Nicole Kain^1,2
Nigel Ashworth^1,2, Nancy Hernandez-Ceron¹, Iryna Hurava¹, Ed Jess¹ and Parisa Hamayeli- Mehrabani¹
1 College of Physicians & Surgeons of Alberta
2 University of Alberta

1. Background
The College of Physicians & Surgeons of Alberta (CPSA) is the Medical Regulatory Authority (MRA) in the province of Alberta, Canada, and is mandated by law to assess the continuing competence of all physicians in that region. Identifying potentially poorly performing physicians improves quality of health care, which ensures patient safety. 

2. Summary of work
CPSA’s Research & Evaluation Unit (REVU) created a composite risk score to use as a screening tool to identify poorly performing physicians. Multivariate models of predictors of complaints, and high risk prescribing were created for physicians’ outcomes. From these, a theoretical composite ‘risk’ score for each physician in Alberta (the “REVU score”) was created. Using the REVU score, we identified potentially high-risk physicians. Along with randomly-selected physicians we then undertook a prospective cohort study to test whether the REVU score can improve the ability to select poorer performing physicians. 

3. Results
Individualized assessments were performed of 94 physicians. In the randomly-selected group 6.4% (3/47) failed the assessment compared to 55.3% (26/47) in the ‘high’ risk selected group. The risk of failure was 8.7 times higher in the selected group (using the REVU score) compared to random. 

4. Discussion
The REVU score helps identify poorer performing physicians. As demonstrated by individualized assessments, high risk physicians are approximately 9 times more likely to fail than randomly-selected physicians. 

5. Conclusions 
The REVU score is a viable screening tool to identify potentially poor performance. It provides an opportunity to identify physicians at higher risk of failing their individualized assessments, making the selection and the assessment process itself more efficient. 

6. Take-home messages / implications for further research or practice 
MRAs have better alternatives than random selection, and can use a REVU score or similar to best utilize limited resources when conducting competence assessments. 

References (maximum three) 
no references