Turnbull J, Carbotte R, Hanna E, Norman G, Cunnington J, Ferguson B, Kaigas T
Department of Continuing Education, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Acad Med. 2000 Feb;75(2):177-81. doi: 10.1097/00001888-200002000-00018.
Remediation of some incompetent physicians has proven difficult or impossible. The authors sought to determine whether physicians with impaired competency had neuropsychological impairment sufficient to explain their incompetence and their failure to improve with remedial continuing medical education (CME).
During a one-year period, 1996-97, all 27 participants in the Physician Review Program (PREP) conducted at McMaster University, a physician competency assessment program, undertook a detailed neuropsychological screening battery.
Nearly all physicians assessed as competent also performed well on the neuropsychological testing. However, a significant number (about one third) of the physicians who performed poorly on the competency assessment had neuropsychological impairments sufficient to explain their poor performances. The difficulties were more marked in elderly physicians.
A significant minority of incompetent physicians have cognitive impairments sufficient to explain both their incompetence and, probably, their failure to improve with remedial CME. Testing physicians for these impairments is important: to detect and treat reversible conditions, to manage irreversible conditions that preclude successful educational intervention, and to facilitate compensation in this instance. Serious consideration should be given to the incorporation of neuropsychological screening in all intensive physician review programs.
事实证明，纠正一些不称职的医生既困难又不太可能。作者试图确定能力受损的医生是否存在足以解释其不称职以及他们在补救性继续医学教育（CME）中未能改善的神经心理损伤。
在1996 - 1997年的一年时间里，参加麦克马斯特大学开展的医生评估项目——医生评审计划（PREP）的所有27名参与者，都接受了一套详细的神经心理筛查。
几乎所有被评估为称职的医生在神经心理测试中也表现良好。然而，在能力评估中表现不佳的医生中有相当一部分（约三分之一）存在足以解释其糟糕表现的神经心理损伤。这些困难在年长医生中更为明显。
相当一部分不称职的医生存在认知损伤，这足以解释他们的不称职以及可能在补救性CME中未能改善的情况。对医生进行这些损伤的检测很重要：以检测和治疗可逆情况，处理排除成功教育干预的不可逆情况，并在此情况下促进补偿。应认真考虑在所有强化医生评审项目中纳入神经心理筛查。
