How safe are your newly employed doctors? Is adoption of routine formative patient safety assessments of clinical competence necessary?

Introduction: Adverse event related morbidity and mortality for patients admitted to hospitals in developed countries remains at 10% worldwide. Significantly, adverse events are linked to clinical management including infection control, clinical judgement and decision-making, treatment errors, communication and documentation lapses. Monitoring of the competence and safety of newly employed doctors in Australian hospitals through work-based assessment (WBA) has been traditionally considered as the role of their clinical Unit’s assigned supervisor. Such monitoring is ad hoc, irregular and task focussed. The patient safety mini-CEX (PSMC) has been seen as readily adaptable to discreet or complex clinical encounters and appears well aligned to assessors’ cognitive frameworks.
Methods: Three cohorts of International Medical Gradates (N = 107) newly in, or seeking employment in public hospitals in Victoria, participated across 476 individual or group encounters for testing of the PSMC in OSCE, fully immersive simulation, and work-based assessment settings. Experienced clinical assessors and facilitators provided postencounter
individual and group formative feedback.
Results: Analysis of the findings from the OSCE and Simulation cohorts (N = 98) suggested that between 15.6% and 44.2% of these cohorts were not competent across eleven of the thirteen PSMC clinical items (Competency Items) common to both the OSCE and simulation encounters. Between 30 and 35 % of the simulation cohort were unsatisfactory with respect to 10 domains of clinical practice. Reliability modelling yielded a Cronbach’s Alpha of .937 for salient items. Post PSMC interactive feedback sessions were critical to supporting participants’ future clinical performance.
Conclusions: The findings suggest that team performance, self-appraisal and demonstration of professional behaviour require that the safety of patients in acute care settings should be addressed within a general medical competency framework4. PSMC assessments of clinical competence appear to support the development of these general competencies.