Harmonization of clinical practice guidelines for primary prevention and screening: actionable recommendations and resources for primary care.

Background: Clinical practice guidelines (CPGs) synthesize high-quality information to support evidence-based clinical practice. In primary care, numerous CPGs must be integrated to address the needs of patients with multiple risks and conditions. The BETTER program aims to improve prevention and screening for cancer and chronic disease in primary care by synthesizing CPGs into integrated, actionable recommendations.

Patients' complaints involving ophthalmologists in the province of Ontario, Canada: a 5-year review.

Objective: To present an overview of complaints against ophthalmologists to the regulatory body in the province of Ontario, Canada, during a 5-year period.

Design: Retrospective cross-sectional study.

Methods: All completed complaints to the College of Physicians and Surgeons of Ontario (CPSO) involving ophthalmologists from January 2013 to May 2018 were reviewed.

Realizing One's Own Subjectivity: Assessors' Perceptions of the Influence of Training on Their Conduct of Workplace-Based Assessments.

Purpose: Assessor training is essential for defensible assessments of physician performance, yet research on the effectiveness of training programs for promoting assessor consistency has produced mixed results. This study explored assessors' perceptions of the influence of training and assessment tools on their conduct of workplace-based assessments of physicians.

Method: In 2017, the authors used a constructivist grounded theory approach to interview 13 physician assessors about their perceptions of the effects of training and tool development on their conduct of assessments.

Primary care performance of alternatively licenced physicians in Ontario, Canada: a cross-sectional study using administrative data.

Objectives: Medical Regulatory Authorities (MRAs) provide licences to physicians and monitor those physicians once in practice to support their continued competence. In response to physician shortages, many Canadian MRAs developed alternative licensure routes to allow physicians who do not meet traditional licensure criteria to obtain licences to practice. Many physicians have gained licensure through alternative routes, but the performance of these physicians in practice has not been previously examined.

Experiential knowledge of risk and support factors for physician performance in Canada: a qualitative study.

Objective: To identify, understand and explain potential risk and protective factors that may influence individual and physician group performance, by accessing the experiential knowledge of physician-assessors at three medical regulatory authorities (MRAs) in Canada.

Design: Qualitative analysis of physician-assessors' interview transcripts. Telephone or in-person interviews were audio-recorded on consent, and transcribed verbatim.

Redeveloping a workplace-based assessment program for physicians using Kane's validity framework.

This paper describes the use of Kane's validity framework to redevelop a workplace-based assessment program for practicing physicians administered by the College of Physicians and Surgeons of Ontario. The developmental process is presented according to the four inferences in Kane's model. was addressed through the creation of specialty-specific assessment criteria and global, narrative-focused reports.

Seventy Years of RN Effectiveness: A Database Development Project to Inform Best Practice.

Background: The appropriate nursing staff mix is imperative to the provision of quality care. Nurse staffing levels and staff mix vary from country to country, as well as between care settings. Understanding how staffing skill mix impacts patient, organizational, and financial outcomes is critical in order to allow policymakers and clinicians to make evidence-informed staffing decisions.

A Call to Investigate the Relationship Between Education and Health Outcomes Using Big Data.

There exists an assumption that improving medical education will improve patient care. While seemingly logical, this premise has rarely been investigated. In this Invited Commentary, the authors propose the use of big data to test this assumption.

Tools for Enhancement and Quality Improvement of Peer Assessment and Clinical Care in Endocrinology and Metabolism.

Members of the College of Physicians and Surgeons of Ontario Endocrinology and Metabolism Peer Review Network have been involved in a quality improvement project to help standardize the peer assessment of physicians practicing in endocrinology and metabolism. This has included developing state-of-the-art summaries of common endocrine problems by Canadian experts in endocrinology and metabolism. These tools have been developed in response to the educational needs, as identified by peer reviewers, of practicing endocrinologists in Ontario.

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario.

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice.

CAEP 2015 Academic Symposium: Leadership within the emergency medicine academic community and beyond.

Objectives: A panel of emergency medicine (EM) leaders endeavoured to define the key elements of leadership and its models, as well as to formulate consensus recommendations to build and strengthen academic leadership in the Canadian EM community in the areas of mentorship, education, and resources.

Methods: The expert panel comprised EM leaders from across Canada and met regularly by teleconference over the course of 9 months. From the breadth of backgrounds and experience, as well as a literature review and the development of a leadership video series, broad themes for recommendations around the building and strengthening of EM leadership were presented at the CAEP 2015 Academic Symposium held in Edmonton, Alberta.

Does the Volume of Ischemic Stroke Admissions Relate to Clinical Outcomes in the Ontario Stroke System?

Background: Better outcomes have been found among hospitals treating higher volumes of patients for specific surgical and medical conditions. We examined hospital ischemic stroke (IS) volume and 30-day mortality to inform regionalization planning.

Methods And Results: Using a population-based hospital discharge administrative database (2005/2006 to 2011/2012), average annual IS patient volumes were calculated for 162 Ontario acute hospitals.

Characteristics of patients receiving long-term opioid therapy for chronic noncancer pain: a cross-sectional survey of patients attending the Pain Management Centre at Hamilton General Hospital, Hamilton, Ontario.

Background: Characteristics of patients receiving long-term opioid therapy (≥ 6 months) for chronic noncancer pain are poorly understood. We conducted a cross-sectional survey of this patient population to explore demographic variables, pain relief, functional improvement, adverse effects and impressions of an educational pamphlet on long-term opioid therapy.

Methods: We invited 260 adult patients presenting to the Pain Management Centre at the Hamilton General Hospital, Hamilton, Ontario, with chronic noncancer pain to complete a 20-item survey.

Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2).

Purpose: To develop and conduct feasibility testing of an evidence-based and theory-informed model for facilitating performance feedback for physicians so as to enhance their acceptance and use of the feedback.

Method: To develop the feedback model (2011-2013), the authors drew on earlier research which highlights not only the factors that influence giving, receiving, accepting, and using feedback but also the theoretical perspectives which enable the understanding of these influences. The authors undertook an iterative, multistage, qualitative study guided by two recognized research frameworks: the UK Medical Research Council guidelines for studying complex interventions and realist evaluation.

Successes and challenges in population-based cancer screening.

Cancer Care Ontario's (CCO's) organized breast, colorectal and cervical cancer screening programs are in different stages of development and maturity. Headed by clinical and scientific leads, the programs reflect a deep understanding of how to design, evaluate and report on programs based on evidence and best practice. Guided by a CCO-Ministry of Health and Long-Term Care ("the Ministry") joint committee and supported by recent investments in information technology infrastructure, the programs provide high-quality cancer screening to Ontario's eligible population.

The relationship between physician participation in continuing professional development programs and physician in-practice peer assessments.

Purpose: To investigate the relationship between physicians' performance, as evaluated through in-practice peer assessments, and their participation in continuing professional development (CPD).

Method: The authors examined the predictive effects of participating in the CPD programs of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada one year before in-practice peer assessments conducted by the medical regulatory authority in Ontario, Canada, in 2008-2009. Two multivariate logistic regression models were used to determine whether physicians who reported participating in any CPD and group-based, assessment-based, and/or self-directed CPD activities were more or less likely to receive satisfactory assessments than physicians who had not.

Internationally educated healthcare workers: focus on physicians in ontario.

The issue of access to licensure for internationally educated health professionals is a critical one, and the impact of inadequate healthcare resources has a profound impact on patients. As the body that licenses doctors in Ontario, issues related to the provincial doctor shortage and problems with access to licensure for international medical graduates (IMGs) have been significant areas of focus for the College of Physicians and Surgeons of Ontario (CPSO). In February 2002, the CPSO Council approved the establishment of the first Physician Resources Task Force.

Self-study of values, beliefs, and conflict of interest: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

Study Design: Observation and survey of values, beliefs, and conflicts of interest.

Objective: To study the values, beliefs, and potential conflicts of interest that the Neck Pain Task Force brought to their deliberations.

Summary Of Background Data: Researchers' values and beliefs were studied to uncover areas of divergence and to develop guiding principles to assist decision making.

Self-study of values, beliefs, and conflict of interest: the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders.

Study Design: Observation and survey of values, beliefs, and conflicts of interest.

Objective: To study the values, beliefs, and potential conflicts of interest that the Neck Pain Task Force brought to their deliberations.

Summary Of Background Data: Researchers' values and beliefs were studied to uncover areas of divergence and to develop guiding principles to assist decision making.

A performance-based conception of competence is changing the regulation of physicians' professional behavior.

It is the obligation of a profession to articulate the special meaning of competence in its field and to foster the good performance of its practitioners through education and discipline. External societal demands for increased accountability, and internal pressures for greater use of measurements of the processes and outcomes of clinical performance, are forcing the medical profession to reevaluate its view of competence and to change the way the profession "manages" the competence of its members. Traditionally, and predicated on the notion of "once in, good for life," medical education has focused on assuring the competence of trainees as they first enter independent professional life.

Physician-patient encounters: the structure of performance in family and general office practice.

Introduction: The College of Physicians and Surgeons of Ontario, the regulatory authority for physicians in Ontario, Canada, conducts peer assessments of physicians' practices as part of a broad quality assurance program. Outcomes are summarized as a single score and there is no differentiation between performance in various aspects of care. In this study we test the hypothesis that physician performance is multidimensional and that dimensions can be defined in terms of physician-patient encounters.

Effectiveness of an enhanced peer assessment program: introducing education into regulatory assessment.

Introduction: The College of Physicians and Surgeons of Ontario developed an enhanced peer assessment (EPA), the goal of which was to provide participating physicians educational value by helping them identify specific learning needs and aligning the assessment process with the principles of continuing education and professional development. In this article, we examine the educational value of the EPA and whether physicians will change their practice as a result of the recommendations received during the assessment.

Methods: A group of 41 randomly selected physicians (23 general or family practitioners, 7 obstetrician-gynecologists, and 11 general surgeons) agreed to participate in the EPA pilot.

Health services utilization after induced abortions in Ontario: a comparison between community clinics and hospitals.

The purpose of this study was to compare postabortion health services utilization of hospital abortion patients with community clinic abortion patients using administrative databases. The study was a retrospective cohort study. The study group consisted of patients with induced abortions (n = 41,039) performed in hospitals or community clinics recorded in the 1995 Ontario Health Insurance Plan claims (OHIP) database.