2014-2015 – Sylvain Boet | Medical Council of Canada
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2014-2015 - Sylvain Boet

Effect of audit and formative assessment on physicians’ perioperative temperature management and patient outcomes: A three-arm cluster randomized controlled trial to compare benchmarked and ranked feedback


Sylvain Boet, MD, PhD


G. Bryson
N. Clavel
J. Brehaut
M. Taljaard
A. Forster
K. Mohamed
D. McIsaac
C. Pysyk
J. Grimshaw



Evidence shows that formative assessment, i.e. feedback, leads to improvement in physicians’ professional practice. Direct comparison between different types of feedback has been identified as a literature gap. Surgical site infection (SSI) is one of the most common post-operative complications and increases the length of hospital stays, operating costs, and postoperative mortality. Perioperative hypothermia is a well-identified factor contributing to SSI. Effective and inexpensive methods of warming are available, yet perioperative hypothermia remains common. We aim to assess the impact of benchmarked and ranked feedback, compared to status quo (no feedback), on anesthesiologists’ perioperative temperature management and subsequent patient outcomes.


Staff anesthesiologists will be recruited for this three-arm cluster randomized controlled trial. During the 6 month baseline phase, anesthesiologists’ perioperative temperature management performance will be audited and no feedback will be given. Anesthesiologists will then be randomized to one of three groups: no feedback (control), benchmarked feedback, ranked feedback. During this 6 month intervention phase, feedback will be provided to anesthesiologists according to group allocation and their temperature management performance will be measured and analyzed. Finally, in the per-intervention phase (6 months), anesthesiologists’ performance will be audited and no feedback will be given to any of the anesthesiologists of the three groups. This phase will allow us to investigate the retention of behavioural change.


This study will answer an important clinical question, relying on strong educational, psychological, and management theories to explore physicians’ performance and subsequent patient outcomes. We will build on previous work from our co-investigators and address a well-identified knowledge gap in the literature. One of the strengths of the proposed study is that we will evaluate the impact of formative assessment in clinical setting beyond the usual learning outcomes, assessing patients’ outcomes. Our tested intervention could easily be generalizable to other domains.