S. Arabsky is program development and evaluation lead, Physician Practice Enhancement Program, College of Physicians and Surgeons of British Columbia, Vancouver, British Columbia, Canada.
N. Castro is director, Physician Practice Enhancement Program, College of Physicians and Surgeons of British Columbia, Vancouver, British Columbia, Canada.
Acad Med. 2020 Nov;95(11S Association of American Medical Colleges Learn Serve Lead: Proceedings of the 59th Annual Research in Medical Education Presentations):S14-S19. doi: 10.1097/ACM.0000000000003642.
Medical regulatory authorities are legally mandated to protect patients by monitoring the practice of medicine. While principally a matter of public safety, many pursue this mission by establishing quality improvement initiatives that prioritize professional development for all rather than identification of substandard performers. Engaging practitioners in directed learning opportunities, however, is rife with challenge given inherent social complexities. This study was run to explore whether relationship-centered coaching could improve physicians' perceptions of the value of engaging with College-mandated peer review.
A quasi-experimental analysis was performed on physician ratings of the effectiveness of peer assessor interactions and assessment processes during 3 time periods: (1) an historical control (March 2016-December 2016; n = 296); (2) a period after assessors were trained to deliver feedback using relationship-centered coaching (December 2016-March 2017; n = 96); and (3) after physicians were given more capacity to choose patient records for peer review and engage in discussion about multisource feedback results (March 2017-December 2018; n = 448).
Psychometric analyses supported the aggregation of survey items into assessor interaction and assessment process subscores. Training assessors to engage in relationship-centered coaching was related with higher assessor interaction scores (4.64 vs 4.47; P < .05; d = 0.37). Assessment process scores did not increase until after additional program enhancements were made in period 3 (4.33 vs 4.17, P < .05, d = 0.29).
Despite peer interactions being inherently stressful for physicians when they occur in the context of regulatory authority visits, efforts to establish a quality improvement culture that prioritizes learning can improve physicians' perceptions of peer review.
医学监管机构依法有责任通过监测医疗实践来保护患者。虽然这主要是公共安全问题，但许多机构通过建立质量改进计划来实现这一目标，这些计划优先考虑所有专业人员的发展，而不是确定表现不佳的人员。然而，让从业者参与有针对性的学习机会充满了挑战，因为其中存在固有的社会复杂性。这项研究旨在探讨关系为中心的辅导是否可以提高医生对参与学院授权同行评审的价值的看法。
对医生对同行评估员互动和评估过程的有效性的评估进行了准实验分析，分为三个时间段：（1）历史对照期（2016 年 3 月至 12 月；n=296）；（2）评估员接受使用关系为中心的辅导来提供反馈的培训期（2016 年 12 月至 2017 年 3 月；n=96）；和（3）在医生有更多能力选择患者记录进行同行评审并就多源反馈结果进行讨论之后（2017 年 3 月至 2018 年 12 月；n=448）。
心理测量分析支持将调查项目汇总为评估员互动和评估过程子分数。培训评估员进行关系为中心的辅导与更高的评估员互动分数相关（4.64 与 4.47；P<0.05；d=0.37）。直到在第三阶段进行了更多的计划增强之后，评估过程分数才增加（4.33 与 4.17，P<0.05，d=0.29）。
尽管同行互动在监管机构访问背景下对医生来说固有压力，但努力建立一个优先考虑学习的质量改进文化可以改善医生对同行评审的看法。
