may be individuals in whom insight is so lacking that they are beyond remediation. If there is a dichotomy between adequate and inadequate levels of insight, testing this could be a cost-effective way of determining where efforts for remediation should be focussed. [ABSTRACT FROM AUTHOR]

BackgroundThe assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. MethodsThe paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. ConclusionStandards that reflect the complexity of medical practice may best be developed through an ‘expert systems’ analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability. [ABSTRACT FROM AUTHOR]

Objectives Following recent changes to eligibility requirements for recognition as a general practitioner in Australia, an increasing proportion of candidates select the non-training, or practice-eligible, route to the RACGP Fellowship Examination, without the benefit of formal general practice training. Design Pass rates for the training and practice-eligible cohorts from the 1996 and 1997 examinations were determined and compared. Setting Royal Australian College of General Practitioners (RACGP). Subjects General practitioner candidates for the RACGP. Results The analysis of the 1996 and 1997 examinations showed that the overall pass rate and individual examination segment scores of the practice-eligible route candidates were lower than those for candidates from the training route. Conclusions The observed difference in performance is more probably due to different preparation for the examination than any systematic bias against particular groups of candidates. All candidates for the examination would benefit from exposure to the general practice curriculum and supervised experience in Australian general practice. [ABSTRACT FROM AUTHOR]