Studying Bias in Evaluations of Doctors

According to an article in the British Medical Journal, official assessments of a doctor’s professionalism should be considered carefully before being accepted due to the tendency for some doctors to receive lower scores than others, and the tendency of some groups of patient or colleague assessors to provide lower scores.

Researchers from the Peninsula College of Medicine and Dentistry in Exeter investigated whether there were any potential patient, colleague and doctor-related sources of bias evident in the assessment of doctors’ professionalism.

A new system of revalidation for all UK doctors is being developed by the General Medical Council (GMC) which could be introduced next year as a way of ensuring doctors are fit to continue to practice. This is likely to involve the use of multi-source feedback from patients, peers and supervisors as part of the evidence used to judge a clinician’s performance. Data from two questionnaires completed by patients and colleagues was used. A group of 1,065 doctors from 11 different settings, including mostly NHS sites took part in the study.

They were asked to nominate up to 20 medical and non-medically trained colleagues to take part in an online secure survey about their professionalism, as well as passing on a post-consultation questionnaire to 45 patients each. Collectively, the doctors returned completed questionnaires from 17,031 colleagues and 30,333 patients.

Analysis of the results that allowed for characteristics of the doctor and the patient to be taken into account, showed that doctors were less likely to receive favorable patient feedback if their primary medical degree was from any non-European country.
Several other factors also tended to mean doctors got less positive feedback from patients, such as that they practiced as a psychiatrist, the responding patient was not white, and the responding patient reported that they were not seeing their “usual doctor.”

From colleagues, there was likely to be less positive feedback if the doctor in question had received their degree from any country other than the UK or South Asia. Other factors that predicted a less favorable review from colleagues included that the doctor was working in a locum capacity, the doctor was working as a GP or psychiatrist, or the colleague did not have daily or weekly professional contact with the doctor.

In fully adjusted models, the doctor’s age, sex, and ethnic group were not independent predictors of patient or colleague feedback. Neither the age or sex profiles of the patient or colleague samples were independent predictors of doctors’ feedback scores, and nor was the ethnic group of colleague samples.

The researchers say they have identified possible “systematic bias” in the assessment of doctors’ professionalism and concluded that “Systematic bias may exist in the assessment of doctors’ professionalism arising from the characteristics of the assessors giving feedback, and from the personal characteristics of the doctor being assessed. In the absence of a standardized measure of professionalism, doctor’s assessment scores from multisource feedback should be interpreted carefully, and, at least initially, be used primarily to help inform doctor’s professional development.”

BMJ 2011; 343:d6212

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