Consider a resident peer review program

Residency Program Insider, January 2, 2007

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Consider a resident peer review program

Peer review-the evaluation of an individual physician's professional performance by his or her peers-may not be reserved for medical staff members. Teaching residents about peer review or allowing them to participate in a peer review program allows physicians-in-training to prepare for the responsibilities in store for them after graduation, and is an excellent tool for helping residents gain competency in practice-based learning and improvement.

Peer review usually includes the identification of opportunities to improve care. This process is typically carried out at the department level, with physician peers reviewing charts of individual cases that were selected for review based on adverse outcomes criteria, such as complications or mortality. The process is required by the Joint Commission, the American Osteopathic Association of Healthcare Facilities Accreditation Program standards, federal laws governing Medicare and Medicaid programs, state laws, and each hospital's bylaws. There are two categories of physician peer review processes:

1. The initial process of reviewing a physician's qualifications and recommending whether to grant that physician the privilege to perform specific procedures or treat specific diseases in the acute care settting.

2. The ongoing monitoring and review of a physician's work within a hospital. This process assesses the physician's current competency for those privileges used for patient care at the hospital.

While all hospital medical staffs are required to have a peer review process in place, residents-despite playing an important role in quality improvement in hospitals-do not participate in peer review because they are not medical staff members. Residents are evaluated by their attendings and program directors, but residents don't typically rate the competence of fellow residents. Although not mandated by accreditors' standards or by law, resident participation in peer review would allow these future medical staff members to gain a better understanding of the technique involved in carrying out peer review.

The main strength of a residency peer review program is to teach residents about the structure and processes of the information gathered by peer review. A major component of any peer review process is performance measures, which indicate how a physician is performing. Defining these indicators provides a more objective way for physicians-or residents, as the case may be-to evaluate each other. Sample indicators may include

  • timely completion of records in the hospital
  • use of specific preprinted orders
  • documentation of complete discharge summaries
  • patient death

    Learning about peer review may help residents achieve competency in practice-based learning and improvement, one of ACGME's six core competencies. You may even consider expanding a peer review program to require residents to complete quality improvement projects that will focus on collecting and analyzing data. Residency programs that are interested in developing a peer review program for residents should consider the following tips:

  • Partner with a faculty champion or high-level support for the program
  • Ensure meetings are scheduled on a regular basis
  • Identify someone who is willing to devote time and resources necessary to gain quality improvement expertise

    All the best,

    Mark Smith

    Consultant with The Greeley Company, a division of HCPro, Inc.
    Marblehead, MA


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