Frequently Asked Questions

Answers to Common Physician Questions about NSPAR

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  1. What is NSPAR?
  2. Why NSPAR?
  3. What are the goals of the NSPAR Program?
  4. What is the value of NSPAR to physicians?
  5. Who participates in NSPAR?
  6. Is NSPAR mandatory?
  7. When selected to participate, how do I manage the process?
  8. How does NSPAR work?
  9. What does NSPAR measure?
  10. How does NSPAR account for the very different types of practice settings seen among family physicians and the various medical and surgical specialties?
  11. Is the NSPAR methodology valid, reliable, and sound?
  12. How is the validity of the NSPAR findings affected when physicians are able to choose which peers and colleagues fill out questionnaires?
  13. Which medical colleagues and coworkers should I choose to fill out questionnaires?
  14. What should I do if I am asked to fill out a questionnaire about a colleague?
  15. Is the confidentiality of individual NSPAR reports protected?
  16. Are the identities of physicians protected?
  17. Will my NSPAR assessment end with the individualized report?
  18. What happens if my report is reviewed?
  19. Can a physician's NSPAR report be used in a disciplinary process or legal proceeding?
  20. Could NSPAR lead to a College investigation of my practice?
  21. Can I receive assistance in interpreting and using the feedback in my NSPAR report?
  22. Can I obtain CME /CPD credit for undertaking an NSPAR review?
  23. Can I request a voluntary NSPAR review?
  24. What if I have questions about the Program or the process?

(1) What is NSPAR?

The Nova Scotia Physician Achievement Review (NSPAR) Program was introduced by the College of Physicians and Surgeons of Nova Scotia in January 2005 to fulfill the College's legislated mandate to conduct peer assessment. NSPAR replaced random peer assessment formerly undertaken for the College by the Atlantic Provinces Medical Peer Review (APMPR). NSPAR is a program of performance assessment and feedback that provides physicians with information about their medical practice through the eyes of their medical colleagues, co-workers and patients. Feedback is presented to physicians in a confidential report that contains individualized data and comparisons to the average scores of physicians with similar practices. Physicians in Nova Scotia are required to participate in this process once every seven years. Back to top

(2) Why NSPAR?

The College of Physicians and Surgeons of Nova Scotia is mandated by the Nova Scotia Medical Act to establish, maintain, and develop standards of qualification and practice among its members and to conduct peer assessment. As public demands for high standards of medical practice grow, so does accountability for continuous practice improvement and professional development among physicians. The College has chosen NSPAR to fulfill its peer assessment mandate because it is physician friendly, cost-effective, confidential, and focused on professional development. Back to top

(3) What are the goals of the NSPAR Program?

The goals of the program are to promote a culture of continuous quality improvement among Nova Scotia physicians and to offer a link between assessment and focused professional development.

More specifically, NSPAR provides a program of peer assessment in which physicians can:

• Obtain detailed feedback on their performance in clinical practice, allowing for self-reflection and practice improvement;

• Measure patient reaction on how well they are meeting patient needs and expectations;

• Demonstrate accountability for continuing professional development to the public and to the medical profession as a whole;

• (For specialists) Measure performance on some of the key pillars of the CANMEDS competencies as outlined by the Royal College of Physicians and Surgeons of Canada. These include the physician's role as communicator, collaborator, manager, health advocate and professional.

The long-term objective of NSPAR is to assist physicians in their ongoing efforts to continuously improve their medical practices. Back to top

(4) What is the value of NSPAR to physicians?

NSPAR focuses on professional development using a positive approach that is unrelated to, and operates at arm's-length from, the College's disciplinary functions. Most physicians value the feedback they receive from NSPAR. Approximately 150 family physician volunteers participated in a 2002 pilot of NSPAR conducted by the Dalhousie University Department of Continuing Medical Education. The vast majority (88.5 percent) felt that their NSPAR report provided useful information, and 61 percent indicated that they had made or were planning to make practice changes in response to the report findings. Family physicians can earn MAINPRO-C credits from the College of Family Physicians of Canada for NSPAR participation, while surgeons and medical specialists are eligible for credits in the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.

The College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada agree that peer assessment programs such as NSPAR are an important aspect of continuing professional development. NSPAR has also received the support of Doctors Nova Scotia (the former Medical Society of Nova Scotia). Back to top

(5) Who participates in NSPAR?

Beginning in 2005, family physicians in active, office-based, primary care practice for at least three years in Nova Scotia are required to participate when selected. In late 2006, the program expanded to include a variety of medical and surgical specialties. Back to top

(6) Is NSPAR mandatory?

Yes. Once selected, physicians are ordinarily expected to complete an NSPAR assessment. However, physicians not in clinical practice (for example, those who work full-time in administration or research or who have recently returned to practice after an extended period of time) may qualify for an exemption or deferral. In addition, physicians who completed the NSPAR Pilot or an APMPR review are eligible for deferral for five years from the date of completion. Physicians selected for assessment who feel that one or more of these categories may apply to them are encouraged to contact the independent research firm handling NSPAR survey distribution. The toll-free number is 1-877-421-1199. Back to top

(7) When selected to participate, how do I manage the process?

A clear set of instructions and an informational video will be sent to all selected participants, along with all necessary tools and surveys. Physicians with further questions about the process are encouraged to phone the independent research firm that is managing NSPAR survey distribution at 1-877-421-1199 (toll-free). Back to top

(8) How does NSPAR work?

NSPAR is a survey-based assessment program. Each month, an independent research firm randomly selects a set number of physicians to receive a package containing the appropriate questionnaires and detailed completion instructions. Physicians identify a selection of patients, medical colleagues and co-workers (for example, office staff, hospital staff, nurses, pharmacists and physiotherapists) with whom they deal directly. Each of these individuals receives a brief questionnaire that is appropriate to their respective comprehension and perspective. Physicians also complete a self-assessment questionnaire. Completed questionnaires are returned to the research firm, which tabulates the results and returns a confidential, personalized report directly to the physician. Sample questionnaires, reports and other materials can be viewed on the NSPAR website. Back to top

(9) What does NSPAR measure?

NSPAR recognizes that excellence in medical practice requires abilities that extend beyond the traditional measures of clinical skills and knowledge. Rather than focusing exclusively on clinical skills and knowledge, NSPAR looks more broadly at areas such as coordination of care and resources, professional development, communication and professional conduct, patient interaction skills, and office management. Back to top

(10) How does NSPAR account for the very different types of practice settings seen among family physicians and the various medical and surgical specialties?

Although there are differences among physician practices, there are also many common elements. The NSPAR tools were developed and validated by physicians and designed to apply to the common elements that can be found among all medical practices. These tools measure physician performance while recognizing the differences between family practice and the practices of various medical and surgical specialties. Back to top

(11) Is the NSPAR methodology valid, reliable, and sound?

The NSPAR tools and methodology have been extensively tested and validated with large physician populations in Alberta and through the NSPAR Pilot Project. The tools are considered psychometrically sound, reliable measures of physician performance. Similar multi-source feedback methods have been adopted by organizations such as the American Board of Internal Medicine. A wide range of background information on the NSPAR methodology is available at www.nspar.ca. This includes the NSPAR Pilot report and a reference list of recent research addressing the psychometric properties, reliability, validity, feasibility and effectiveness of multi-source feedback (360-degree feedback). Back to top

(12) How is the validity of the NSPAR findings affected when physicians are able to choose which peers and colleagues fill out questionnaires?

The validity of the findings is not affected when physicians select peers and colleagues to fill out assessment questionnaires, provided that the sample size is sufficiently large. Research indicates that such findings are not significantly biased by the method of reviewer selection or by the relationship between reviewers and physicians. (Ramsey, P.G., et al (1993). Use of peer ratings to evaluate physician performance. Journal of the American Medical Association. 269:13, 1655:1660.). Back to top

(13) Which medical colleagues and coworkers should I choose to fill out questionnaires?

The most informed and objective assessment usually comes from medical colleagues and coworkers with whom you work most closely. It is important to recognize that NSPAR is not an examination or test. NSPAR feedback is intended to help identify opportunities for practice improvement. Therefore, choose colleagues whose opinions you respect and value. As a courtesy, it is advisable to notify colleagues and coworkers before providing their names as NSPAR reviewers. Back to top

(14) What should I do if I am asked to fill out a questionnaire about a colleague?

When completing the questionnaire, be objective and honest, recognizing the importance of your feedback to the quality of your colleague's assessment. Filling out a colleague questionnaire ordinarily takes five to ten minutes. Promptly return the completed questionnaire according to the instructions provided. Back to top

(15) Is the confidentiality of individual NSPAR reports protected?

Yes. Confidentiality of information collected through the survey process is protected under the Nova Scotia Medical Act. NSPAR information is designed strictly for professional development purposes. Apart from the research firm that compiles and mails the confidential report, the reviewed physician is ordinarily the only party to see its contents. Exceptions are described in Section 18. Back to top

(16) Are the identities of physicians protected?

Yes. As described in Section 18, the identities of physicians participating in NSPAR are known only to those people who need direct contact with them. The NSPAR review is designed to provide scores to physicians on attributes that are measured by the surveys. These scores are assigned “flags” when they are unusually high or low. Only reports with flags are reviewed (anonymously) by the Practice Improvement Committee of the College. These reports do not contain names, and are reviewed without the identity of the physician being revealed to the committee as a whole. Back to top

(17) Will my NSPAR assessment end with the individualized report?

In most cases it will. However, approximately 10 percent of assessed physicians may require or request further practice improvement and/or professional development assistance based on the findings of their NSPAR assessment. This assistance could take the form of a telephone interview and/or a practice visit. Doctors Nova Scotia (formerly the Medical Society of Nova Scotia) has named experienced physicians to provide this assistance. This follow-up is designed to be helpful and formative. It is not intended to identify “under-performing” physicians. The Practice Improvement Committee also reviews highly rated reports to learn more about factors that contribute to exemplary medical practice. Back to top

(18) What happens if my report is reviewed?

When a report is reviewed, the independent research firm provides the physician's name, address and telephone number to one designated member of the Practice Improvement Committee. That member sets up a telephone interview with the physician to place the report results in context. The results of this interview are discussed in a non-nominal manner (to protect the identity of the physician) by the Practice Improvement Committee. The Committee either formulates advice for the physician about self-directed improvement or recommends an individualized learning experience in the form of a practice visit from a physician peer. Back to top

(19) Can a physician's NSPAR report be used in a disciplinary process or legal proceeding?

No. Under the Nova Scotia Medical Act, NSPAR results and reports for individual physicians are protected from use or disclosure in any disciplinary process or legal proceeding. Neither the College, patients, or physicians can use them in a disciplinary process or legal proceeding. Back to top

(20) Could NSPAR lead to a College investigation of my practice?

There are only two ways that NSPAR could result in a College investigation. Participation in NSPAR is mandatory, subject to a limited set of exemptions and deferrals. Eligible physicians who fail to participate and complete the NSPAR assessment may, after repeated reminders, be referred to the Registrar of the College. Additionally, practice visitors who observe problematic behavior such as impairment or abusive conduct may choose to end the assessment and report their observations to the Registrar of the College. Back to top

(21) Can I receive assistance in interpreting and using the feedback in my NSPAR report?

Physicians wishing to receive assistance with interpreting their report or undertaking practice improvements or professional development are encouraged to contact the NSPAR Medical Director at (902) 422-5823, toll-free in Nova Scotia at 1-877-282-7767, or by e-mail at info@nspar.ca. Back to top

(22) Can I obtain CME / CPD credit for undertaking an NSPAR review?

Yes. Family physicians can earn MAINPRO-C credits from the College of Family Physicians of Canada for NSPAR participation, while surgeons and medical specialists are eligible for credits in the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. More information on obtaining credit is available from these organizations. Back to top

(23) Can I request a voluntary NSPAR review?

Yes. The NSPAR Program will make every effort to accommodate physicians who wish to participate in an NSPAR review before they are randomly selected. Such requests are subject to assessment volumes, the physician's practice type, and the date of the physician's last assessment. Please contact the NSPAR program for more information. Back to top

(24) What if I have questions about the Program or the process?

To maintain confidentiality, physicians with questions about the process, survey instruments, instructions or other confidential material should contact the independent research firm that manages NSPAR survey distribution. The toll-free number is 1-877-421-1199 . Regular NSPAR updates are also contained in the College's newsletter and on the NSPAR website, www.nspar.ca. Back to top

For questions about the program and its parameters, or to provide feedback, physicians are encouraged to contact the NSPAR program by phone at (902) 422-5823, toll-free in Nova Scotia at 1-877-282-7767, or by e-mail at mpower@cpsns.ns.ca.