Help, I’ve been selected for PAF!

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Don’t panic! We’re here to help.

CPSA has a legislative duty to ensure competence in the medical profession. This is done in a variety of ways through our competence programs, with one newer addition: Physician Assessment and Feedback (PAF).

Approximately 150 physicians participate in this program each year, from a combination of random selection and physicians with risk factors for complaints (you can find your own risk score in your MD Snapshot-Practice Checkup, sent annually to your CPSA Portal). The intent of PAF is to proactively identify patterns of practice that might place a physician at higher risk of a complaint, and further provide appropriate supports to help members address identified practice vulnerabilities.

What to expect from PAF

There is currently no cost to the physician for this assessment.

If you are selected to participate in PAF, you will be asked to fill out a Practice Overview Questionnaire and identify any conflict of interest with our pool of practice visitors.

A practice visitor who is familiar with your scope of practice will be assigned to review approximately 10 patient charts from the last two to three years. They will look for adherence to CPSA’s Patient Record Content standard of practice, and assess whether clinical reasoning is appropriate and documented well enough to follow.

Usually, charts will be accessed remotely via EMR—if you use paper charting, an in-person visit or secure transfer of chart copies will be arranged.

After the patient record review, a conversation is arranged with a member of your team to review office processes, such as after-hours care, management of abnormal results, tracking of referrals and other more procedural aspects of care. You will also meet with the practice visitor, to review some cases (usually four or five) in more detail—this process is referred to as chart-stimulated recall (CSR). This conversation helps clarify a differential diagnosis or follow-up plan, or to understand patient factors which might make providing care more challenging. The practice visitor then prepares a visit report, which is submitted to CPSA.

A CPSA senior medical advisor is then assigned to your file. They use the sources of information derived from the practice visit to identify opportunities for further improvement in your practice, both in terms of clinical care and alignment with CPSA’s Standards of Practice. In 2022, about 80% of physicians participating in PAF had opportunities which could be addressed through self-remediation alone. About 20% of physicians were referred from PAF to CPSA’s Individual Practice Review (IPR) program for further education and supports.

The most common type of support needed is for documentation. Generally, we recommend participants take a medical records keeping course to clarify the type and amount of information that should be documented in a patient’s chart to ensure an adequate record of encounters as well as a complete cumulative patient profile (CPP). Another commonly recommended course is the Canadian Medical Protective Association (CMPA)’s new Advanced Diagnostic Reasoning Course, offered as a free, two-session webinar. A repeat practice visit is also usually conducted after six to twelve months, to assess the implementation of any required practice improvements.

Proactive improvements

This proactive approach to assessing physician performance is intended to improve patient care and prevent complaints before they happen. Participants consistently report that they attained worthwhile skills and knowledge from the required courses and many report they observe significant practice improvements.

To date, most physicians in PAF have been family physicians and general practitioners. In 2022, we developed a process to screen specialist physicians and will select more specialists into the PAF program in 2023.

Want to know more? Visit our website or reach out by emailing PAF@cpsa.ab.ca.