Assessment of physician competence in prehospital trauma care.

In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, self-assessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. Significant positive correlations were found between the results of the written examination and the peer evaluation on two of four measures (r = 0.36, P = 0.001; r = 0.23, P = 0.05) as well as on the two measures regarding self-evaluation and peer evaluation (r = 0.54, P = 0.001; r = 0.38, P = 0.05). It was found that those physicians who were trained in the army's medical officer course scored significantly higher on the written examination (P = 0.001) and were rated more highly by their senior peers (P = 0.048) than those who did not receive such training. It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.