Updates from the Physician Practice Enhancement Program

A good foundational program has evolved to become even better

Quality assurance activities, such as ensuring the competence of registrants, are not new to the College. In fact, the original Committee on Medical Practice Assessment (COMPA) began conducting peer reviews in 1987. The COMPA program was well accepted by community based physicians because it was collegial, remedial and educational, and it often led to a practice improvement diffusion effect among colleagues.

With all of its strengths, the original program was relatively expensive and inefficient (only 100 assessments were conducted in a given year), and was unable to comment on the standards of practice of all physicians. Nevertheless, it provided a solid foundation for a new, expanded and more comprehensive peer assessment program for all physicians.

When considering what an ideal physician assessment program should look like, the College concluded that it must:

  • be educational, remedial, collegial (like the previous COMPA program) and not punitive
  • be created and administered by physicians, for physicians
  • be peer-based
  • be able to capture the CanMEDS competencies
  • be applicable to all BC practising clinical physicians on a cyclical basis
  • guarantee confidentiality under section 26(2) of the College Bylaws which state that the information cannot be shared under FOI legislation, legal requests or by any other College department other than the Medical Practice Assessment Committee (MPAC), a committee comprised of family physicians and specialists
  • be able to capture systemic clinic environments which may impact  physician performance
  • be efficient and cost-effective
  • not be duplicative

In 2011, building on these principles, the College renamed the COMPA program to the Physician Practice Enhancement Program (PPEP). The PPEP is comprised of three distinct assessment modules:

  • peer assessment of recorded care
  • assessment of office premises and processes
  • multi-source feedback (MSF)

The peer assessment of recorded care is no different than that previously conducted under COMPA except that assessors now conduct 500 peer assessments annually, which necessitated the expansion of the assessor pool to 60 physiciansall of whom have undergone peer assessments themselves and attended the College’s assessor training workshop.

Currently, the assessment of office premises and processes is being conducted by the physician peer assessors; however, in future, this process will be modified to become a much more valuable evidence-based teaching opportunity for clinic staff. Using a tracer methodology adopted by the College’s facility accreditation programs, office assessments will focus on reprocessing of instruments, storage of drugs, and patient safety issues.

The multi-source feedback component of the PPEP was initiated in February 2013 and is administered by an external company called Pivotal Research Inc., an Alberta-based firm that processes the feedback reports from 25 patients, eight physician colleagues and eight co-workers (nurses, MOAs, pharmacists) of the physician's choosing. The data used to develop the final report is completely anonymized. Due to the amount of data collected, response rates, and the coordination of the MSF component with the office visit, it is not unusual for the entire process to take six months or more from start to finish.

The Medical Practice Assessment Committee reviews the peer assessment and MSF reports and, based on assessment outcomes, may recommend remedial or educational activities to the physician.

While the PPEP is still very much in the beginning stages of implementation, ideas for enhancements are already being considered, such as:

  • Expanding the program to include specialists who choose to practise outside of the hospital environment (e.g., dermatology, ENT, orthopedics). Specialists interested in becoming assessors should contact the PPEP staff.
  • Piloting an e-assessment program that will make the assessments more objective, efficient and allow for instant access to evidence-based standards for teaching purposes.
  • Engaging in academic research to help answer the question: How is feedback best given to physicians to improve their clinical care? Physicians who have already been assessed will be asked to participate in a survey to evaluate the program.

The Physician Practice Enhancement Program is a collegial program that proactively assesses and educates physicians to ensure they meet high standards of practice throughout their professional lives. The goal of the program is to promote quality improvement in community-based physicians’ medical practice by highlighting areas of excellence and identifying opportunities for professional development.

Are you about to be assessed? Click here to find answers to frequently asked questions about the assessment process.