The relationship between competence and performance: implications for assessing practice performance
Version of Record online: 17 OCT 2002
Volume 36, Issue 10, pages 901–909, October 2002
How to Cite
Rethans, J.-J., Norcini, J. J., Barón-Maldonado, M., Blackmore, D., Jolly, B. C., LaDuca, T., Lew, S., Page, G. G. and Southgate, L. H. (2002), The relationship between competence and performance: implications for assessing practice performance. Medical Education, 36: 901–909. doi: 10.1046/j.1365-2923.2002.01316.x
- Issue online: 17 OCT 2002
- Version of Record online: 17 OCT 2002
- Received 20 March 2002; editorial comments to authors 13 June 2002; accepted for publication 17 June 2002
- clinical competence/*standards;
- physicians, family/*standards;
- education, medical, continuing/*standards;
- quality of health care/standards
Objective This paper aims to describe current views of the relationship between competence and performance and to delineate some of the implications of the distinctions between the two areas for the purpose of assessing doctors in practice.
Methods During a 2-day closed session, the authors, using their wide experiences in this domain, defined the problem and the context, discussed the content and set up a new model. This was developed further by e-mail correspondence over a 6-month period.
Results Competency-based assessments were defined as measures of what doctors do in testing situations, while performance-based assessments were defined as measures of what doctors do in practice. The distinction between competency-based and performance-based methods leads to a three-stage model for assessing doctors in practice. The first component of the model proposed is a screening test that would identify doctors at risk. Practitioners who ‘pass’ the screen would move on to a continuous quality improvement process aimed at raising the general level of performance. Practitioners deemed to be at risk would undergo a more detailed assessment process focused on rigorous testing, with poor performers targeted for remediation or removal from practice.
Conclusion We propose a new model, designated the Cambridge Model, which extends and refines Miller's pyramid. It inverts his pyramid, focuses exclusively on the top two tiers, and identifies performance as a product of competence, the influences of the individual (e.g. health, relationships), and the influences of the system (e.g. facilities, practice time). The model provides a basis for understanding and designing assessments of practice performance.