Physician Scores on a National Clinical Skills Examination as Predictors of Complaints to Medical Regulatory Authorities

TLDR

Poor patient‑physician communication raises the risk of patient complaints and malpractice claims. The study aimed to determine whether scores on a national clinical skills examination of patient‑physician communication predicted future complaints in medical practice. The authors followed 3,424 physicians who took the 1993‑1996 Medical Council of Canada clinical skills exam, tracked complaints filed with Ontario or Quebec regulators through 2005, and used multivariate Poisson regression to relate exam scores to complaint rates. A two‑standard‑deviation lower communication score was associated with a 38% higher rate of retained complaints, and physicians in the lowest quartile of scores accounted for an additional 9.2% of complaints, confirming that communication scores predict future regulatory complaints.

Abstract

Poor patient-physician communication increases the risk of patient complaints and malpractice claims. To address this problem, licensure assessment has been reformed in Canada and the United States, including a national standardized assessment of patient-physician communication and clinical history taking and examination skills.To assess whether patient-physician communication examination scores in the clinical skills examination predicted future complaints in medical practice.Cohort study of all 3424 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed up until 2005, including the first 2 to 12 years of practice.Patient complaints against study physicians that were filed with medical regulatory authorities in Ontario or Quebec and retained after investigation. Multivariate Poisson regression was used to estimate the relationship between complaint rate and scores on the clinical skills examination and traditional written examination. Scores are based on a standardized mean (SD) of 500 (100).Overall, 1116 complaints were filed for 3424 physicians, and 696 complaints were retained after investigation. Of the physicians, 17.1% had at least 1 retained complaint, of which 81.9% were for communication or quality-of-care problems. Patient-physician communication scores for study physicians ranged from 31 to 723 (mean [SD], 510.9 [91.1]). A 2-SD decrease in communication score was associated with 1.17 more retained complaints per 100 physicians per year (relative risk [RR], 1.38; 95% confidence interval [CI], 1.18-1.61) and 1.20 more communication complaints per 100 practice-years (RR, 1.43; 95% CI, 1.15-1.77). After adjusting for the predictive ability of the clinical decision-making score in the traditional written examination, the patient-physician communication score in the clinical skills examination remained significantly predictive of retained complaints (likelihood ratio test, P < .001), with scores in the bottom quartile explaining an additional 9.2% (95% CI, 4.7%-13.1%) of complaints.Scores achieved in patient-physician communication and clinical decision making on a national licensing examination predicted complaints to medical regulatory authorities.