The assessment and maintenance of competence of physicians has received worldwide attention,1^–4 partly in response to concerns about poor performance by physicians and the safety of patients 5 6 and partly as a result of demands for accountability to patients and funding agencies.2^–4 New approaches to quality improvement have resulted, as have initiatives focusing on identifying and assessing poor performance.7^–9

Throughout the Western world, thinking about competence has shifted. Medical expertise and clinical decision making are increasingly recognised as only components of competence. Communication skills, interpersonal skills, collegiality, professionalism, and a demonstrated ability to continuously improve must also be considered when assessing physicians. 2^–4 7 8 10 11

Multisource feedback, using questionnaire data from patients, medical colleagues, and coworkers, is gaining acceptance and credibility as a means of providing primary care physicians with quality improvement data as part of an overall strategy of maintaining competence and certification. 1 7 8 Work with Canadian, American, and Scottish generalist physicians shows that this method is reliable, valid, and feasible. 7 8 12^–15 Research in both industry and medicine shows that multisource feedback systems (or 360° feedback) can result in individual improvement and the adoption of new practices. 12 16^–18

The College of Physicians and Surgeons of Alberta, the statutory medical registration body for the province of Alberta, adopted a performance appraisal or multisource feedback system for all physicians in its jurisdiction—the physician achievement review program. This system focuses on quality improvement and operates entirely separately from the …