The Practice Enhancement Program for Saskatchewan Physicians (PEPSask) is an educational program that encourages physicians to continually improve through practice-based quality assessment.
PEPSask is supported through equal annual funding from the College of Physicians and Surgeons of Saskatchewan, Saskatchewan Health Authority, and the Saskatchewan Medical Association. Oversight of the program is done by a committee that functions independently of the funding organizations.
Prior to its introduction, the PEPSask Committee surveyed existing provincial assessment programs and found that physicians improved when given feedback on specific areas, as well as advice on how to do so. After its introduction in 1994, PEPSask assessed their physicians by conducting in-office audits—sending trained peer assessors to review charts and determine whether a physician was following existing standards and guidelines. This assessment technique, while effective, was expensive and labour intensive.
With upwards of 2,500 physicians in Saskatchewan, and a goal of assessing every eligible physician once every 5 years, there are a lot of assessments to complete.
In early 2020, PEPSask adopted MCC 360 as the first tool in their updated assessment process. Dr. George Carson, an obstetrician gynecologist and the co-chair of the PEPSask Committee explains, “we have to do more with the resources that we’ve got, and MCC 360 does this.”
Physicians are randomly selected from the eligible pool according to PEPSask’s selection criteria, and those selected are required to complete MCC 360.
The main objective of the program is in the name: Practice Enhancement Program. Dr. Carson believes that participating in the assessment process can be a fantastic opportunity for a physician. “It’s highly unlikely that any of us is perfect.” To reinforce this point, he volunteered to undergo the assessment process on his own practice, believing that it was only fair as a committee member to understand what was being asked of Saskatchewan physicians. In keeping with the experiences of most physicians who complete MCC 360, he was reassured by the feedback he received and identified changes that could improve his practice. He reflects, “reinforcement that you’re doing a good job is itself a good thing.”
Once a physician participant completes the feedback collection for MCC 360, they receive a report, and a call is arranged with a physician acting as a coach to review the report and assist with an action plan for positive change. The PEPSask Committee, which decides on the results of all assessments, also reviews each physician’s MCC 360 report and considers the presence of pre-established indicators associated with an increased chance of problematic performance (these indicators include increased age, patient volumes, practice in isolation, and the absence of learners in the practice, among others). If any significant concerns are detected, an in-office visit is arranged to follow up. MCC 360 effectively acts as a screening tool for the more expensive and labour-intensive in-office visits. Used in this way, PEPSask regards MCC 360 and in-office assessments as complementary tools.
MCC 360 delves into performance in the CanMEDS physician roles of communicator, collaborator, and professional. Dr. Carson explains, “communicator and collaborator in particular are intrinsically important to patient care, and we weren’t actually measuring those very well with the in-office assessments.” These competencies are transferable across disciplines so physicians can discuss them together; this facilitates building a pool of physician coaches.
PEPSask trusts that most physician participants will consider the suggestions for their practice and implement them. The intended purpose of MCC 360 is quality improvement; however, Dr. Carson’s worry is always the possibility of a false-negative. Using only 3 CanMEDS roles for assessment, could MCC 360 approve a practice and overlook a problem that results in a patient getting hurt? The medical expert role—a role that was well measured with the previous in-office visits—is not measured by MCC 360, but Dr. Carson hopes research might offer some insight into possible correlation. To mitigate this risk, PEPSask randomly selects some physicians who have had good outcomes on their MCC 360 for an in-office assessment; neither the physician nor the assessor knows the reason the in-office assessment is being done.
By comparing a sufficient number of in-office assessment results with both positive MCC 360 results and poor MCC 360 results, PEPSask hopes to determine whether MCC 360’s measured competencies of communicator, collaborator, and professional is adequately screening for parallel problems that may exist in the medical expert role. This would allow PEPSask to spend their limited resources conducting in-office assessments where they are needed most. PEPSask is the first organization to collect such data and plans to share the results with the Medical Council of Canada (MCC).
Although MCC 360 (and multi-source feedback in general) is not suitable to be used in isolation for quality-assurance purposes, combining MCC 360 data about communicator, collaborator, and professional roles with data assessing the medical expert role measured by other tools is appropriate and can provide a more holistic assessment of physician performance.*
PEPSask expected to complete 150 physician assessments this year, but with MCC 360, they are on track to exceed that number. This will allow them to report to their funding agencies that they have completed more assessments than they have previously been able to achieve. The use of MCC 360 coupled with in-office assessments brings PEPSask closer to their goal of routinely reviewing all eligible physicians and delivering high-quality care to all patients in Saskatchewan.
MCC 360 is a national multi-source feedback program designed for physicians practising in Canada to help develop their CanMEDS roles of communicator, professional, and collaborator. The program focuses on the physician, helping them better understand their practice, including their strengths and areas for improvement by collecting feedback from colleagues, coworkers, and patients, as well as from individualized one-on-one coaching. By completing the program, physicians can earn 12 or more continuing professional development (CPD) credits with the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. The program is delivered by leaders in physician assessment and the MCC and is supported by a dedicated team and customer service agents.
For more information, visit MCC 360.
* MCC 360 is intended to be used for formative purposes and is not meant to provide a pass or fail decision about a physician, or to rank-order physicians. As a quality-assurance committee, opinions (such as observations about a practice) are protected. This keeps the findings of PEPSask at arms-length from the College of Physicians and Surgeons of Saskatchewan. Bylaws require PEPSask to report to the college anyone found to be an immediate threat to the well-being of patients in Saskatchewan.