Physicians

FREQUENTLY ASKED QUESTIONS

What does MPAR measure?

MPAR recognizes that excellence in medical practice requires abilities that extend beyond the traditional measures of clinical skills and knowledge. Rather than focusing on clinical skills and knowledge, MPAR looks more broadly at such areas as coordination of care and resources, professional development, communication, professional conduct, patient interaction skills and office management.

Is MPAR mandatory?

Yes.  Beginning in 2011, all Manitoba physicians who have practised medicine in the province for at least 3 years will be required to participate in the MPAR process. Once selected, physicians must, by law, complete the MPAR assessment. Each year, approximately 14 percent of Manitoba physicians will be surveyed. Physicians not in clinical practice (for example, those in full-time administration or research) may qualify for an exemption or deferral (based on unavailability of tools for this assessment at the present time). Those who recently returned to practice after an extended period of time off may also be deferred.

Is MPAR methodology valid, reliable, and sound?

The MPAR tools and methodology have been tested extensively and validated with a large physician cohort in Alberta (PAR) and Nova Scotia (NSPAR).  Similar multi-source feedback methods have been adopted by organizations such as the American Board of Internal Medicine and have been explored for use in the United Kingdom, Ireland, New Zealand and Australia. The tools are considered psychometrically sound, reliable measures of physicians’ performance.

A wide range of background information on PAR methodology is also available on the NSPAR and PAR websites.

http://www.nspar.ca/

http://www.par-program.org/

How does MPAR work?

MPAR is a survey-based assessment program. Each month, an independent firm, Pivotal Research, randomly selects a set number of physicians to receive a package containing practice-appropriate questionnaires and detailed completion instructions. Physicians identify a selection of 25 patients, 8 medical colleagues and 8 co-workers (e.g. office staff, hospital staff, nurses, pharmacists, physiotherapists) with whom they deal directly.  Each of these individuals receives a brief questionnaire. The physicians under review also complete a self-assessment questionnaire. Completed questionnaires are returned to the research firm, which tabulates the results and returns a confidential, personalized report directly to the reviewed physician. Sample surveys, reports and other materials can be viewed on the MPAR website.

Physicians choose which peers and colleagues fill out questionnaires. Does this affect the validity of the MPAR findings?

Provided that the sample size is sufficiently large, the validity of the findings is not affected when physicians select peers and colleagues to complete assessment questionnaires. Findings are not significantly biased by the method of reviewer selection or by the relationship between reviewers and physicians. (Ramsey, P.G., et al (1993). Use of peer ratings to evaluate physician performance. Journal of the American Medical Association. 269:13, 1655:1660).

Which medical colleagues and co-workers should I choose to fill out questionnaires?

The most informed and objective results come routinely from those medical colleagues and co-workers with whom you work most closely. It is important to recognize that MPAR is not an examination or a test. MPAR feedback is intended to help identify opportunities for practice enhancement. We encourage you to choose colleagues whose opinions you respect and value. As a courtesy, you should notify colleagues and co-workers before providing their names as MPAR reviewers.

What should I do if I am asked to fill out a questionnaire about a colleague?

When completing the questionnaire, be objective and honest, recognizing the importance of your feedback to the quality of your colleague’s assessment. Remember the answers you provide will be included with the responses from all other respondents. Completing a colleague’s questionnaire ordinarily takes five to ten minutes. We ask that you return the completed questionnaire promptly following the instructions provided.

Who has access to individual MPAR reports?

MPAR information is designed for professional development. Apart from the research firm that compiles and mails the confidential report, the reviewed physician is usually the only party to see its contents. The identities of physicians participating in MPAR are known only to those people who need direct contact with them.

The MPAR review is designed to provide scores to physicians on attributes that are measured by the surveys. These scores are assigned “flags” when they are unusually high or low. Physicians whose scores are flagged in the lowest and highest 10 percent of reviews will be contacted by a Physician Advisor from the Physician Practice Enhancement Committee. The Physician Advisor will set up a telephone interview with the physician to place the report results in context. Only reports with flags are reviewed non-nominally by the Physician Practice Enhancement Committee of the College. These reports are reviewed without the physician’s identity being revealed to the committee as a whole.

What happens if my report is reviewed?

Approximately 10 percent of assessed physicians may require or request further practice improvement and/or professional development assistance based on the findings of their MPAR assessment. This assistance could take the form of a telephone interview and/or a practice visit. This follow-up is designed to be helpful and formative. It is not intended to identify “under-performing” physicians. Reports rated in the upper 10 percentile are reviewed in order to identify factors that contribute to exemplary medical practice.

When a report is flagged for review, the independent research firm provides the physician’s name, address and telephone number to one of the Physician Advisors of the Physician Practice Enhancement Committee. The Physician Advisors, who are themselves physicians, will set up a telephone interview with the physician being reviewed in order to place the report results in context. The results of this interview are discussed by the Physician Practice Enhancement Committee in a non-nominal manner (to protect the identity of the physician). The Committee either advises the physician about self-directed improvement or recommends an individualized learning experience which may be in the form of a practice visit from a physician peer.

Could MPAR lead to a College investigation of my practice?

The only way that MPAR will result in a College investigation is as a result of a physician’s unreasonable failure to comply with MPAR (without previous deferral or exemption) or in extremely unusual instances when it is deemed that the public is at immediate risk of harm or there is a serious breach of ethics. The physician may then be referred to the Registrar who in turn may refer to the Investigation Chair.

What are the goals of MPAR?

The goals of the program are to foster a culture of continuous quality improvement among Manitoba physicians and to offer a link between assessment and focused professional development. MPAR serves as the basis for an individualized, self-directed program of professional development and quality improvement.

More specifically, MPAR provides an assessment from which physicians will obtain detailed information on their performance in clinical practice, while encouraging self-reflection and practice enhancement.

MPAR measures patient feedback on how their needs and expectations are being met.

MPAR measures performance on some of the key pillars of the CANMEDS competencies as outlined by the Royal College of Physicians and Surgeons of Canada. These include the physician’s role as communicator, collaborator, manager, health advocate and professional.

MPAR’s objective is to assist physicians in the ongoing acquisition of new knowledge, skills and ways of thinking to maintain and improve performance.

Is there CPD credit for undertaking an MPAR review?

Yes. Participants in MPAR may earn MAINPRO-C credits from The College of Family Physicians of Canada or Maintenance of Certification / CPD credits from the Royal College of Physicians and Surgeons of Canada. More information on obtaining credit is available from these organizations at their respective web sites.

College of Family Physicians of Canada

Royal College of Physicians & Surgeons of Canada

What if I have questions about the program or the process?

To ensure confidentiality, physicians with questions about the process, survey instruments, instructions or other confidential material are encouraged to contact the independent research firm that manages MPAR survey distribution. The toll-free number is 1-855-756-6969.

Regular MPAR updates are available on the MPAR website and will be published in College publications. For questions about the program or to provide feedback, physicians are encouraged to contact the MPAR Program Coordinator by phone at (204) 774-4344, Ext. 153, toll-free in Manitoba at 1-877-774-4344, Ext. 153, or by e-mail at cpd@cpsm.mb.ca.