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The need to assess the cognitive function in doctors whose performance is being investigated has been highlighted in a number of studies. In 2001, the National Clinical Assessment Authority (NCAA) was established in England to evaluate doctors and dentists referred because of long term concerns about their performance. In 2008 a clinical screening tool for impaired cogntive function was introduced to the occupational health section of the NCAA assessment. The aim was to identify those practitioners who should be referred for formal neuropsychological testing. This paper describes an audit of cases assessed between 2008 and 2010.
Methods
An audit of cases assessed using the Addenbrookes Cognitive Examination Revised screening tool (ACE-R) was performed. All cases referred for full NCAA assessment and seen by by a single occupational health assessor between April 2008 and June 2010 were included. The main outcome measures were total and sub-domain scores on the ACE-R and referrals for formal neuropsychological testing.
Results
48 doctors and dentists were assessed. The mean age of the sample was 54.6 years. Mean total ACE-R score was 92.3, maximum score 100 and minimum 76. The cut off score for referral is 88. Subdomain scores for memory, verbal fluency and language were significantly correlated with total score and likelihood for referral for formal testing. Declared cardiovascular risk factors and country of first qualification were significantly associated with low total scores. 6 cases were referred for formal testing, five of which had abnormalities.
Discussion
The ACE-R has been shown to be an acceptable effective and efficient screening tool in the setting of a clinical examination of doctors and dentists with performance concerns. However, care should be exercised when assessing practitioners whose first language is not that used in the ACE-R. More research is required to establish its positive predictive value in this population.