Health care quality and medical competencies in the practice of emergency medicine: on-scene job performance evaluation

Objective: To demonstrate a job performance evaluation system for an out-of-hospital emergency service. The specific aim was to study the association between length of experience and the demonstration of medical competencies by means of job performance evaluations of newly hired physicians. Methods: Prospective observational cohort study based on direct observation of the care process in the Madrid Emergency and Rescue Service (SAMUR). Four subgroups were identified according to years of experience in this out-of-hospital emergency service: up to 1 year, up to 3 years, up to 5 years, and >= 5 years. The job performances of physicians in the different groups were compared to that of the most experienced physicians. Results: A total of 6450 care process observations were carried out between 2006 and 2010. Twenty-two had worked for up to 1 year, 21 for up to 3 years, 16 for up to 5 years, and 16 for >= 5 years. There were no significant differences between the groups in age, sex, or mean number of performance observations. Considerably more newly hired physicians had specialist training. Only 11.5% of the most experienced physicians had such training, whereas 68.2% of those with up to 1 year's experience and 61.9% of those with up to 3 years' experience had training (P<.05). In the job performance comparisons by years of out-of-hospital emergency practice experience, significant differences were found between the evaluations of the most experienced (>= 5 years) and those with only up to 1 year on the job (P<.001) and also between the most experienced and those who had been on the job between 2 and 3 years (P=.049). The largest number of satisfactory ratings came in the group of physicians with 3 to 4 years of experience. Conclusions: On-scene job performance evaluations revealed that only physicians with between 4 and 5 years of experience were able to provide emergency care comparable to that given by physicians with more >= 5 years of experience. [Emergencias 2012;24:84-90]