What determines how we practice? Insights from the Asch study
Presenter: Robert Englander, MD, Senior Director for Competency-based Learning and Assessment, Association of American Medical Colleges
Facilitator: Curt Olson, PhD
Background: A fundamental assumption of continuing education of health professionals is that clinical performance is educationally sensitive. That is, it can be improved through activities aimed at changing practice. However, studies by David Asch, MD, MBA and colleagues at the University of Pennsylvania suggest that a powerful predictor of how a physician practices is where he or she received residency training.
Questions to be addressed in the discussion include:
1. How can we make sense out of the findings of the Asch study? What hypotheses might account for them?
2. What questions does this study raise regarding physician performance?
3. What other factors are thought/known to influence how physicians practice?
4. What is the evidence that these other factors are influential?
Dr. Englander has selected the following recent articles to stimulate discussion on this topic.
• D.A. Asch, S. Nicholson, S. Srinivas, J. Herrin, A.J. Epstein. Evaluating obstetrical residency programs using patient outcomes. Journal of the American Medical Association, September 23/30, 2009, vol. 302, pp. 1277-83 Link to online article
• D.A. Asch, A. Epstein, S. Nicholson. Evaluating medical training programs by the quality of care delivered by their alumni. Journal of the American Medical Association, September 5, 2007, vol. 298, pp. 1049-51. Link to online article