The Competent Physician: What Does the Public Expect?

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

Abstract

Purpose

A representative public survey was conducted to inform a practice analysis exercise for a national licensing examination in medicine. This survey targeted three non-medical expert competencies from the CanMEDS framework (Frank, 2005).

Perspective

Medical licensing examinations impact medical students, residents, practicing physicians, other healthcare professionals, and most importantly, the general public. A practice analysis is a key activity that not only informs the set of knowledge and skills that should be assessed as outlined by the resulting test blueprint but it also provides important validity evidence for the interpretation of high-stakes medical licensing examination scores. The opinions of healthcare professionals indicate what medical knowledge and skills competent physicians should demonstrate.

However, as end-users, it is also critical that members of the public have a voice in determining some of the non-medical expert competencies physicians should exhibit.

Methods

A nationally representative adult sample was selected based on census population information. Respondents were required to have visited a physician at least once within the last year.

A total of 1,102 respondents completed the public survey. The survey included 38 Likert scale questions that targeted three non-expert medical competencies (professional, collaborator, and communicator CanMEDS roles) and one open-ended question regarding competencies the public thought were most important for a physician to demonstrate.

Results

Public responses to the set of 38 selected-response questions were highly similar to those provided by physicians, indicating a high degree of agreement between different stakeholders.

A total 997 responses were provided to the open-ended question “What are the most important competencies that a physician should have?” The content of responses was grouped into four main themes. Comments that overlapped across multiple themes were coded more than once.

• The largest theme related to physician skills or characteristics (N = 748). Responses grouped under this theme most often referred to listening to patients (N = 261), demonstrating empathy (N = 234), being a good communicator (N = 213), and demonstrating understanding (N = 89).

•The second largest theme related to physician knowledge and credibility (N = 673). Responses coded under this theme often made reference to the ability to demonstrate a broad knowledge base (N =271) a range of experience (N = 261), including up to date training (N=125).

•The third largest theme concerned the ability to demonstrate a patient-centered approach (N=416). Comments that fell under this theme included referring to another doctor or specialist as needed (N=91), focusing on the patient problem N=88) and demonstrating of a range of diagnostic skills (N=78).

•The final theme identified concerned issue of timing (N = 119). The majority of these comments related to taking time to listen and care for patients (N = 100).

Scholarly significance

The blueprint of a medical licensing examination should mirror practice in the field. As such, public opinion provides an important and unique perspective on what non-medical expert competencies are essential for a physician to demonstrate in an encounter with a patient.

Author

• Marguerite Roy, Medical Council of Canada