Jocelyn Lockyer PhDSenior Associate Dean, Education

Professor, Department of Community Health Sciences

University of Calgary

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No financial conflicts of interest to report College of Physicians and Surgeons of Alberta—

Physician Achievement Review Program ◦ Since 1996◦ Instrument development, testing, and

assessment

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CollaboratorsCPSA

◦ John Swiniarski, Bryan Ward (deceased), Trevor Theman

◦ Physician Performance CommitteeUniversity of Calgary

◦ Research Team..Claudio Violato, Herta Fidler◦ Physician Advisor..Ray Lewkonia

Pivotal Research Inc◦ Steve Dennis

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◦ Describe the Alberta Physician Achievement Review (PAR) Program

◦ Discuss the evidence supporting PAR as a tool for screening and quality improvement

◦ Describe dissemination and uptake by others within and outside Canada

◦ Provide an opportunity to answer questions about PAR

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Multisource feedback program (aka 360 degree evaluation)

Questionnaire based assessment Feedback about observable behaviors is

obtained every 5 years from◦ 8 Physician colleagues (peers, referring MDs,

referral MDs)◦ 8 Co-workers (e.g., nurses, pharmacists,

dieticians)◦ 25 Patients ◦ Self

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MSFSelf-assessment

Co-workers

Medical colleagues

Patients

First level screen which might◦ Provides physicians with data about their practices to

guide improvement◦ Identify need for further assessments

Source of unique and useful data that can inform many of the CanMEDs roles, particularly◦ Communicator◦ Collaborator◦ Professional◦ Medical expert

Relatively inexpensive Adaptable Repeat administration (5 years)

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General/family physicians (revised 2010)

Surgical specialists Medical specialists

◦Pediatrics◦Psychiatry◦All other medical specialists

Anesthesiologists “Episodic care” providers Diagnostic Imaging Laboratory Medicine

PAR Survey

Self-Analysis

Response

PARCommittee

Review

IndividualizedAssessment

Advice toPhysician

Feedback

Office Peer Review

CompetenceAssessment

Diagram 1

The College’s PAR Program

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Good assessment should offer1. Validity or coherence2. Reproducibility or consistency (reliability)3. Equivalence4. Feasibility5. Educational effect6. Catalytic effect7. Acceptability

Norcini et al, Criteria for good assessment: Consensus statement and recommendations from the Ottawa 2010 Conference, Medical Teacher 2011

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Criteria Evidence

Validity Developed by physicians with input from physicians, health care professionals and patients.Factor analyses showing items correlate in intended ways to form scales.Positive but low correlation between sources.

Reliability 22-25 patients, 8 colleagues and 8 co-workers for reliability suitable for formative (lower stakes) assessment based on G- and D-studies.

Equivalence Comparisons in Nova Scotia and Alberta.Comparisons by different schools of graduation.

Acceptability High response rates from all sources.>70% of physicians report obtaining valuable feedback.

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Criteria Evidence

Educational effect

49% report making a change in practice as a direct result of PAR. Most changes on patient care, communication with patients, colleagues, and co-workers and stress managementImprovement in scores when tested 5 years apart.

Catalytic effect Not studied.

Total 9816

Family medicine 4355

Surgeons 1161

Anesthesiologists 472

Medicine (and subspecialties) 1506

Pediatricians 442

Psychiatrists 617

Episodic care 842

Diagnostic imaging 271

Laboratory medicine 150

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Dissemination◦ >25 publications in peer review journals

Adopted◦ Nova Scotia (NS-PAR)◦ Manitoba (M-PAR)

Being Tested◦ British Columbia◦ Council of Teaching Hospitals of Ontario◦ Royal College of Physicians and Surgeons of Canada

Practice eligible route Tested

◦ Medical Council of Ireland◦ Netherlands (Internal Medicine)◦ Singapore (Emergency Medicine)

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Questionnaire based assessment in which feedback about observable behaviors is provided by other physicians, co-workers (e.g., nurses, social workers), and patients

Program that meets criteria for a ‘good assessment’ Initiative that can be adopted and used by others but

attention needs to be paid to◦ Purpose

Quality improvement/formative assessment◦ How it functions in different settings with special reference to

how physicians use the data to inform practice change

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