The purpose of this longitudinal study was to gather extrapolation evidence of validity by assessing whether performance on a national medical licensing exam, in addition to practice and socio-demographic variables, is predictive of future physician performance in practice. The study focused on a cohort of 3,404 physicians who were registered with the College of Physicians and Surgeons of Alberta (CPSA) and who completed the Medical Council of Canada Qualifying Examination (MCCQE) Parts I and II between 1992–2017. Separate multivariate quasi-Poisson regression models were run to assess the degree of relationship between first-time pass/fail status on the MCCQE I and II, and several CPSA socio-demographic variables and several CPSA socio-demographic variables, in addition to complaints/physician and various prescribing flags. Candidates who failed the MCCQE I on their first attempt had 27% more complaints lodged against them, compared to those who passed. Physicians who failed the MCCQE II on their first attempt prescribed 2+ benzodiazepines and 2+ opioids to 30% more patients than those who passed. Conclusions: Performance on the MCCQE Part I and II is an important predictor of physician performance. Combined with other critical variables, these measures provide important evidence to aid in risk modeling efforts and to guide educational interventions for physicians at an early stage of their careers.

Background The inappropriate and/or high prescribing of benzodiazepine and ‘Z’ drugs (BDZ +) is a major health concern. The purpose of this study was to determine whether physician or pharmacist led interventions or a simple letter or a personalized prescribing report from a medical regulatory authority (MRA) was the most effective intervention for reducing BDZ + prescribing by physicians to patients 65 years of age or older. Methods This was a four-armed, one year, blinded, randomized, parallel-group, investigational trial in Alberta, Canada. Participants were fully licensed physicians (n = 272) who had prescribed 4 times the defined daily dose (4 + DDD) or more of any BDZ + to an older patient at least once in the 3rd quarter of 2016. All physician-participants were sent a personalized prescribing profile by the MRA. They were then randomized into four groups that received either nothing more, an additional personal warning letter from the MRA, a personal phone call from an MRA pharmacist or a personal phone call from an MRA physician. The main outcomes were prescribing behavior change of physicians at one year in terms of: change in mean number of older patients receiving 4 + DDD BDZ + and mean dose BDZ + prescribed per physician. To adjust for multiple statistical testing, we used MANCOVA to test both main outcome measures simultaneously by group whilst controlling for any baseline differences. Results All groups experienced a significant fall in the total number of older patients receiving 4 + DDD of BDZ + by about 50% (range 43–54%) per physician at one year, and a fall in the mean dose of BDZ + prescribed of about 13% (range 10–16%). However, there was no significant difference between each group. Conclusions A personalized prescribing report alone sent from the MRA appears to be an effective intervention for reducing very high levels of BDZ + prescribing in older patients. Additional interventions by a pharmacist or physician did not result in additional benefit. The intervention needs to be tested further on a more general population of physicians, prescribing less extreme doses of BDZ + and that looks at more clinical and healthcare utilization outcomes.

Introduction: Feedback is invaluable in helping learners improve their performance and clinical competence, but studies have historically documented contrasting perspectives between learners and teachers in how much feedback is given by teachers to learners in clinical training. We explore why there is a discrepancy between learner and teacher perceptions of the feedback that is shared in a clinical teaching encounter. Methods: We recruited 23 preceptors (clinical teachers) from a mid-size Canadian medical school that has a diverse group of generalist and focused specialties. We used inductive content analysis to explore preceptors’ perceptions of both how much feedback they shared with learners, as well as amount of feedback that they believe learners would report was shared. Results: Analysis of interviews generated two themes: (i) difficulty among preceptors in quantifying the feedback they share to learners, and; (ii) discrepancies between preceptors in the definition of feedback. Discussion: The key themes identified in this study highlight that preceptors’ varying definitions of feedback and their difficulty in ascertaining how much feedback they share with learners can be attributed to a lack of a common understanding of feedback. When engaging in a feedback conversation, both the teacher and the learner engage in a meaning-making process that yields a shared understanding that feedback is occurring, and that information offered by the teacher is aimed at supporting the learner. We recommend that both faculty development sessions and educational sessions with learners should incorporate early check-ins to ensure a shared understanding of the definition of feedback.