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© 2021 CMA Joule Inc. or its licensors CMAJ | MAY 3, 2021 | VOLUME 193 | ISSUE 18 E647 T raditional continuing professional development (CPD) activities may increase physicians’ knowledge, but usu­ ally fall short of the goal of changing clinical practice, let alone improving patient outcomes.1 The Future of Medical Edu­ cation in Canada recently called for a new approach to CPD to support practice improvement and improve the health of Can­ adians.2 This new approach calls for a shift from passive learning, typified by attending lectures, to more active learning that engages physicians in processes of quality improvement (QI), such as measuring practice metrics, comparing these to bench­ marks and developing measurable improvement plans, as appro­ priate. However, many physicians have not embraced QI in prac­ tice because of barriers that include a lack of interest, dedicated time, incentives and proficiency in QI methods, or the absence of relevant clinical data.3–6 We discuss how this is likely to change, given new incentives created by certification, professional regu­ lation and system alignment with QI activities. The Royal College of Physicians and Surgeons of Canada (RCPSC) requirements for maintenance of certification include a practice assessment with peer feedback or a comparison to benchmarks, a process associated with changes in physician practice patterns and improvement in patient outcomes.7 This assessment is known as “Section 3.” The RCPSC provides incen­ tives by giving specialists 3 hours of credit toward their mainte­ nance of certification for every 1 hour spent participating in Sec­ tion 3 activities. Many specialists may already be participating in QI work that qualifies for Section 3 credits. For example, about 150 Canadian hospitals are participating in a national QI effort that was recently launched to reduce the use of inappropriate red blood cell transfusions.8 This program engages multiple spe­ cialists, including surgeons, internists, hematologists, anesthesi­ ologists and transfusion medicine physicians, in auditing and monitoring transfusion rates, comparing them with national benchmarks of appropriate use and making changes in their hos­ pitals’ transfusion practices. This QI work can count toward Sec­ tion 3 credit. Similarly, the College of Family Physicians of Canada (CFPC) requires family physicians to participate in the Mainpro+ CPD program.9 The CFPC is developing a “Professional Learning Plan” to encourage family physicians to measure their performance, self­reflect and make changes to improve their practices. For example, family physicians can audit aspects of their practices, like antibiotic or opioid prescribing, and make changes to improve patient care. Although physicians should ideally com­ pare practices to benchmarks or peers, this is not always feasible given the lack of readily available data. Provincial regulators are moving in the same direction by replacing random peer audits, which likely lead to minimal prac­ tice change, with requirements that engage physicians in QI in their own practice. For example, the College of Physicians and Surgeons of Ontario (CPSO) replaced their peer audit program with a new program that allows physicians to count their contri­ butions to hospital QI efforts toward CPSO requirements.10 In this program, hospitals submit evidence of improvement activities and certify to the CPSO that specific physicians were involved. A similar CPSO program is available for individual physicians work­ ing in community settings. Regulators in other provinces are designing comparable assessment programs as a requirement for licensure. New funding agreements between provincial governments and health care organizations are also increasingly linked to quality benchmarks. For example, Alberta’s primary care networks have funding linked to assessing primary care health quality indicators, including waiting times for appointments, achievement of screening and prevention practice standards and other selected metrics of quality (e.g., opioid prescribing).11 In some provinces, hospitals are required to report on measures of quality, such as patient­reported COMMENTARY

Aligning continuing professional development with quality improvement