We appreciate the comments by Dr. Dastgeer and Mr. Ebadi and agree that one should proceed with care when addressing an issue as serious as physician competence. As we noted in our article, we would not recommend using MicroCog1 alone to make critical decisions about competence to practice but, rather, as an initial screening tool to assess the need for further neuropsychological evaluation.
We respectfully disagree with the suggestion that MicroCog may discriminate against older physicians. The test interface is simple, with responses entered using only the number keypad and three other keys. Also, one of us (L.L.K.) compared physicians reporting less computer experience with those with high levels of experience (all physicians reported some computer experience) and found that there was no significant difference between the two groups on the MicroCog Global Cognitive Proficiency Score [t(66) = .913, P = .364].2
Further, the MicroCog normative groups are stratified by age and education level, with the highest level being more than 12 years of education. Thus, an 83-year-old physician is compared with a group of the general population, aged 80–89, with more than 12 years of education. We do not find that this would place an older physician at any unfair disadvantage.
Other tools are available to screen for cognitive difficulty, such as the Saint Louis University Mental Status (SLUMS) Examination.3 However, we opine that the MicroCog is a more appropriate and sensitive instrument for use in physician competence assessments. As noted, the MicroCog uses age- and education-adjusted reference groups. It assesses processing speed, which is the measurement most sensitive to brain impairment.
Dastgeer and Ebadi point out some limitations of our study, which were acknowledged in the article. We agree that the results of a cognitive examination that is not normed on foreign-born individuals must be interpreted with caution when administered to such individuals. CPEP, the Center for Personalized Education for Physicians, has a neuropsychologist interpret the results, including whether language and cultural issues may have influenced the findings. While a stratified sample of randomly selected physicians would be a better control group, we believe that the volunteer control group provided an adequate comparison.
As cited in our article, there is a growing body of research that is consistent with the findings of our study. We stand by the results of this and other studies that suggest that an assessment of neuropsychological functioning should be an integral part of any evaluation of physician competence.
Lauri L. Korinek, PhD
Psychologist, Neuropsychological Services, CMHI-Fort Logan, Denver, Colorado; [email protected].
Elizabeth J. Korinek, MPH
Chief executive officer, CPEP, The Center for Personalized Education for Physicians, Denver, Colorado.
1 Elwood RW. MicroCog: Assessment of cognitive functioning. Neuropsychol Rev. 2001;11:89–100.
2 Korinek L. Neuropsychological differences between physicians referred for competency evaluations and a control group of physicians. Diss Abstr Int. 2001;66:2824.
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.