Assessing Doctors at Work — Progress and Challenges

A fair amount of scrutiny has been given recently to the assessment of medical students' competence before they enter practice. In this issue of the Journal, Epstein provides a timely summary of advances in this arena.1 In contrast, little attention has been paid to the assessment of doctors who are already in practice. As Epstein points out, far from being a fixed attribute or trait, competence comprises multidimensional sets of behaviors that are dependent on both environmental and individual factors.24 As a result, the assessment of competence must go beyond the identification of who practitioners are, on the basis . . .