Summer 2017 (Volume 27, Number 2)

The 2017 Practice Reflection Award

By Sahil Koppikar, MD; and Henry Averns, MB, ChB, FRCP (UK), FRCPC

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Co-winners of Gold
Henry Averns, MB, ChB, FRCPC; and Sahil Koppikar, MD

Firstly, we would like to thank the CRA for this award and for recognizing the importance of practice reflection in improving patient care. Whilst clinical audits are common practice in many countries, the Royal College of Physicians and Surgeons of Canada (RCPSC) does not currently mandate them. Recently, the CRA has recognized that a self-regulating profession must clearly engage in reflection and practice change. This has resulted in various self-assessment continuing medical education (CME) programs as the CRA aims to develop a repository of projects. However, it still remains unclear how many Canadian rheumatologists actually participate in self-reflection programs.

We first evaluated rheumatologists’ perceptions around clinical audits. An anonymous survey across eastern Ontario showed that only one rheumatologist had practice reflection embedded as part of their practice. All rheumatologists agreed that clinical audits have the potential to improve patient care and achieve the standard of care. However, lack of time, staff shortages, and lack of experience with clinical audits were key barriers.

To help clinicians less confident in the process, we developed an audit that could be easily applied on a broad scale. Ten Eastern Ontario Rheumatology Association (EORA) members participated in a clinical audit around appropriate hydroxychloroquine (HCQ) dosing and toxicity screening. Each clinic received screening forms, audit standards, and a questionnaire to be filled during clinical encounters. Each form added only 30 seconds to a patient encounter. We found that rheumatologists are consistently below recommended standards. Therefore, a simple intervention was conducted by providing each clinic with HCQ dosing charts that could be easily applied during each visit. Feedback suggested that this audit was beneficial in improving prescribing habits to meet standards of care. Further, rheumatologists were willing to consider more self-assessment programs in the future.

It is clear that rheumatologists recognize the importance of practice reflection. Providing clinicians with audit standards, forms and some guidance will eliminate barriers and allow for reflection programs to be applied broadly in a straightforward and cost-effective manner. Furthermore, as a trainee, this project instilled an early culture of reflection that will be carried throughout my career.

We would like to thank the EORA and all participants including Drs. Davis, Doris, Karsh, Kraag, Liu, Midzic, Purvis, Schellenberg, and Thomson.

Sahil Koppikar, MD
Rheumatology Resident
University of Toronto
Toronto, Ontario

Henry Averns, MB, ChB, FRCP (UK), FRCPC
Consultant Rheumatologist
Ontartio Rheumatology Association
Kingston, Ontario

Dr. Averns and Dr. Koppikar, co-winners of the gold Practice Reflection Award,
pose with Dr. Christopher Penney.