Future Directions
Several complementary areas of research would augment these findings.
Among those concepts requiring a deeper dive are the variation in values
in performance metric measurement between genders and practitioners at
different stages of clinical practice. This understanding could lead to
the application of specific metrics within these populations or guide
more effective discussions. They may also expose important biases that
are embedded in specific measurement strategies and metrics. Lastly,
they may call into question the equitability of the process to determine
which metrics will be used to assess performance.
In addition to variability from within the interview cohort, our work
had led us to consider whether excellent performance should be defined
in a single manner from within a clinical group, academic structure or
administrative construct. There are likely elements of performance that
are ubiquitous to all physicians (elements such as safety and patient
reported outcome measures) and others which may be less universal. This
concept gets to the notion of whether we ask all physicians to change to
move to a specific phenotype of practitioner or whether we accept a
variety of clinical phenotypes and define good clinical practice
(including performance variables) for each of these.