What is PPEP? If a physician receives a letter from the College stating that s/he has been chosen to undergo a review by the PPEP, is participation required? Why would a physician be chosen for an assessment? How often will a physician be assessed? What evidence does the College have that the peer assessment process has any merit?
The efficacy of peer assessments has been well established in the research literature since the 1980s and 90s. Most physician regulating bodies have adopted some form of the peer practice assessment. The College of Physicians and Surgeons of Ontario implemented its original peer assessment program in 1980. Through evaluation of program data on thousands of physicians, it found that physicians who receive assistance from that College perform better, six years later, compared to a group of physicians assessed for the first time.1
Further studies have demonstrated that providing detailed individualized feedback and optimizing the one-to-one interaction between assessors and physicians is a promising method for further improving physician behaviour.2
- Norton, PG, Dunn, EV, Beckett, R, Faulkner, D, Long-term follow-up in the peer assessment program for nonspecialist physicians in Ontario, Canada, Joint Commission Journal, June 1998.
- Miller, A., Archer, J. Impact of workplace based assessment on doctors’ education and performance; a systemic review. BMJ 2010;341:c5064
What evidence does the College have that the multi-source feedback (MSF) process has any merit?
Other colleges in Alberta, Nova Scotia and Manitoba, have more than 25 years of collective experience with the Physician Achievement Review Program, which is similar to this College’s MSF component. While it is very difficult to gauge improvement in patient outcomes or complaints, it is apparent that most physicians feel the MSF tool provides information on aspects of the CanMEDS competencies, such as communication and collaboration, which cannot be assessed by a peer review alone. Studies have shown that improvements in physician performance occur after participation in a MSF program.1 The College will continue to gather information to gauge the value of this program to both the public and physicians.
- Violato, C., Lockyer, J., Fidler, H. Changes in Performance: a 5-year longitudinal study of participants in a multi-source feedback programme. Medical Education 2008: 42: 1007–1013.
Can a physician opt out of the multi-source feedback component?
The MSF is part of the PPEP assessment. There are, however, situations where certain components of the MSF may not be applicable. Program staff will review applicability on a case-by-case basis.
Why should an experienced physician who has never been subject of a complaint be assessed? Is a physician’s participation in PPEP in any way related to an MSP audit? What happens to information that is collected about a physician and a physician’s practice as part of PPEP?
Does the College assess physicians who work in a hospital setting?
At this time, information from quality assurance activities conducted by the hospital cannot be shared with the College and vice versa. As such, the College focuses its activities on physicians who work outside the hospital environment, including private facilities.
While the intent is not to duplicate efforts, it is recognized that a family physician working as a hospitalist or emergency physician is different from that of a community family physician and therefore may require a separate review. Physicians are still required to complete the pre-visit questionnaire should they receive one. Physicians must indicate where and when they last worked and at which location they wish to be assessed. The information is reviewed by PPEP staff to determine whether an assessment should take place. If there has been little or no community-based work for six to 12 months, the assessment may be deferred or cancelled.
Does the College assess physicians who work exclusively in the ER? Is it fair for an assessment to take place in an office that does not belong to the physician subject to participation in PPEP?
The Physician Practice Enhancement Program is a mandatory process. All physicians selected by the College for assessment, including locums, must engage in the PPEP (section 1-19 and 9-1 of the College Bylaws). The assessor will require a workspace to review charts and conduct the interview. In situations where locum physicians are assessed at multi-physician clinics, PPEP staff will determine whether other physicians at that location will be assessed in order to reduce clinic disruption. The assessor will make every effort to minimize disruptions to the clinic.
Does the College have authority to assess the office and charts in a private location? What about patient confidentiality? Are patients required to give consent before the College can review their records? If a physician does not have an office where s/he regularly works locum shifts, is participation in PPEP still required? What is the process for the office assessment component of a physician’s review? For physicians who have a narrow scope of practice, how can the College conduct an accurate assessment when a true “peer” cannot be found?
The PPEP endeavors to match an assessor with similar expertise in the area of care to conduct the assessment. Should assessees have concerns regarding the assessor’s scope of practice, they are encouraged to contact program staff.
Physicians should note that by limiting their scope of practice, they may be subject to the requirements outlined in sections 2-3(2)(c) and 2-8(2) of the College Bylaws should they wish to re-enter clinical practice or change the focus of their current practice.
Do physicians who have no locum/walk-in shifts planned for the future or who only take occasional shifts need to be assessed? Do physicians who are retired from family practice and now only work as a locum or walk-in clinic need to be assessed? Do physicians who only work in BC part time need to be assessed?