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Academic Medicine:
doi: 10.1097/ACM.0b013e31822bc375
Letters to the Editor

Assessing Physicians' Competence

Dastgeer, Ghulam M. MD, LRCP, MRCS, FRCS, AAUCM; Ebadi, Del A. MSci

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Staff physician, Primary Care Department, Northampton VA Medical Center, Leeds, Massachusetts; dastageer2008@hotmail.com. (Dastgeer)

Professor of mathematics and statistics, Boulder College, Boulder, Colorado. (Ebadi)

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To the Editor:

The study reported by Korinek et al1 addressed an important topic. But we have some serious concerns about its generalizability.

First, the study relied heavily on the use of MicroCog screening.2 An older physician may not do well on the MicroCog test. It is computer based, and an older physician is more likely to suffer from cyberphobia and/or incompetence. We are concerned that the study findings could be inadvertently used to discriminate against older physicians and perhaps even prematurely terminate their careers.

Second, the exclusion criteria for both groups that were studied excluded all international medical graduates (IMGs). The authors acknowledge that this limits the generalizability of their findings and that the MicroCog has not been validated for any foreign-born group.

With these limitations in mind, we suggest the SLUMS (Saint Louis University Mental Status) Examination3 for screening IMGs and computer-challenged older physicians. It is a simple, practical, cheap, face-to-face test.

Third, we do not think the control group accurately represented the physician population who are practicing in the United States. The authors addressed the same concern.

Fourth, the authors mention that the participants in the two study groups were “tested under different personal circumstances” that could have affected their performance on the test. In our view, a study of this kind would probably be most accurate if a random sample without any bias were selected to represent the entire population.

Our goal in pointing out the above problems is to urge readers to be cautious in using the study findings because, in our opinion, they do not accurately represent the nation's physicians regarding the issue of competency and underlying cognitive problems.

Ghulam M. Dastgeer, MD, LRCP, MRCS, FRCS, AAUCM

Staff physician, Primary Care Department, Northampton VA Medical Center, Leeds, Massachusetts; dastageer2008@hotmail.com.

Del A. Ebadi, MSci

Professor of mathematics and statistics, Boulder College, Boulder, Colorado.

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References

1 Korinek LL, Thompson LL, McRae C, Korinek E. Do physicians referred for competency evaluation have underlying cognitive problems? Acad Med. 2009;84:1015–1021. http://journals.lww.com/academicmedicine/Fulltext/2009/08000/Do_Physicians_Referred_for_Competency_Evaluations.13.aspx. Accessed May 24, 2011.

2 Elwood RW. MicroCog: Assessment of cognitive functioning. Neuropsychol Rev. 2001;11:89–100.

3 Tariq SH, Tumosa N, Chibnall JT, Perry MH, Morley JE. Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder—A pilot study. Am J Geriatric Psychiatry. 2006;14:900–910.

© 2011 Association of American Medical Colleges

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