Practice Analysis for Undifferentiated Physicians: Determining the Frequency of Clinical Encounters

• In Event: Developing a Blueprint for a National Medical Licensing Examination Program: From Soup to Nuts

Abstract

Purpose

The primary purpose of this study is to review and summarize the frequency of the most common and important diagnoses encountered by Canadian physicians as an important part of a practice analysis effort aimed at the development of a blueprint and accompanying test specifications for a national medical licensing examination program.

Perspective

In developing an updated test blueprint for a licensing examination, it is important that the latter reflect the activities of the profession in question. Common approaches for a practice analysis that result in the development of a test blueprint include a job analysis or task inventory (Raymond, 2001). A practice analysis often includes a survey of the targeted population with respect to defining the importance of various professional activities and their frequency. Though important, this survey may be insufficient in comprehensively capturing the professional’s activity in the appropriate context for the undifferentiated physician who is either entering residency or who has been recently licensed (LaDuca, 1994). Surveying recent graduates may be adequate to capture what they consider important but it might not accurately reflect frequency of clinical encounters because of the diversity of practices.

Methods

Frequencies of main diagnoses in Canada were obtained for varying age groups, settings, and specific health groups. Frequently used medications and performed procedures were also obtained.

Materials

Frequency data were obtained through publically available documents from the Canadian Institute for Health Information and from specific provincial ambulatory billing databases.

Results

Top ten lists of main diagnoses were obtained for five age groups (general population, 0 to 18 years, 19-44 years, 45-64 years and >65 years) in three settings (inpatient hospitalization, emergency department, and outpatient care/clinics). In addition, main diagnoses were obtained for chronic illnesses, mental health and women’s health. More than 80 clinical encounters were identified across the age groups and settings. Most commonly used medications and performed procedures were also identified.

Scholarly significance

When doing a practice analysis, it is important to capture the professional’s activities in the proper context. This may be challenging when doing so for the undifferentiated professional through a “classic” job analysis. This study illustrates that using available physician data can yield additional critical information, i.e., a large number of clinical encounters in various settings across patient age groups. These data are in keeping with what Canadian physicians most frequently encounter in practice and are extremely valuable in conducting a practice analysis.

References

LaDuca, A. (1994). Validation of professional licensure examinations. Professions theory, test
design, and construct validity. Evaluation & the Health Professions, 17, 178-197.

Raymond, M.R. (2001). Job analysis and the specification of content for licensure and
certification examinations. Applied Measurement in Education, 14, 369-415.

Author

• Claire Touchie, Medical Council of Canada