A comparison of performance assessment programs for medical practitioners in Canada, Australia, New Zealand, and the United kingdom

To compare programs designed to assess the performance of practicing doctors in Canada, Australia, New Zealand, and the United Kingdom. Senior representatives of 11 organizations undertaking performance assessments were invited to provide a description of their programs, using a standardized written questionnaire. Collectively, the 11 organizations provide 16 performance assessment programs that operate on three levels: those that screen populations of doctors (Level 1), those that target "at risk" groups (Level 2), and those that assess individuals who may be performing poorly (Level 3). The 16 programs differ in such areas as the number of doctors enrolled, the number of assessments undertaken, the referral mechanisms, the outcomes of assessment, and in the resources provided for the task. They particularly differ in their choice of tools to assess performance. Although a uniform international approach to performance assessment may be neither feasible nor desirable, an international comparison of current practice, as provided in this report, should stimulate further debate on the development of better performance assessment processes.