Problem of objective performance assessment of primary health care physicians.

Training programmes for primary health care physicians often lack methods for valid and reliable performance assessment of the trainees. A set of rating scales has been developed with the aim of increasing the objectivity of measurement of practical skills required for the management of cardiac failure. To prove the validity of the content and structure, as well as the inter-observer reliability, the scales were tested by the method of "competent judges" with the use of video-recorded clinical simulation. Calculated Kendall's coefficient of concordance W was at the minimum acceptable level of 0.5. The results reveal considerable differences among examiners (competent judges) regarding internal criteria of acceptable level of performance, and they point out the need for further search for more objective methods of performance assessment.