Jocelyn Lockyer PhD Senior Associate Dean, Education Professor, Department of Community Health Sciences University of Calgary 1

 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 2

Collaborators  CPSA ◦ John Swiniarski, Bryan Ward (deceased), Trevor Theman ◦ Physician Performance Committee  University of Calgary ◦ Research Team..Claudio Violato, Herta Fidler ◦ Physician Advisor..Ray Lewkonia  Pivotal Research Inc ◦ Steve Dennis 3

◦ 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 4

 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 5

6 MSF Self-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) 7

8  General/family physicians (revised 2010)  Surgical specialists  Medical specialists ◦ Pediatrics ◦ Psychiatry ◦ All other medical specialists  Anesthesiologists  “Episodic care” providers  Diagnostic Imaging  Laboratory Medicine

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Good assessment should offer 1. Validity or coherence 2. Reproducibility or consistency (reliability) 3. Equivalence 4. Feasibility 5. Educational effect 6. Catalytic effect 7. Acceptability  Norcini et al, Criteria for good assessment: Consensus statement and recommendations from the Ottawa 2010 Conference, Medical Teacher

11 CriteriaEvidence ValidityDeveloped 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. Reliability22-25 patients, 8 colleagues and 8 co-workers for reliability suitable for formative (lower stakes) assessment based on G- and D-studies. EquivalenceComparisons in Nova Scotia and Alberta. Comparisons by different schools of graduation. AcceptabilityHigh response rates from all sources. >70% of physicians report obtaining valuable feedback.

12 CriteriaEvidence 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 management Improvement in scores when tested 5 years apart. Catalytic effectNot studied.

Total9816 Family medicine4355 Surgeons1161 Anesthesiologists472 Medicine (and subspecialties)1506 Pediatricians442 Psychiatrists617 Episodic care842 Diagnostic imaging271 Laboratory medicine150 13

 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) 14

 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 15

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