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.