UC San Diego PACE program described as assessment, remediation option for referred physicians

The University of California San Diego’s PACE program told the Medical Board of California on Aug. 19, 2025, how it assesses physicians referred for competence concerns and how it supports remediation and monitoring. Peter Bull, director of administration for UCSD PACE, described assessment components, grading categories and the program’s remedial education and monitoring services.

Why it matters: PACE is frequently referenced in disciplinary cases as an outside assessment and education provider. The board and its staff use PACE findings to shape conditions, remediation and monitoring when licensees are referred for evaluation.

What PACE told the board - Purpose and methods: PACE conducts hybrid assessments (remote components plus one- to two-day in-person work in San Diego) that sample multiple data points — written exams, chart-stimulated recall, simulated patient encounters and multispecialty case conferences. Bull emphasized using multiple qualified judges, objective measures and a multidisciplinary conference to reach conclusions. - Frameworks used: PACE maps its evaluations to the ACGME/ABMS six core competencies (patient care and procedural skills; medical knowledge; practice-based learning and improvement; interpersonal and communication skills; professionalism; systems-based practice) and applies Miller’s pyramid (knows → knows how → shows → does) to describe what different tests measure. - Outcome categories: Final reports use four categories: (1) consistent with safe practice, (2) minor isolated deficits with recommendations, (3) significant and broad-based deficiencies (recommendations commonly include updating knowledge, supervised practice and possible restrictions), and (4) unsafe to practice at time of assessment (some in this group may be reassessable after remediation; others are not). Historical PACE data presented by Bull showed roughly 60–65% in categories 1–2, ~22% in category 3, and ~10% in category 4 among the dataset shown. - Fitness for duty: PACE separates competency from fitness-for-duty evaluations (the latter focuses on health conditions such as cognitive, neurologic or substance-related impairment), typically using a two- to three-day on-site process with specialty medical, neuropsychological and simulated-task testing. Fitness outcomes are reported as fit, fit with accommodations, or unfit. - Remediation and follow-up: PACE offers longitudinal Physician Enhancement Program services (monthly chart review, mentoring, quarterly reports), CME courses targeted at performance gaps (medical records, prescribing, clinician communication, professional boundaries, managing high-impact emotions), and a PACE-plus one-to-one coaching package. Some specialty programs include simulation, proctoring and prospective oversight.

Discussion points from the board Board members asked about recidivism metrics, applicability to allied health professionals, and use of PACE for late-career screening. Bull noted recidivism was measured by physicians returning to the same course multiple times; PACE assesses PAs and podiatrists in some programs but generally does not include nurses in behavioral programs because of workplace dynamics. He described a late-career health-screening product the program developed, and acknowledged legal and policy challenges after an EEOC case involving mandatory age-based screening by an employer.

Ending Board members thanked Bull for clarifying PACE’s processes; several members said the information will help them interpret PACE reports when they appear in disciplinary files.