Objective: To design and test a program that assesses clinical competence as a second stage in a peer review process and to determine the program's reliability.
Design and setting: A three-cohort study of Ontario primary care physicians.
Participants: Reference physicians (n = 26) randomly drawn from the Hamilton, Ontario, area; volunteer, self-referred physicians (n = 20); and physicians referred by the licensing body (n = 37) as a result of a disciplinary hearing or peer review.
Main outcome measures: Standardized patients, structured oral examinations, chart-stimulated recall, objective structured clinical examination, and multiple-choice examination.
Results: Test reliability was high, ranging from 0.73 to 0.91, and all tests discriminated among subgroups. Demographic variables relating to the final category were age, Canadian or foreign graduates, and whether or not participants were certified in family medicine.
Conclusions: The study demonstrated the feasibility, reliability, and validity of a multicomponent examination in the peer review process.