An evaluation typically includes the following four components. Occasionally, additional components may be added to adequately address the presenting concerns.

Chart Stimulated Recall Examination: In a chart stimulated recall (CSR) examination, assessors (physicians in the same specialty as the physician being evaluated) review a sample of the physician’s charts and discuss with the physician the management of those particular patients. The discussion focuses on obtaining insight into the physician’s knowledge base, decision making process, and the range of diagnostic/management options considered. Typically, the discussion ranges over a wide area, as the examiners probe for additional information by exploring the physician’s knowledge of related conditions or proposing hypothetical cases. The charts are also reviewed to assess the overall quality of documentation.

Test Stimulated Recall Examination: In a test stimulated recall (TSR) examination, the physician first completes a written examination. The scored exam is reviewed by an assessor from the same specialty, who uses the exam to identify potential gaps in the physician’s knowledge. The assessor then explores the physician’s knowledge further, focusing primarily on areas that appear weaker. This may be done by posing additional questions and/or presenting hypothetical cases designed to explore the depth and breadth of the physician’s knowledge of the area. In some instances, a two-hour one-on-one oral examination is substituted for the TSR.

Standardized Patient Examination: In a standardized patient examination, the physician performs a focused history and physical examination on more than one person who has been carefully trained to portray a patient with a specific medical problem. The cases are carefully selected to include medical problems commonly encountered in the physician’s particular specialty/practice. The physician is asked to develop a management plan, and to relay the plan to the simulated patient. At the conclusion of each encounter, the physician writes a progress note for the encounter, and the “patient” rates the physician’s interpersonal skills. The interactions are video taped, and the tape is reviewed by an assessor who evaluates the physician’s interpersonal interaction, history and physical examination skills, and ability to develop an appropriate plan. The quality of each progress note is also evaluated by the assessor.

Psychological Evaluation: The standard psychological evaluation includes psychological testing (MMPI-2) and a one- to two-hour clinical interview. The interview and MMPI-2 interpretation are conducted by a psychologist who has extensive experience in the evaluation of physicians for problems that could interfere with their ability to practice medicine. The purpose of the evaluation is to provide information regarding the physician’s personality dynamics and current level of psychological and cognitive functioning. The specific referral question involves whether the physician manifests any psychopathology, cognitive impairment, or behavioral aberration that would impair his/her ability to practice medicine.