Key Points Question Is competency-based assessment associated with changes in rates of identification of and support for residents in difficulty compared with traditional assessment? Findings In this cohort study of 458 Canadian medical residents, there were significant reductions in the proportions of residents receiving flagged assessments on multiple rotations, reductions in proportions of residents defined as being in difficulty, and increases in documented evidence identifying that gaps were discussed with the resident following introduction of a competency-based assessment program. Meaning Competency-based assessment may contribute to better identification of and support for residents in difficulty.

This study highlights the necessary conditions for assessing the success of implementation of educational innovations. Reciprocal communication between users and developers is vital. This reflects the approaches recommended in the Ottawa Consensus Statement on research in assessment published in Medical Teacher in March 2011.

, 2002). It is estimated that over 90% of personal health services are delivered in communitybased primary care (White et al., 1961) and yet such services account for only about 35% of health service costs (Ontario Health Services Restructuring Commission, 2000). In international comparisons, a higher quality of primary care services has been shown to correlate with better health status indicators, higher satisfaction of the population, and lower costs of the health system (Starfield, 1994; 1998). Recent reviews (Macinko et al., 2003; Schoen et al., 2004) confirm the central role of primary care and indicate important issues to be addressed. Thus the rationale for developing a stronger and more integrated comprehensive primary health care system in Canada is on a firm foundation. Canadian family physicians/general practitioners (FPs/GPs) provide first contact or primary care services in their offices for patients who choose to access these services. Patients are not required to enrol or

BackgroundLicensed physicians in Alberta are required to participate in the Physician Achievement Review (PAR) program every 5 years, comprising multi-source feedback questionnaires with confidential feedback, and practice visits for a minority of physicians. We wished to identify and classify issues requiring change or improvement from the family practice visits, and the responses to advice.MethodsRetrospective analysis of narrative practice visit reports data using a mixed methods design to study records of visits to 51 family physicians and general practitioners who participated in PAR during the period 2010 to 2011, and whose ratings in one or more major assessment domains were significantly lower than their peer group.ResultsReports from visits to the practices of family physicians and general practitioners confirmed opportunities for change and improvement, with two main groupings – practice environment and physician performance. For 40/51 physicians (78%) suggested actions were discussed with physicians and changes were confirmed. Areas of particular concern included problems arising from practice isolation and diagnostic conclusions being reached with incomplete clinical evidence.ConclusionThis study provides additional evidence for the construct validity of a regulatory authority educational program in which multi-source performance feedback identifies areas for practice quality improvement, and change is encouraged by supplementary contact for selected physicians.

Objective: This study set out to identify the perspectives of family physicians (FP/ GPs) on the quality and capacity of the services they provide and of the system in which they work, to assess their responsiveness to potential changes and to determine their suggestions for future directions to enhance primary care services. Methods: Thematic results from prior focus groups with FP/GPs provided direction for a questionnaire sent to practitioners in the urban study area. Seventy-four questions, most using a five-point Likert scale, were grouped into 10 sections: physician issues (based on themes from the focus groups), access to specialist services, workload, scope of practice, primary care physician networks, interdisciplinary collaborative practice, complexities and challenges of family practice, future directions, comments and demographics. Results: Five hundred and eighty-three FP/GPs were surveyed, and 300 responses (52%) were analyzed for frequencies and comparisons using SPSS. In addition to informative responses to the various survey sections noted above, specific physician suggestions for future directions to improve quality and capacity were identified. These included access to specialists/consultants, teamwork/collaborative practice, access to diagnostics, electronic records/technology, time and remuneration. Conclusions: The identified suggestions by FP/GPs to enhance the quality and capacity of health services contribute to a framework for policy development at national, provincial/territorial and regional levels and can be used as a reference point for the progress of primary care reform initiatives. RésuméObjectif : L' étude vise à déterminer le point de vue des médecins de famille (MF/MG) sur la qualité et la capacité des services qu'ils offrent et sur le système dans lequel ils travaillent, à évaluer leur souplesse face aux changements potentiels et à déterminer leurs suggestions sur les orientations futures en vue d' améliorer les services de soins primaires. Méthodes : Les résultats thématiques découlant de groupes de travail antérieurs avec les MF/MG ont déterminé l' orientation du questionnaire envoyé aux praticiens de