Intended for healthcare professionals

Education And Debate

Multisource feedback: a method of assessing surgical practice

BMJ 2003; 326 doi: (Published 08 March 2003) Cite this as: BMJ 2003;326:546
  1. Claudio Violato, professor (,
  2. Jocelyn Lockyer, associate professora,
  3. Herta Fidler, coordinator—evaluation, research and special projectsb
  1. a Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 University Drive NW, Calgary, AB T2N 4N1, Canada
  2. b Office of Continuing Medical Education and Professional Development, University of Calgary
  1. Correspondence to: C Violato
  • Accepted 10 December 2002

New methods are needed for assessing surgeons' performance across a wide range of competencies. Violato and colleagues describe the development of a programme based on feedback from medical colleagues, coworkers, and patients for the assessment of surgeons throughout Alberta, Canada

The assessment and maintenance of competence of physicians has received worldwide attention,14 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.24 New approaches to quality improvement have resulted, as have initiatives focusing on identifying and assessing poor performance.79

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. 24 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 1215 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 1618

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 …

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