Peer Review Assessments

Expand all Collapse all

• What is a Peer Review?

  • An opportunity for reflection on the quality of service you provide
  • An educational process
  • Based on observations by a colleague with similar experiences and responsibilities
  • A sampling of your day-by-day performance in practice
  • A measurement of your performance against a variety of hard and soft standards of practice
  • An exercise to identify priorities for improvement in practice
  • An important step in planning a professional development strategy

• When is a Peer Review recommended?

  • In response to a complaint (usually by a patient or a patient’s family, or by a colleague, or by the Medical Examiner’s office),
  • In response to a pattern of prescribing (e.g. narcotics that are monitored by the College).  (In these cases, a registrar handling the case file believes the physician needs help to identify deficiencies or to respond to deficiencies that create remediable risks to patient care.), or
  • When ordered by Council in response to a finding of deficient practice after a formal investigation.

• The Office Visit: The Most Common Type of Peer Review

  Most often, office visits apply to primary care practitioners, but any physician’s office practice can be reviewed with an office visit.

  The following components of medical practice are covered during an office review:

  • Administrative aspects of running an office (e.g. scheduling, paper flow, staffing)
  • Technical aspects of providing a medical service (e.g. taking a history, performing a physical examination, arranging investigations and consultations, prescribing treatments)
  • Professional responsibilities (e.g. availability, reporting to third parties, maintaining competence through continuous professional development)

  The following components of medical practice are not covered during an office review:

  • Breadth of medical knowledge
  • Communication with patients
  • Surgical skills

  Peer reviews are conducted by physicians who:

  • have similar practices and responsibilities to the physician being reviewed,
  • receive special training on how to conduct an office review,
  • observe, listen and report their findings, and
  • are not there to teach, give opinion or try to change beliefs or behavior.

  The components of an office review are:

  • the introductory interview to acquaint the reviewer with the practice,
  • an inspection of the physical office,
  • an audit of medical records, and
  • a discussion of cases in the physician’s own practice (chart stimulated recall).

  1. Introductory Interview
     • patient population served (age, morbidities, whether episodic or continuous care, etc.)
     • system in which the practitioner works (solo/partners,  availability of support services, specialists, trained staff, public health and other health services)
     • professional development activities
     • managing responsibilities (notifying patients of test results, availability of chaperones, arrangements for after-hours care, etc.)
  2. Office Facility Inspection
     • drugs
     • sterilizers
     • washing facilities
     • equipment (rooms, tables, tools)
     • privacy needs
  3. Chart Audit
     1. General Requirements
        • identification of the patient
        • identification of the person entering information in the record
        • legibility
        • organization of the charts
        • allergies, medication lists, problem lists
        • test results
        • consultants letters
     2. Specific Requirements
        • histories and findings on physical examinations are present and support the diagnoses made
        • diagnoses are present
        • investigations and consultations are used to support the diagnoses or treatments
        • treatments are recorded (prescriptions - dosage and instructions and quantity)
        • treatments are appropriate to the diagnoses
        • follow-up plans are recorded
  4. Case-based discussion (Chart-stimulated recall)
     
     This discussion provides an opportunity to:
     • fill in the gaps in recorded information, and
     • describe the clinical reasoning that led to the diagnostic, investigative and treatment choices made.
       
       Language used by the reviewer in this discussion is in the spirit of inquiry and every effort will be made to avoid debate.  

• Reports

  The reviewer sends the College a report of his or her findings, which includes his or her opinion as to whether the practice meets or exceeds expected standards of practice.

  Next, one of the registrars meets with the physician to discuss the report’s accuracy, interpretations, and the feasibility and the value of its recommendations.

  The registrar looks for insight shown by the physician into the quality of his or her practice.  The physician may not agree with all of the findings but should have plausible explanations where he or she does not.  The registrar will generally look for:

  • An ability to acknowledge imperfections. 
  • Motivation to improve. 
  • Sincere effort to change those things that are important to patient safety or the quality of care.

• Follow-Up

  Education (as evidenced by changes in practice or behavior) is the goal of peer reviews coordinated by the College. The College will follow-up with the physician as necessary to evaluate improvements to practice.

• Special Peer Reviews (or Practice Assessments)

  Peer reviews are typically performed in office practices; however, depending on the nature of the concern that generated the need for a peer review, the assessment may need to take place in another practice setting in order to appropriately assess the physician’s practice (e.g. inpatient and emergency departments, multiple facilities, etc.).

  Assessment tools beyond those used in a typical office assessment may be required, depending on the nature of the concern and the complexity of the physician’s practice environment. These tools can include, but are not limited to, direct observation (to assess technical/procedural skills), discussions with the physician’s colleagues and staff (to assess competencies related to communication and professionalism), oral interviews, etc.