Tim Norfolk and Prof Niro Siriwardena have recently published a discussion paper in Quality in Primary Care describing ‘A comprehensive model for diagnosing the causes of individual medical performance problems: skills, knowledge, internal, past and external factors (SKIPE)‘.
The SKIPE model, developed by Tim Norfolk, an occupational psychologist, through his work with underperforming doctors, sets out in logical relationship and progression the causal factors determining effective medical performance or underperformance. It highlights how the relationship between competence and performance is moderated by specific, discrete causal factors both within the individual and external to the individual.
This model builds on a previous paper describing a unifying theory of clinical practice, the RDM-p model, which captures the primary skill sets required for effective medical performance (relationship, diagnostics and management), and the professionalism that needs to underpin them. The SKIPE model is currently being used, in conjunction with the RDM-p model, for the in-depth assessment and management of doctors whose performance is a cause for concern.