Family Practice Vol. 7, No. 3, 168-174
© Oxford University Press 1990
research-article |
Competence and Performance: Two Different Concepts in the Assessment of Quality of Medical Care
*Department of General Practice, University of Limburg Postbus 616, 6200 MD, Maastricht, The Netherlands
Department of General Practice, University of Limburg Postbus 616, 6200 MD, Maastricht, The Netherlands
Department of Medical Sociology, University of Limburg Postbus 616, 6200 MD, Maastricht, The Netherlands
Department of Educational Development and Research, University of Limburg Postbus 616, 6200 MD, Maastricht, The Netherlands
**Department of Epidemiology, University of Limburg Postbus 616, 6200 MD, Maastricht, The Netherlands
Correspondence to:Dr Rethans
In the debate about ‘what is a competent general practitioner?’ little attention has been paid to the actual practice situation of general practitioners. This paper, based on the 18 most important studies in the literature about medical competence, tries to re-initiate this debate by proposing a clear distinction between ‘competence’, (what a physician is capable of doing) and ‘performance’ (what a physician does in his day-to-day practice). With this distinction we looked at whether studies defined both competence and performance, how they dealt with these concepts, what measurement instruments were used and what the conclusions of the studies were. Although it is the common reasoning that competence is a good predictor of performance this concept could not be affirmed. This survey shows that the majority of studies use wrong concepts and come to invalid conclusions. With the empirical distinction between competence and performance however, this paper proposes new directions for the quality assessment of general practitioners.