Assessments conducted by PEP
Quality improvement approach
CPSBC recognizes that all licensees are dedicated to providing the highest standard of care. The pursuit of quality is a continuous process. Quality improvement focuses on a culture of reflection, learning, and continual practice improvement to strengthen patient care. Under Practice Enhancement Program (PEP), there are several assessments intended to support our licensees’ quality improvement.
Self-directed assessment
The self-directed assessment engages eligible licensees in a light-touch, CPD-compatible program with a five-year cycle to complete three quality improvement activities. This builds on the principles of right-touch regulation and commitment to fulfill our mandate of ensuring quality care for patients in BC.
Self-directed assessments are proactive, self-driven, and encourages licensees to reflect on their own delivery of health care without a large time commitment. The goal of a self-directed assessment is to encourage self-reflection and continued improvement and learning throughout a career in medicine.
Synergy with continuing professional development requirements
All licensees must comply with continuing professional development (CPD) requirements. Activities that licensees currently undertake for CPD may also align with one or all three of the core components of the self-directed assessment. This would satisfy the requirements for both.
Email sda@cpsbc.ca to confirm.
Continuing professional development credits
The self-directed assessment uses the College of Family Physicians of Canada's Professional Learning Plan (CFPC PLP) peer-supported pathway to guide quality improvement activities.
It is a one-credit-per-hour assessment activity certified by the CFPC for 20 Mainpro+® certified credits.
Self-directed assessments will use the Royal College of Physicians and Surgeons’ Practice Improvement Roadmap under the Maintenance of Certification (MOC) Program. This Practice Improvement Roadmap is designed to guide both individual and team-based learning, reflection, and continuous practice improvement. It draws on established quality improvement principles and is adapted from The Ottawa Hospital Innovation Framework™ (© The Ottawa Hospital, 2022).
Complete 3 core component activities and meet with a program advisor
In a self-directed assessment, licensees guide their own professional development goals within a quality improvement framework. Using a quality improvement approach, licensees select quality improvement activities that fall into the three core components, complete those activities, and reflect on their outcomes.
Licensees have five years to complete three activities plus a facilitated feedback session with a program advisor.
Core components
The three core components echo the three bases of the Cambridge model (the relationship between competence and performance includes system and individual related influences) and include:
Focus on improvements to clinical care by learning about a clinical skill or topic.
The licensee may consider using their patient panel demographics to identify areas for improvement that may support effective clinical care (e.g. using EMR data to determine that there is a large proportion of patients with type 2 diabetes and take a course to learn how to improve clinical care for these patients).
Identify areas for improvement in the licensee's practice environment, chart documentation, or clinic operations (e.g. improve office flow for patient visits, improve patient documentation by using voice recognition software).
Reflect on the licensee's professional life, work-life balance, communications and approach to team-based care (e.g. seek formal feedback from patients, colleagues, and co-workers).
Facilitated feedback discussion
This conversation is led by a program advisor. It is a progress check-in and a collaborative coaching discussion to review the status of the licensee's quality improvement activities, examine barriers and explore potential issues. This session helps refine areas for improvement and promotes a culture of continuous practice enhancement.
The check-in is scheduled around the mid-point of the five-year cycle.
Email sda@cpsbc.ca to request an earlier session.
Program advisors
Program advisors are licensed BC physicians, surgeons, and podiatric surgeons who have successfully completed peer assessments in their own practice. Their participation in the assessments help them assist others who are starting on their self-directed assessment journeys.
Program advisors hold a full licence, remain clinically current, and are in good standing with CPSBC. They have specialized assessment training and bring diverse practice backgrounds from across the province.
Interested in becoming a program advisor?
Email pep@cpsbc.ca for more information.
How it works
Licensees selected to participate in an assessment will receive an email to complete a pre-assessment questionnaire (PAQ).
The PAQ confirms eligibility for SDA and provides background information for the program.
For each of the three core components, licensees can complete:
- the CFPC professional learning plan peer-supported pathway,
- the RCPSC Practice Improvement Roadmap,
- the UBC CPD Personal Learning Plans,
- FPSC's Practice Support Program, or
- other quality improvement programs.
Once they have completed a quality improvement plan and associated activity, they submit their certificate of completion and complete a self-directed activity form to describe the activity completed.
At the mid-point of the five-year cycle or when two core components are fulfilled and documents are submitted, program staff will contact the licensee to schedule the facilitated feedback session with a program advisor.
A final summary report is sent to the licensee once all components and activities are completed.
PEP evaluation and development
Program evaluation provides information on the effectiveness, efficiency, and impact of a program, enabling informed decision-making and continuous improvement.