Measuring physician performance using the CanMEDS framework: proposal for an innovative approach

Kiran Rabheru, MD

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Measuring physician performance using the CanMEDS framework: proposal for an innovative approach

GRASP (Global Review and Assessment of Staff Physicians’ Performance) is a proposed new tool for assessing physician performance. Integrating the familiar CanMEDS framework with the global assessment scale, Observed Structured Assessment of Technical Skills, it uses milestones to measure the progress of all physicians. Readers are invited to comment and participate in further development of GRASP.

 

KEY WORDS:  CanMEDS framework, physician performance, performance appraisal, assessment tool, Observed Structured Assessment of Technical Skills, OSATS, LEADS, GRASP, Global Review and Assessment of Staff Physicians’ Performance Top

 

The need for a tool to measure physician performance

 

Physicians have a profound impact on patient safety, quality of care, team function, and overall costs to the health care system. However, monitoring and evaluating physician performance in today’s complex health care environment can be a daunting task. A universally accepted tool that can be used to evaluate systematically the performance of physicians across all groups is needed. Such measures can then be used in decisions regarding the granting of institutional credentials and privileges. Top

 

A thorough review of the literature and consultation with many senior physician leaders across Canada revealed that there is an urgent need for a performance evaluation tool, and physician leaders are enthusiastically seeking one.1,2,3,4,5 To have universal utility and acceptability, such a tool must be based on a well-defined framework, which itself is created by and for physicians. To resonate with all physicians and be accepted, the tool must be deeply rooted in an inherent set of core values.

 

This paper is an introduction to work in progress to develop such a tool and an invitation to the reader to collaborate further on researching the proposed model for evaluating physician performance. Top

 

Overview of the GRASP

 

GRASP (for Global Review and Assessment of Staff Physicians’ Performance) was produced by adapting and integrating the well-known CanMEDS framework6 and physician milestones7 with the global assessment scale, Observed Structured Assessment of Technical Skills (OSATS).8 The main goal was to help standardize the process of performance evaluation and credentialing of all physicians for institutional privileges. The GRASP has the capacity to make the evaluation process physician friendly, fair, clear, transparent, and predictable. Most important, it is based on the CanMEDS framework, with which every physician is already familiar, making the process of life-long learning an integral part of each and every physician’s daily life. Top

 

CanMEDS framework

 

CanMEDS6 is a framework developed by the Royal College of Physicians and Surgeons of Canada in the 1990s, and later adopted by the College of Family Physicians of Canada. Its overarching goal is to improve patient care by enhancing physician training.9 The CanMEDS framework serves as a foundation for medical education and practice in Canada. It has also been adapted around the world, both within and outside the health professions, and has become the most widely accepted and applied physician competency framework in the world. As every physician, who is trained, certified, and licensed to practise in Canada must comply with the CanMEDS roles, it seems logical that they should continue to ascribe to the same set of values as they continue in their career and train future physicians.

 

The CanMEDS framework was chosen over the renowned LEADS framework10,11 to develop the GRASP. The LEADS framework, which was developed through collaboration between the Health Care Leaders Association of British Columbia and Royal Roads University, identifies key leadership capabilities, and features five domains: Lead self, Engage others, Achieve results, Develop coalitions, and Systems transformation. Each of these five domains consists of four core measureable capabilities. Top

 

The LEADS framework has been endorsed by organizations such as the Canadian Health Leadership Network,12 and adopted by the Canadian Society of Physician Leaders in collaboration with the Canadian Medical Association (CMA)13 as a basis for leadership development toward the Canadian Certified Physician Executive (CCPE) credential.14,15

 

The core difference between the CanMEDS and LEADS frameworks, which helped refine the GRASP as a tool for physician performance evaluation, is that CanMEDS deals with professional competencies specifically tailored for physicians, while LEADS deals with capabilities for all health care workers. Top

 

The CanMEDS framework consists of seven physician roles, all of which are important in evaluating physician performance. Discussions with physician leaders and colleagues revealed unanimous agreement that all of the roles are critical in assessing each physician. There are no exemptions to achieving these competencies simply by virtue of area of special interest, expertise, or scope of practice. Top

 

A physician with limited clinical practice — a researcher, surgeon or anesthesiologist, for example — would still have to meet the requirements for the roles of Medical expert, Communicator, Collaborator, and Professional, in addition to those of Academic, Scholar, and Advocate. The intent is not to minimize the importance of the latter three roles; on the contrary, it is to highlight the need for all physicians to meet acceptable standards in all seven roles, regardless of their area or scope of practice. All physicians would all have to abide by the same rules and be held to the same level of accountability. Top

 

OSATS assessment tool

 

OSATS is a global assessment scale used to evaluate the performance of trainees.16 The OSATS scale was chosen, as it integrates and synthesizes data collected from various sources to help form a comprehensive assessment. This usually includes a checklist of tasks successfully completed, attributes that the candidate must have, and multiple sources of feedback regarding each candidate. The final dichotomous outcome, e.g., granting or withholding of privileges, is based on a meta-observational global assessment of each candidate conducted in a semi-structured and objective manner, using milestones that are clearly articulated and understood by all. Top

 

The positive effect of OSATS on learning during formative stages and its relative superiority in the precise assessment of clinical skills compared with the traditional evaluation method has been well established.17 Human behaviour is complex and involves integration of data from many sources over a prolonged period. The OSATS allows evaluators to be very flexible, but also precise at the same time. The evaluator can select data from a wide range of sources, provide objective feedback based on serial incremental progression toward milestones that are well understood and accepted, a priori, and help poorly performing trainees take remedial action.

 

The OSATS template was selected based on these characteristics, as it seems well suited for measuring overall performance in complex environments of human interaction. It is to be used in synchrony with the CanMEDS roles, using physician milestones as behavioural anchors. Top

 

Caveats for those using the GRASP

 

Context

Physicians are held to a very high standard of moral, ethical, and professional accountability by virtue of their role in society and society’s expectations. Personality traits are usually ingrained and stable, but may change to some extent, based on circumstances. Some are evident only when a person is undergoing unusual stress and, thus, may not reflect their usual pattern of behaviour. Such situations, especially negative behaviour, are often brought to leaders’ attention by observers, who may not be familiar with the physician or the circumstances.

 

Thus, the context in which a particular behaviour is observed must be kept in mind. In most situations, the GRASP is used as a formative, not punitive, tool. Most infractions are remediable and the physician may benefit from support and mentoring to achieve better outcomes. Top

 

Personality traits

Challenges arise when physicians demonstrate unprofessional behaviour and create repeated problems for others, including patients, their families, staff members, and colleagues. If such unacceptable behaviours are frequent, they may be reported by several reputable observers and have a significant impact on the smooth operation of the institution.

 

Routine and regular performance appraisals often do not address these issues, which arise in crises when there is a reported incident. GRASP provides an opportunity to incorporate these incidents into a systematic performance review process and evidence-based practice. Top

 

Supportive work environment and formative opportunities

People cannot perform at their best in environments or under circumstances that are ambiguous. In a healthy workplace, clear achievable goals are defined, and resources and incentives are established to achieve them. All physician leaders must be able to provide a formative, supportive environment to manage expectations and help physicians achieve their goals. Top

 

For most physicians, performance evaluation will be a positive experience — a formative and goal-setting exercise. However, for a small minority who, despite every opportunity and support, fall below the standards expected of a physician, a universally accepted tool such as the GRASP may be invaluable in making the evaluation process less ambiguous.

 

Sources of feedback for determining physician milestones

Including feedback from various sources in an objective way is critical when evaluating complex human behaviour. Well-accepted and standardized behavioural anchors, or physician milestones, for the GRASP were adapted from the Royal College’s milestone document,7 but are intentionally broadly defined. Top

 

The word “consistently,” used in most milestones, is open to interpretation. In general, consistently means physicians maintain a particular standard of behaviour or repeat a particular task with minimal variation. The literature in this area18 suggests that the question of what is “good enough” cannot simply be based on a single observation of an act or behaviour. Rather, it must take into account the context, the motivation, frequency of occurrence, the connotation, and the consequences or impact of the act or behaviour. Top

 

It is vital to rely on multiple sources of objective, well-documented, unbiased, and impartial data about each physician’s performance. Sources of feedback may include peers, patients, families, allied health professionals, as well as many of the usual institutional metrics. This feedback can then be viewed through the lens of the GRASP to evaluate each CanMEDS role and the physician’s performance on each milestone over time.

 

Insight and judgement

Finally, physician leaders must answer a key question in open dialogue with each physician they are evaluating: “Does this physician possess insight and reasonable judgement relevant to his or her actions or behaviours in a given situation or scenario?” Top

 

Physicians who demonstrate good insight and judgement are generally the ones who possess mature and healthy defense mechanisms and have the mental flexibility to be able to perform some degree of meta-reflection on their own behaviour. They are also willing to acknowledge their contribution or role in a situation or scenario and take advantage of learning opportunities to improve their own attitudes, skills, performance, and behaviour.

 

Conversely, a physician who is unwilling to rethink components of his or her attitude, who demonstrates excessive defensive behaviour, who possesses a relative deficiency of mental flexibility, who is firm and rigid and lacks the ability to develop insight into improvement opportunities should raise a red flag that must be addressed proactively by the leader. Top

 

High stakes

 

Although this proposed tool for evaluating physician performance holds great potential and has been described by physician leaders who have reviewed it to date as heuristic, innovative, and thought-provoking, its implementation faces many potential barriers. It also seeks to uncover relevant areas of physician competencies that have traditionally not been considered in evaluation of performance.

 

Thus, it is imperative that a concept such as this be considered with a great deal of care, thought, and reflection — and it must be scientifically rigorous. At this stage, it would be useful to approach the idea of using the GRASP to evaluate physician performance as an academic initiative and to establish validity, reliability, and end-user experience. To make this a high-impact tool, I believe that it must resonate with all physicians if it is to achieve the intended result, which is to make physicians’ and patients’ lives better. Top

 

An invitation

 

I invite all interested physician leaders to provide comments and feedback about the concept of using the CanMEDS framework to evaluate physician performance, and, in particular, about the utility of using the GRASP at their institution. As part of this project, I also invite leaders to join me in conducting a pilot project to evaluate the utility of such a tool and refine it further. Top

 

References

1.Flood SC. Using qualitative self-evaluation in rating physician performance. Fam Pract Manag 1998;5(5):22-34. Available: http://tinyurl.com/zrtm7c2 (accessed 26 Jan. 2016).

2.Criticisms of physician performance measurement and reporting. In Value-based purchasing guide. Washington, DC: National Business Coalition on Health; 2011. Available: http://tinyurl.com/gsjj2ej (accessed 26 Jan. 2016).

3.Physician performance measurement & reporting introduction. In Value-based purchasing guide. Washington, DC: National Business Coalition on Health; 2011. Available: http://tinyurl.com/hgr6487 (accessed 26 Jan. 2016).

4.Physician performance evaluation/profiling: how to challenge your profile or designation by a health plan. Denver: Colorado Medical Society; n.d. Available: http://tinyurl.com/zaf27mb (accessed 26 Jan. 2016).

5.Capko J. 5 steps to a performance evaluation system. Fam Pract Manag 2003;10(3):43-8. Available: http://tinyurl.com/6nqgt2c (accessed 26 Jan. 2016).

6.CanMEDS: better standards, better physicians, better care. Ottawa: Royal College of Physicians and Surgeons of Canada; 2014. Available: http://tinyurl.com/9ty9dm2 (accessed 26 Jan. 2016).

7.CanMEDS milestones. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available: http://canmeds.royalcollege.ca/en/milestones

8.Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84(2):273-8.

9.Working Group on Curriculum Review. CanMEDS – family medicine.  Mississauga: College of Family Physicians of Canada; 2009. Available: http://tinyurl.com/hzrrea4

(accessed 26 Jan. 2016).

10.LEADS in a caring environment framework. Ottawa: Canadian College of Health Leaders and Canadian Health Leadership Network; 2016. Available: http://leadscollaborative.ca/site/framework (accessed 26 Jan. 2016).

11.Dickson G, Tholl B. The LEADS in a caring environment capabilities framework:  a “for health, by health” enabler for leadership capacity development and leadership talent management. Ottawa: Canadian College of Health Leaders and Canadian Health Leadership Network; 2011. Available: http://tinyurl.com/gs3ezt9 (accessed 26 Jan. 2016).

12.LEADS framework & tools. Ottawa: Canadian Health Leadership Network; 2015. Available: http://tinyurl.com/hf4qrtv (accessed 26 Jan. 2016).

13.LEADS in a caring environment framework. Ottawa: Canadian Medical Association; 2016. Available: http://tinyurl.com/j98g2he (accessed 26 Jan. 2016).

14.Recognizing physician leadership — a credential that will set you apart. Ottawa: Canadian Association of Physician Leaders; 2015. http://tinyurl.com/hrx265s (accessed 26 Jan. 2016).

15.2015 assessment form. Ottawa: Canadian Medical Association; 2015. Available: http://tinyurl.com/h3mr5rg (accessed 26 Jan. 2016).

16.Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84(2):273-8.

17.Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327(7422):1032-7.

18.Landon BE, Normand SL, Blumenthal D, Daley J. Physician clinical performance assessment: prospects and barriers. JAMA 2003;290(9):1183-9.

 

Author

Kiran Rabheru, MD, CCFP, FRCP, DABPN, CCPE, is a professor of psychiatry at the University of Ottawa and medical director, Geriatric Psychiatry and Electroconvulsive Therapy Program, at The Ottawa Hospital.

 

Correspondence to: krabheru@toh.ca

 

This article has been reviewed by a panel of physician leaders.

Top

 

GRASP (Global Review and Assessment of Staff Physicians’ Performance) is a proposed new tool for assessing physician performance. Integrating the familiar CanMEDS framework with the global assessment scale, Observed Structured Assessment of Technical Skills, it uses milestones to measure the progress of all physicians. Readers are invited to comment and participate in further development of GRASP.

 

KEY WORDS:  CanMEDS framework, physician performance, performance appraisal, assessment tool, Observed Structured Assessment of Technical Skills, OSATS, LEADS, GRASP, Global Review and Assessment of Staff Physicians’ Performance Top

 

The need for a tool to measure physician performance

 

Physicians have a profound impact on patient safety, quality of care, team function, and overall costs to the health care system. However, monitoring and evaluating physician performance in today’s complex health care environment can be a daunting task. A universally accepted tool that can be used to evaluate systematically the performance of physicians across all groups is needed. Such measures can then be used in decisions regarding the granting of institutional credentials and privileges. Top

 

A thorough review of the literature and consultation with many senior physician leaders across Canada revealed that there is an urgent need for a performance evaluation tool, and physician leaders are enthusiastically seeking one.1,2,3,4,5 To have universal utility and acceptability, such a tool must be based on a well-defined framework, which itself is created by and for physicians. To resonate with all physicians and be accepted, the tool must be deeply rooted in an inherent set of core values.

 

This paper is an introduction to work in progress to develop such a tool and an invitation to the reader to collaborate further on researching the proposed model for evaluating physician performance. Top

 

Overview of the GRASP

 

GRASP (for Global Review and Assessment of Staff Physicians’ Performance) was produced by adapting and integrating the well-known CanMEDS framework6 and physician milestones7 with the global assessment scale, Observed Structured Assessment of Technical Skills (OSATS).8 The main goal was to help standardize the process of performance evaluation and credentialing of all physicians for institutional privileges. The GRASP has the capacity to make the evaluation process physician friendly, fair, clear, transparent, and predictable. Most important, it is based on the CanMEDS framework, with which every physician is already familiar, making the process of life-long learning an integral part of each and every physician’s daily life. Top

 

CanMEDS framework

 

CanMEDS6 is a framework developed by the Royal College of Physicians and Surgeons of Canada in the 1990s, and later adopted by the College of Family Physicians of Canada. Its overarching goal is to improve patient care by enhancing physician training.9 The CanMEDS framework serves as a foundation for medical education and practice in Canada. It has also been adapted around the world, both within and outside the health professions, and has become the most widely accepted and applied physician competency framework in the world. As every physician, who is trained, certified, and licensed to practise in Canada must comply with the CanMEDS roles, it seems logical that they should continue to ascribe to the same set of values as they continue in their career and train future physicians.

 

The CanMEDS framework was chosen over the renowned LEADS framework10,11 to develop the GRASP. The LEADS framework, which was developed through collaboration between the Health Care Leaders Association of British Columbia and Royal Roads University, identifies key leadership capabilities, and features five domains: Lead self, Engage others, Achieve results, Develop coalitions, and Systems transformation. Each of these five domains consists of four core measureable capabilities. Top

 

The LEADS framework has been endorsed by organizations such as the Canadian Health Leadership Network,12 and adopted by the Canadian Society of Physician Leaders in collaboration with the Canadian Medical Association (CMA)13 as a basis for leadership development toward the Canadian Certified Physician Executive (CCPE) credential.14,15

 

The core difference between the CanMEDS and LEADS frameworks, which helped refine the GRASP as a tool for physician performance evaluation, is that CanMEDS deals with professional competencies specifically tailored for physicians, while LEADS deals with capabilities for all health care workers. Top

 

The CanMEDS framework consists of seven physician roles, all of which are important in evaluating physician performance. Discussions with physician leaders and colleagues revealed unanimous agreement that all of the roles are critical in assessing each physician. There are no exemptions to achieving these competencies simply by virtue of area of special interest, expertise, or scope of practice. Top

 

A physician with limited clinical practice — a researcher, surgeon or anesthesiologist, for example — would still have to meet the requirements for the roles of Medical expert, Communicator, Collaborator, and Professional, in addition to those of Academic, Scholar, and Advocate. The intent is not to minimize the importance of the latter three roles; on the contrary, it is to highlight the need for all physicians to meet acceptable standards in all seven roles, regardless of their area or scope of practice. All physicians would all have to abide by the same rules and be held to the same level of accountability. Top

 

OSATS assessment tool

 

OSATS is a global assessment scale used to evaluate the performance of trainees.16 The OSATS scale was chosen, as it integrates and synthesizes data collected from various sources to help form a comprehensive assessment. This usually includes a checklist of tasks successfully completed, attributes that the candidate must have, and multiple sources of feedback regarding each candidate. The final dichotomous outcome, e.g., granting or withholding of privileges, is based on a meta-observational global assessment of each candidate conducted in a semi-structured and objective manner, using milestones that are clearly articulated and understood by all. Top

 

The positive effect of OSATS on learning during formative stages and its relative superiority in the precise assessment of clinical skills compared with the traditional evaluation method has been well established.17 Human behaviour is complex and involves integration of data from many sources over a prolonged period. The OSATS allows evaluators to be very flexible, but also precise at the same time. The evaluator can select data from a wide range of sources, provide objective feedback based on serial incremental progression toward milestones that are well understood and accepted, a priori, and help poorly performing trainees take remedial action.

 

The OSATS template was selected based on these characteristics, as it seems well suited for measuring overall performance in complex environments of human interaction. It is to be used in synchrony with the CanMEDS roles, using physician milestones as behavioural anchors. Top

 

Caveats for those using the GRASP

 

Context

Physicians are held to a very high standard of moral, ethical, and professional accountability by virtue of their role in society and society’s expectations. Personality traits are usually ingrained and stable, but may change to some extent, based on circumstances. Some are evident only when a person is undergoing unusual stress and, thus, may not reflect their usual pattern of behaviour. Such situations, especially negative behaviour, are often brought to leaders’ attention by observers, who may not be familiar with the physician or the circumstances.

 

Thus, the context in which a particular behaviour is observed must be kept in mind. In most situations, the GRASP is used as a formative, not punitive, tool. Most infractions are remediable and the physician may benefit from support and mentoring to achieve better outcomes. Top

 

Personality traits

Challenges arise when physicians demonstrate unprofessional behaviour and create repeated problems for others, including patients, their families, staff members, and colleagues. If such unacceptable behaviours are frequent, they may be reported by several reputable observers and have a significant impact on the smooth operation of the institution.

 

Routine and regular performance appraisals often do not address these issues, which arise in crises when there is a reported incident. GRASP provides an opportunity to incorporate these incidents into a systematic performance review process and evidence-based practice. Top

 

Supportive work environment and formative opportunities

People cannot perform at their best in environments or under circumstances that are ambiguous. In a healthy workplace, clear achievable goals are defined, and resources and incentives are established to achieve them. All physician leaders must be able to provide a formative, supportive environment to manage expectations and help physicians achieve their goals. Top

 

For most physicians, performance evaluation will be a positive experience — a formative and goal-setting exercise. However, for a small minority who, despite every opportunity and support, fall below the standards expected of a physician, a universally accepted tool such as the GRASP may be invaluable in making the evaluation process less ambiguous.

 

Sources of feedback for determining physician milestones

Including feedback from various sources in an objective way is critical when evaluating complex human behaviour. Well-accepted and standardized behavioural anchors, or physician milestones, for the GRASP were adapted from the Royal College’s milestone document,7 but are intentionally broadly defined. Top

 

The word “consistently,” used in most milestones, is open to interpretation. In general, consistently means physicians maintain a particular standard of behaviour or repeat a particular task with minimal variation. The literature in this area18 suggests that the question of what is “good enough” cannot simply be based on a single observation of an act or behaviour. Rather, it must take into account the context, the motivation, frequency of occurrence, the connotation, and the consequences or impact of the act or behaviour. Top

 

It is vital to rely on multiple sources of objective, well-documented, unbiased, and impartial data about each physician’s performance. Sources of feedback may include peers, patients, families, allied health professionals, as well as many of the usual institutional metrics. This feedback can then be viewed through the lens of the GRASP to evaluate each CanMEDS role and the physician’s performance on each milestone over time.

 

Insight and judgement

Finally, physician leaders must answer a key question in open dialogue with each physician they are evaluating: “Does this physician possess insight and reasonable judgement relevant to his or her actions or behaviours in a given situation or scenario?” Top

 

Physicians who demonstrate good insight and judgement are generally the ones who possess mature and healthy defense mechanisms and have the mental flexibility to be able to perform some degree of meta-reflection on their own behaviour. They are also willing to acknowledge their contribution or role in a situation or scenario and take advantage of learning opportunities to improve their own attitudes, skills, performance, and behaviour.

 

Conversely, a physician who is unwilling to rethink components of his or her attitude, who demonstrates excessive defensive behaviour, who possesses a relative deficiency of mental flexibility, who is firm and rigid and lacks the ability to develop insight into improvement opportunities should raise a red flag that must be addressed proactively by the leader. Top

 

High stakes

 

Although this proposed tool for evaluating physician performance holds great potential and has been described by physician leaders who have reviewed it to date as heuristic, innovative, and thought-provoking, its implementation faces many potential barriers. It also seeks to uncover relevant areas of physician competencies that have traditionally not been considered in evaluation of performance.

 

Thus, it is imperative that a concept such as this be considered with a great deal of care, thought, and reflection — and it must be scientifically rigorous. At this stage, it would be useful to approach the idea of using the GRASP to evaluate physician performance as an academic initiative and to establish validity, reliability, and end-user experience. To make this a high-impact tool, I believe that it must resonate with all physicians if it is to achieve the intended result, which is to make physicians’ and patients’ lives better. Top

 

An invitation

 

I invite all interested physician leaders to provide comments and feedback about the concept of using the CanMEDS framework to evaluate physician performance, and, in particular, about the utility of using the GRASP at their institution. As part of this project, I also invite leaders to join me in conducting a pilot project to evaluate the utility of such a tool and refine it further. Top

 

References

1.Flood SC. Using qualitative self-evaluation in rating physician performance. Fam Pract Manag 1998;5(5):22-34. Available: http://tinyurl.com/zrtm7c2 (accessed 26 Jan. 2016).

2.Criticisms of physician performance measurement and reporting. In Value-based purchasing guide. Washington, DC: National Business Coalition on Health; 2011. Available: http://tinyurl.com/gsjj2ej (accessed 26 Jan. 2016).

3.Physician performance measurement & reporting introduction. In Value-based purchasing guide. Washington, DC: National Business Coalition on Health; 2011. Available: http://tinyurl.com/hgr6487 (accessed 26 Jan. 2016).

4.Physician performance evaluation/profiling: how to challenge your profile or designation by a health plan. Denver: Colorado Medical Society; n.d. Available: http://tinyurl.com/zaf27mb (accessed 26 Jan. 2016).

5.Capko J. 5 steps to a performance evaluation system. Fam Pract Manag 2003;10(3):43-8. Available: http://tinyurl.com/6nqgt2c (accessed 26 Jan. 2016).

6.CanMEDS: better standards, better physicians, better care. Ottawa: Royal College of Physicians and Surgeons of Canada; 2014. Available: http://tinyurl.com/9ty9dm2 (accessed 26 Jan. 2016).

7.CanMEDS milestones. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015. Available: http://canmeds.royalcollege.ca/en/milestones

8.Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84(2):273-8.

9.Working Group on Curriculum Review. CanMEDS – family medicine.  Mississauga: College of Family Physicians of Canada; 2009. Available: http://tinyurl.com/hzrrea4

(accessed 26 Jan. 2016).

10.LEADS in a caring environment framework. Ottawa: Canadian College of Health Leaders and Canadian Health Leadership Network; 2016. Available: http://leadscollaborative.ca/site/framework (accessed 26 Jan. 2016).

11.Dickson G, Tholl B. The LEADS in a caring environment capabilities framework:  a “for health, by health” enabler for leadership capacity development and leadership talent management. Ottawa: Canadian College of Health Leaders and Canadian Health Leadership Network; 2011. Available: http://tinyurl.com/gs3ezt9 (accessed 26 Jan. 2016).

12.LEADS framework & tools. Ottawa: Canadian Health Leadership Network; 2015. Available: http://tinyurl.com/hf4qrtv (accessed 26 Jan. 2016).

13.LEADS in a caring environment framework. Ottawa: Canadian Medical Association; 2016. Available: http://tinyurl.com/j98g2he (accessed 26 Jan. 2016).

14.Recognizing physician leadership — a credential that will set you apart. Ottawa: Canadian Association of Physician Leaders; 2015. http://tinyurl.com/hrx265s (accessed 26 Jan. 2016).

15.2015 assessment form. Ottawa: Canadian Medical Association; 2015. Available: http://tinyurl.com/h3mr5rg (accessed 26 Jan. 2016).

16.Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997;84(2):273-8.

17.Moorthy K, Munz Y, Sarker SK, Darzi A. Objective assessment of technical skills in surgery. BMJ 2003;327(7422):1032-7.

18.Landon BE, Normand SL, Blumenthal D, Daley J. Physician clinical performance assessment: prospects and barriers. JAMA 2003;290(9):1183-9.

 

Author

Kiran Rabheru, MD, CCFP, FRCP, DABPN, CCPE, is a professor of psychiatry at the University of Ottawa and medical director, Geriatric Psychiatry and Electroconvulsive Therapy Program, at The Ottawa Hospital.

 

Correspondence to: krabheru@toh.ca

 

This article has been reviewed by a panel of physician leaders.

Top