Patient care appraisal as a guide for the design of continuing medical education: 10 years' experience in the Maritime provinces.

Patient care appraisal is a process whereby physicians set down criteria and standards of patient care, prepare a summary of relevant health care activities derived from medical records and other sources of data, analyse the shortcomings discovered and design remedial programs. An attempt was made to introduce such a peer review system to 19 community hospitals in the Maritime provinces as a mechanism to improve the quality of health care. Maximum use was made of all existing quality assurance methods, complemented by innovations compatible with known educational and psychological principles. The staffs of the hospitals were willing to participate but problems were encountered in maintaining their motivation. Much of the success was related to the appropriate use of interested and competent medical record librarians in the retrieval, compilation and display of information. A positive attitude towards peer reviews and peer learning evolved in the participants. It is recommended that practising physicians, health care institutions and university divisions of continuing medical education continue and extend such cooperation and find new ways to apply the peer review mechanisms.