To the Editor: In their Commentary, Dr Holmboe and colleagues1 effectively reinforced the point that up-to-date and robust medical knowledge, as well as accurate and effective knowledge synthesis and problem solving, are key to high-quality and effective physician performance. Assessing substantive medical knowledge is an integral part of licensure and specialty certification. Unfortunately, maintaining a high level of medical knowledge and effective clinical judgment skills is presented as being a distinct endeavor from efforts to promote better health outcomes by improving clinical processes at the microsystem level. Distinguishing the substantive medical knowledge domain from the process improvement domain fits the traditional model of separating the activity of direct patient care from the activity of clinical process improvement. In this approach, the former is performed by clinicians in the clinical examination room, while the latter is usually directed by quality improvement professionals who develop system and process changes designed to improve the clinical substrate where care is delivered.
Dewar MA. Assessing Competencies of Knowledge and Process Improvement. JAMA. 2008;299(19):2276-2277. doi:10.1001/jama.299.19.2276-a