title: Setting performance standards for medical practice: a theoretical framework.
abstract: BACKGROUND
  The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work.
  
  
  METHODS
  The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards.
  
  
  CONCLUSIONS
  Standards that reflect the complexity of medical practice may best be developed through an "expert systems" analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.
authors.affiliation: School of Medicine, James Cook University, Townsville, Queensland 4811, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Southgate
authors.forename: R B
authors.initials: RB
authors.lastname: Hays
authors.forename: J
authors.initials: J
authors.lastname: Norcini
authors.forename: H
authors.initials: H
authors.lastname: Mulholland
authors.forename: B
authors.initials: B
authors.lastname: Ayers
authors.forename: J
authors.initials: J
authors.lastname: Woolliscroft
authors.forename: M
authors.initials: M
authors.lastname: Cusimano
authors.forename: P
authors.initials: P
authors.lastname: McAvoy
authors.forename: M
authors.initials: M
authors.lastname: Ainsworth
authors.forename: S
authors.initials: S
authors.lastname: Haist
authors.forename: M
authors.initials: M
authors.lastname: Campbell
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004501:Education, Medical; D004650:Employee Performance Appraisal / Q000458:organization & administration; D019317:Evidence-Based Medicine; D006801:Humans; D010820:Physicians / Q000592:standards*; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards