Physicians' clinical experience and its association with healthcare quality: a systematised review

Abstract

Background and purpose: There is conflicting evidence regarding whether physicians' clinical experience affects healthcare quality. Knowing whether an association exists and which dimensions of quality might be affected can help healthcare services close quality gaps by tailoring improvement initiatives according to physicians' clinical experience. Here, we present a systematised review that aims to assess the potential association between physicians' clinical experience and different dimensions of healthcare quality.

Methods: We conducted a systematised literature review, including the databases MEDLINE, Embase, PsycINFO and PubMed. The search strategy involved combining predefined terms that describe physicians' clinical experience with terms that describe different dimensions of healthcare quality (ie, safety, clinical effectiveness, patient-centredness, timeliness, efficiency and equity). We included relevant, original research published from June 2004 to November 2020.

Results: Fifty-two studies reporting 63 evaluations of the association between physicians' clinical experience and healthcare quality were included in the final analysis. Overall, 27 (43%) evaluations found a positive or partially positive association between physicians' clinical experience and healthcare quality; 22 (35%) found no association; and 14 (22%) evaluations reported a negative or partially negative association. We found a proportional association between physicians' clinical experience and quality regarding outcome measures that reflect safety, particularly in the surgical fields. For other dimensions of quality, no firm evidence was found.

Conclusion: We found no clear evidence of an association between measures of physicians' clinical experience and overall healthcare quality. For outcome measures related to safety, we found that physicians' clinical experience was proportional with safer care, particularly in surgical fields. Our findings support efforts to secure adequate training and supervision for early-career physicians regarding safety outcomes. Further research is needed to reveal the potential subgroups in which gaps in quality due to physicians' clinical experience might exist.

Keywords: health professions education; healthcare quality improvement; professional competence.

Figure 1

Selection process for the articles included in this study.

Figure 2

Overall frequency and the nature of associations between physicians’ clinical experience and healthcare quality. A total of 63 associations from 52 articles were included;positive: a proportional relationship between healthcare quality and physicians’ clinical experience; partial: some but not all outcomes within an evaluation pointed in one direction; negative: inverse relationship between healthcare quality and physicians’ clinical experience.

Figure 3

Frequency of associations grouped into six healthcare quality dimensions. A total of 63 associations from 52 articles were included; positive: proportional relationship between quality and physicians’ clinical experience; partial: some but not all outcomes within an evaluation pointed in one direction; negative: inverse relationship between quality and physicians’ clinical experience.