Objective.-To design and test a program that assesses clinical competence as a second stage in a peer review process and to determine the program's reliability.

Design and Setting.-A three-cohort study of Ontario primary care physicians.

Participants.

• Reference physicians (n=26) randomly drawn from the Hamilton,

• Ontario, area;

• volunteer, self-referred physicians (n=20);

• and physicians referred by the licensing body (n=37) as a result of a disciplinary hearing or peer review.

Main Outcome Measures.-Standardized patients, structured oral examinations, chart-stimulated recall, objective structured clinical examination, and multiple-choice examination.

Results.-Test reliability was high, ranging from 0.73 to 0.91, and all tests discriminated among subgroups.