title: Assessing the practising physician using patient surveys: a systematic review of instruments and feedback methods.
abstract: BACKGROUND
  Individual physician performance assessment is a vital part of the medical regulation debate. In this context, the patient perspective is seen as a potentially valid component. Yet, the theoretical and empirical evidence base for such patient assessments is unclear.
  
  
  OBJECTIVE
  To identify and evaluate instruments designed to assess patients' experiences with an individual practising physician, and to provide performance feedback at the individual level.
  
  
  METHODS
  Nine electronic databases were searched with no language restrictions: PubMed (1985-), Embase (1985-), PsycInfo (1985-), SIGLE (1985-), HMIC (1985-), ASSIA (1985-), CINAHL (1985-), Cochrane (1985-) and Dare (1985-).
  
  
  METHODS
  Inclusion: (i) completed by patients; (ii) assess practising doctors; (iii) have capacity to assess individual doctors for performance feedback; and (iv) used for individual performance feedback. Exclusion: (i) completed by colleagues, observers or third parties; (ii) assess medical students, nurses or non-physicians; (iii) assess purely at an organizational level; and (iv) not been used for individual feedback. All electronic outputs were independently assessed by three reviewers. Data were extracted independently by two of three reviewers using a defined template.
  
  
  RESULTS
  Six instruments met the inclusion criteria. They all combine evaluation at both organizational and individual level and implementation methods lack standardization. There is limited data on their construct validity or correlations with other attributes. The purpose and method of individual feedback are not well specified, and the evidence to date about the effectiveness of feedback to obtain improvement indicates professional resistance.
  
  
  CONCLUSIONS
  For formative goals, more clarity is needed about the aim of providing patient assessments feedback to individual doctors: 'who' should do it and 'how' to do so to best effect. We need to know whether feedback improves doctor performance and how these evaluations correlate with other physician attributes. For summative purposes more research is required on validity and reliability.
authors.affiliation: School of Medicine, Swansea University, Swansea SA2 8PP, UK.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Evans
authors.forename: Adrian
authors.initials: A
authors.lastname: Edwards
authors.forename: Sean
authors.initials: S
authors.lastname: Evans
authors.forename: Benjamin
authors.initials: B
authors.lastname: Elwyn
authors.forename: Glyn
authors.initials: G
authors.lastname: Elwyn
mesh_terms: D005246:Feedback; D019538:Health Care Surveys; D006801:Humans; D017060:Patient Satisfaction; D011787:Quality of Health Care