Multisource Feedback in Evaluating the Performance of Doctors: The Example of the UK General Medical Council Patient and Colleague Questionnaires

Purpose Internationally, there is increasing interest in monitoring and evaluating doctors’ professional practice. Multisource feedback (MSF) offers one way of collecting information about doctors’ performance. The authors investigated the psychometric properties of two questionnaires developed for this purpose and explored the biases that may exist within data collected via such instruments. Method A cross-sectional study was conducted in 11 UK health care organizations during 2008–2011. Patients (n = 30,333) and colleagues (n = 17,012) rated the professional performance of 1,065 practicing doctors, using the General Medical Council Patient Questionnaire (PQ) and Colleague Questionnaire (CQ). The psychometric properties of the questionnaires were assessed, and regression modeling was used to explore factors that influenced patient and colleague responses on the core questionnaire items. Results Although the questionnaires demonstrated satisfactory internal consistency, test–retest reliability, and convergent validity, patient and colleague ratings were highly skewed toward favorable impressions of doctor performance. At least 34 PQs and 15 CQs were required to achieve acceptable reliability (G > 0.70). Item ratings were influenced by characteristics of the patient and colleague respondents and the context in which their feedback was provided. Conclusions The PQ and CQ are acceptable for the provision of formative feedback on a doctor’s professional practice within an appraisal process. However, biases identified in the questionnaire data suggest that caution is required when interpreting and acting on this type of information. MSF derived from these questionnaires should not be used in isolation to inform decisions about a doctor’s fitness to practice medicine.

[1]  R. Lipner,et al.  The Value of Patient and Peer Ratings in Recertification , 2002, Academic medicine : journal of the Association of American Medical Colleges.

[2]  Bryan Burford,et al.  Validation of a multi-source feedback tool for use in general practice , 2010, Education for primary care : an official publication of the Association of Course Organisers, National Association of GP Tutors, World Organisation of Family Doctors.

[3]  A James O'Malley,et al.  Case-mix adjustment of the CAHPS Hospital Survey. , 2005, Health services research.

[4]  G. Elwyn,et al.  Learning in practice Review of instruments for peer assessment of physicians , 2004 .

[5]  A. Zaslavsky,et al.  Effects of survey mode, patient mix, and nonresponse on CAHPS hospital survey scores. , 2009, Health services research.

[6]  L. Rabinovich,et al.  International Comparison of Ten Medical Regulatory Systems: Egypt, Germany, Greece, India, Italy, Nigeria, Pakistan, Poland, South Africa and Spain , 2009 .

[7]  J. Norcini Current perspectives in assessment: the assessment of performance at work , 2005, Medical education.

[8]  J. Ware,et al.  Asian‐American Patient Ratings of Physician Primary Care Performance , 1997 .

[9]  M. Elliott,et al.  Race/ethnicity, language, and patients' assessments of care in Medicaid managed care. , 2003, Health services research.

[10]  N. Taub,et al.  Patient feedback in revalidation: an exploratory study using the consultation satisfaction questionnaire. , 2011, The British journal of general practice : the journal of the Royal College of General Practitioners.

[11]  M. Elliott,et al.  Racial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care. , 2001, Health services research.

[12]  A. Dickens,et al.  Assessing the professional performance of UK doctors: an evaluation of the utility of the General Medical Council patient and colleague questionnaires , 2008, Quality & Safety in Health Care.

[13]  Ron D Hays,et al.  Equivalence of mail and telephone responses to the CAHPS Hospital Survey. , 2005, Health services research.

[14]  H. Pincus,et al.  Race/Ethnicity, Socioeconomic Status, and Satisfaction With Health Care , 2005, American journal of medical quality : the official journal of the American College of Medical Quality.

[15]  P Sandercock,et al.  Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke. United Kingdom Collaborators in the International Stroke Trial. , 1998, Stroke.

[16]  G. Elwyn,et al.  Assessing the practising physician using patient surveys: a systematic review of instruments and feedback methods. , 2007, Family practice.

[17]  Ronald M Epstein,et al.  Influences on patients' ratings of physicians: Physicians demographics and personality. , 2007, Patient education and counseling.

[18]  Christine Wright,et al.  Factors associated with variability in the assessment of UK doctors’ professionalism: analysis of survey results , 2011, BMJ : British Medical Journal.

[19]  L. Mackillop,et al.  A single generic multi-source feedback tool for revalidation of all UK career-grade doctors: Does one size fit all? , 2011, Medical teacher.

[20]  Brian Jolly,et al.  Generalisability: a key to unlock professional assessment , 2002, Medical education.

[21]  G. Elwyn,et al.  Using a 'peer assessment questionnaire' in primary medical care. , 2005, The British journal of general practice : the journal of the Royal College of General Practitioners.

[22]  C. Violato,et al.  Multisource feedback: a method of assessing surgical practice , 2003, BMJ : British Medical Journal.

[23]  S. Schroter,et al.  The General Practice Assessment Survey (GPAS): tests of data quality and measurement properties. , 2000, Family practice.

[24]  L. Rabinovich,et al.  International Comparison of Ten Medical Regulatory Systems , 2009 .

[25]  F. Buzzard General Medical Council , 1913, British medical journal.

[26]  J. Archer,et al.  Use of SPRAT for peer review of paediatricians in training , 2005, BMJ : British Medical Journal.

[27]  C. Watkins,et al.  Measuring the quality of general practice. , 1973, The Journal of the Royal College of General Practitioners.

[28]  Robert A. Lew,et al.  Design Based on Intra-Class Correlation Coefficients , 2010 .

[29]  Steven M Downing,et al.  Reliability: on the reproducibility of assessment data , 2004, Medical education.

[30]  Does the method of administration influence the UK GMC patient questionnaire ratings? , 2010, Primary Health Care Research & Development.

[31]  L. Rajmil Health measurement scales. A practical guide to their development and use, 3rd ed , 2005 .

[32]  J. Carline,et al.  Use of peer ratings to evaluate physician performance. , 1993, JAMA.

[33]  Julian Archer,et al.  Assuring validity of multisource feedback in a national programme , 2010, Archives of Disease in Childhood.

[34]  M. Greco,et al.  What distinguishes general practitioners from consultants, according to colleagues? , 2007 .

[35]  L. Meeuwesen,et al.  Patients' evaluation of quality of care in general practice: what are the cultural and linguistic barriers? , 2008, Patient education and counseling.

[36]  P. Streets,et al.  Postgraduate Medical Education and Training Board , 2009 .

[37]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[38]  Heidi C. Pearson,et al.  Satisfaction with care among low-income female outpatients , 2007, Psychology, health & medicine.

[39]  J. Allsop,et al.  Quality Assurance in Medical Regulation: in an international context , 2012 .

[40]  S. Woods,et al.  The Influence of Ethnicity on Patient Satisfaction , 2005, Ethnicity & health.

[41]  L W T Schuwirth,et al.  When enough is enough: a conceptual basis for fair and defensible practice performance assessment , 2002, Medical education.

[42]  John L Campbell,et al.  A multi‐method analysis of free‐text comments from the UK General Medical Council Colleague Questionnaires , 2009, Medical education.

[43]  Eva Nick,et al.  The dependability of behavioral measurements: theory of generalizability for scores and profiles , 1973 .

[44]  J. Archer,et al.  Factors that might undermine the validity of patient and multi‐source feedback , 2011, Medical education.

[45]  P. Lelliott,et al.  Questionnaires for 360-degree assessment of consultant psychiatrists: Development and psychometric properties , 2008, British Journal of Psychiatry.

[46]  C. Violato,et al.  Assessment of physician performance in Alberta: the physician achievement review. , 1999, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[47]  M. Roland,et al.  Understanding why some ethnic minority patients evaluate medical care more negatively than white patients: a cross sectional analysis of a routine patient survey in English general practices , 2009, BMJ : British Medical Journal.

[48]  C. Violato,et al.  Assessment of Pediatricians by a Regulatory Authority , 2006, Pediatrics.

[49]  A. Hassell,et al.  Development and reliability testing of TAB a form for 360° assessment of Senior House Officers’ professional behaviour, as specified by the General Medical Council , 2005, Medical teacher.

[50]  John L Campbell,et al.  Multisource feedback questionnaires in appraisal and for revalidation: a qualitative study in UK general practice. , 2012, The British journal of general practice : the journal of the Royal College of General Practitioners.

[51]  Jocelyn Lockyer,et al.  Multisource feedback in the assessment of physician competencies. , 2003, The Journal of continuing education in the health professions.

[52]  M. Greco,et al.  Patient assessment of surgeons' interpersonal skills: A tool for appraisal and revalidation , 2005 .

[53]  M. Elliott,et al.  Racial/Ethnic Differences in Patients’ Perceptions of Inpatient Care Using the HCAHPS Survey , 2010, Medical care research and review : MCRR.

[54]  M. Elliott,et al.  How do proxy responses and proxy-assisted responses differ from what Medicare beneficiaries might have reported about their health care? , 2008, Health services research.

[55]  Julian Archer,et al.  mini-PAT (Peer Assessment Tool): A Valid Component of a National Assessment Programme in the UK? , 2008, Advances in health sciences education : theory and practice.