1. Physician Assessment & Retraining:
The Experience of the KSTAR/JPS
Health Network Collaboration
Presented at the
Global Community Engaged Medical Education Muster
Uluru, Northern Territory
27-30 October, 2014
By
Nancy W Dickey, MD
Professor, Department of Family Medicine
Executive Director, Rural & Community Health Institute
Texas A&M University Health Science Center College of
Medicine

2. Faculty/Presenter
Disclosure
Slide 1
• Faculty: Nancy W Dickey, MD
• Relationships with commercial
interests:
– Consulting Fees: Association
of Academic Health Centers
– Others: Employee of Texas
A&M University Heatlh
Science Center College of
Medicine

3. Disclosure of Commercial
Support
Slide 2
• This program has received in-kind
support from Texas A&M University
Health Science Center in the form of
travel support
• AAHC consulting is not related to this
forum.
• Potential for conflict(s) of interest:
None
 Nancy W Dickey, MD, has received
funding from Texas A&M University
Health Science Center supporting this
program.

4. Mitigating Potential Bias
Slide 3
• The AAHC consulting is not related
to curriculum development or this
conference.
• The support of the University is in
support of an expectation of
developing curriculum and sharing
best practices across the globe. A
full report will be made back to
the university regarding my
presentation and additional
lessons learned for incorporation
into university curriculum.

5. “The education of the doctor which
goes on after he has his degree is,
after all, the most important part of
his education.”
John Shaw Billings1(pp.75)
Medicine in quotations. In: Huth EJ, Murray TJ, eds. Views of health and disease through the ages.
Second ed. Philadelphia, PA: American College of Physicians; 2006

6. Background Information on Physician
Re-Entry to the Workforce
Physician Re-entry to the Workforce Project Survey:
A survey of 1795 physicians <65 years.
• 19.4% (348) re-entered clinical practice after absence
• 49.5% of reentrants were in primary care
• Top reasons for leaving: personal health (38%), “hassle
factors” (38%), rising malpractice rates (28%)
• Top reasons for re-entering: availability of part-time
work/flex scheduling (42%), financial need (44%),
wanted to provide volunteer services (41%), change in
family or personal circumstances (28%)

7. Definitions
• Re-entry: A physician who once practiced
medicine (without any performance problems),
who wants to return to their same scope of
practice after a prolonged interruption in their
practice (assume > 2 years)
• Retraining: A physician wants to change their
scope of practice, whether or not they have had a
practice interruption (example: a surgeon who
wants to transition to doing outpatient primary
care in a free clinic)

8. Definitions
• Remedial Education: physicians who have
identified educational needs or other difficulties:
associated with their practice of medicine (such
as a board action, restriction of privileges, etc.)
In reality, remedial education probably can applied
to all of these groups, but the stigma of the word
remedial can be problematic for some.

9. KSTAR: Assessments
• One of 6 U.S. physician assessment programs
• KSTAR has completed over 80 assessments in the
past 6 years, 17 in the last year alone
• Most are two-day competency evaluations
ordered by medical boards, medical groups, or
done for physicians wanting to return to practice
after an absence
• The re-entry KSTAR assessment acts as a filter to
screen out examinees who are unfit for mini-residency
training and is the backbone for making
an educational plan for clinic training

10. KSTAR Assessment
Components
• Two or more standardized patients
• Presentation and critique of six peer reviewed
charts
• NBME/PLAS Primum Clinical Case Series
• NBME/PLAS Pharmacotherapeutics Test
• NBME/PLAS Ethics and Communication Test
• NBME/PLAS Clinical Specialty Subject Exam
• Cognitive Screening with MicroCog (computer)
• ECG/Rhythm Recognition Test
• Fetal Monitor Strip Test (in development)

11. Evaluations at JPS
• Regular feedback given to mini-residency
physicians
• Two formal written evaluations are done at 6 and
12 weeks
• Multi-source (360) feedback forms filled out by
many members of the healthcare team
• A final evaluation is competed by residency
director, including commentary on the six core
ACGME competencies
• Program can be extended beyond 3 months if
needed – which has been done a few times

12. Demographics, Data, and
Outcomes: JPS Mini-Residency
PHYSICIANS BY SPECIALTY – FIRST 28
GRADUATES:
Family Medicine 32%
Obstetrics and Gynecology 28%
Internal Medicine 18%
General Surgery 14 %
Pediatrics 7%

13. Demographics, Data, and
Outcomes: JPS Mini-Residency
Years Out of Practice
Zero 21%
1-5 yrs 36%
6-7 yrs 7%
8-10 yrs 29%
>10 yrs 3%
Note: In previous a previous study, the largest
group has tended to fall in the 5-10 years out range.

14. Demographics, Data, and
Outcomes: JPS Mini-Residency
• Age groups represented:
Age <40 11%
40-49 43%
50-59 25%
60-69 18%
Age >70 3%
(Average age from the AMA/AAP Re-Entry to the
Workforce Survey was approximately 50 yrs for
both males and females)

15. Demographics, Data, and
Outcomes: JPS Mini-Residency
Years Out of Practice
Zero 21%
1-5 yrs 36%
6-7 yrs 7%
8-10 yrs 29%
>10 yrs 3%
Note: In previous a previous study, the largest
group has tended to fall in the 5-10 years out range.

16. Demographics, Data, and
Outcomes: JPS Mini-Residency
REASONS FOR ASSESSMENT/RE-ENTRY
License/Privileges at Risk 43% (remedial)
-------------------------------------------------------------------
Personal/Family Needs 32% (re-entry)
Illness 14%
Change of Practice Scope 3.5%
Retired 3.5%
Administrator 3.5%

17. Demographics, Data,
and Outcomes
• 10 physicians to date scored low enough on
their KSTAR assessment that they were NOT
allowed to proceed to the JPS Mini-Residency
Program (rejection rate of approximately 20%)
• All but 3 physicians completed the mini-residency
in 3 months (education goals met)
• All but 2 physicians completed the mini-residency
and are currently practicing (one
stopped due to health problems)

18. What Are We Learning?
• Re-entry training can be done, allowing
physicians to return to unrestricted practice.
• The assessment is invaluable for differentiating
physician performance and for crafting an
educational plan.
• Most major barriers can be overcome (and a
“can-do” approach really helps!)
• Mini-residency training has been used for board-referred
remedial training.
• More research needed on outcomes.

19. References
1) Baumer JG, Christansen RG, Webb AR. A Mini-Residency Model for
Reentry and Remedial Physicians (recently submitted for publication).
2) Jewett et al: A national survey of ‘inactive’ physicians in the United
States of America: enticements to reentry. Human Resources for Health
2011 9:7.
3) The Physician Reentry into the Workforce Project. 2011
[http://www.aap.org/reentry].

20. Questions
date 20