Q: Why do I have to come to the College for my Peer Review? Why don't you come to my practice and observe me in my own environment?
A: The Peer Review assesses each candidate's ability to gather patient information, provide counselling and follow-up, communicate effectively with patients and demonstrate clinical knowledge with the aid of common resources. To provide a fair and objective assessment, we have to ensure that all members are assessed as equitably as possible in a standardized format. A consistent assessment would be impossible in the workplace, where there are too many variables that could not be controlled, such as levels of staff support, pace, number, and difficulty of cases.

In addition, current legislation would require patient consent before any interaction(s) could be observed by an assessor, which could impact the effectiveness of any assessment.

Most significantly, candidates tell us that when they come to the College (sometimes for the first time since registering with OCP), they enjoy the opportunity of sharing ideas for their learning portfolios with their peers. We believe this promotes a positive learning opportunity with colleagues.

Q: If I don't meet the standards at the Peer Review, what will happen to me?
A: Most pharmacists (approximately 86 per cent) meet and exceed the standards for the Peer Review. For those few falling below the standards, the Quality Assurance Committee looks at the results to determine the appropriate level of remediation and which programs would best assist the candidate in improving his/her knowledge or skills. Candidates are usually asked to consider their results and develop an action plan to address their learning needs. They will be invited to consult with or meet our Professional Development Advisor, who will assist them in determining what courses or activities would be most useful in facilitating remediation. Those candidates falling below the standards in clinical knowledge or communication skills, or two of the four categories tested, are asked to return for a reassessment at the end of an agreed-upon remediation period.

Each candidate, regardless of whether or not they met the standard, receives a booklet of personalized results that can help them plan their future continuing education initiatives. The Quality Assurance program is set up to be educational rather than punitive, and every effort is made to direct members to educational resources that will assist them in continuing to successfully meet the standards set by their peers.

Q: Who sets the standards for the Peer Review?
A: The standards, which are really acceptable levels of practice, are set by representative groups of pharmacists from across the province. One group meets to deliberate on the standards for the standardized patient interviews and another group meets to deliberate on the standards for the clinical knowledge portion.

Each group has members of different gender and ages, from various locations and practice settings that represent different pharmacists practising around the province. The groups review each question and case, and determine through a consensus process what a reasonable level of knowledge; skills and performance would be for Ontario pharmacists. The professional judgement of practising pharmacists determines the standards, and the Minimal Level of Competency (MPL) is derived.

Q: Is the Peer Review used for any other purpose?
A: Yes, you may have noticed through reading deciding on Discipline that in certain discipline cases, members have been given an opportunity to lessen their penalty by agreeing to complete the Peer Review and any necessary remediation. The Complaints Committee can also refer members to the Peer Review.

The Ontario College of Pharmacists believes that ensuring the knowledge and skills of its members is important for protection of the public. Participation in a competency-based assessment with accompanying remediation may prove more useful in assisting members in practice and protecting the public than fines or suspensions.

Individuals who are working with the Registration Programs area to become licensed may also be referred by a Registration Panel to participate in the Peer Review.

Q: Is it possible for my employer to find out that I have been selected for the Peer Review?
A: No. Your participation in the Peer Review (as randomly selected by our member database), is confidential. Staff members in the Continuing Competency Programs will not divulge your participation to any third party inquiry. Your participation and results are confidential within the Ontario College of Pharmacists as well, and all information contained in your Quality Assurance file is restricted.

Should your information be required for the purposes of remediation and participating in continuing education, a waiver will be provided to you, to release the results to the institution stipulated on the waiver.

If you have an inquiry regarding your results or activities, you will be required to provide your Ontario College of Pharmacists membership number, for the security of your confidential information.

Q: Who creates the cases that are used in the Clinical Knowledge Assessment and the Standardized Patient Interviews?
A: A diverse group of practising pharmacists, in two writing teams, support the Clinical Knowledge Assessment and Standardized Patient Interviews.

Each writer drafts possible cases or assessment questions and then each group meets three or four times a year to review and determine final cases. Writers typically draw on their own professional experiences to ensure that cases and questions reflect current clinical practice. (Prior to participating on the teams, all writers must also have successfully completed the Peer Review Weekend.)


Q: Given the diverse settings in which pharmacists practice, how does the College ensure the cases reflect current practice?
A: In addition to the writing teams, all cases and questions go through teams of pharmacist reviewers and standard setters. Each team evaluates the cases for relevancy and importance to the profession. In addition, the reviewers ensure the elements needed to address the clinical issue is found in the references provided to the candidates and the standard setters determine the performance level required to meet the standard for that component.

We ensure that the teams include pharmacists with diverse backgrounds. In creating the teams we consider each applicant's practice setting, gender, years of experience, training background (international and domestic training) and practice location(s).

Q: How does the College ensure that cases remain clinically current and reflective of changing practice trends?
A: Clinical currency is essential to the QA Program. The teams have determined that it is reasonable to use each case (from a large pool of cases and questions) for up to two years without review. Each case is subsequently sent to the writers, reviewers and standard setters to be reviewed and selected to stay in the question pool, be re-written or be discarded. During this process the reviewers use the current reference editions that are provided to candidates.

Furthermore, whenever a medical or pharmaceutical study impacting clinical decision-making or a new clinical guideline is published, all cases and questions affected would re-enter the review process.

Q: How does the College ensure consistency in content and difficulty levels from one Peer Review Weekend session to the next?
A: The cases included in each Peer Review Weekend are compiled based on a blueprint that covers the major clinical areas. The blueprint ensures consistency in the clinical areas covered, the number of cases included from each clinical area and the level of difficulty for each question.

For example, each exam includes a set number of cardiovascular cases, anti-infective cases, hormone endocrine cases, respiratory cases, etc. An exam review group also reviews the final exam content to ensure it is reasonable and fair.

Q: I am not aware of any other health profession that requires its members to undergo a PeerReview. Why do we have to continuously prove our competence?
A: To ensure that all health practitioners serve Ontarians with high quality care, all 23 Ontario health professions have a quality assurance program in place. (All health Colleges have created quality assurance programs to meet the legislated requirements of the Regulated Health Professions Act, 1993.) However, quality assurance is not limited to health professions as public accountability for competency is becoming the norm for many other professionals including pilots, teachers, professors and engineers.

Q: I thought everyone would eventually be included in the Peer Review. For some this has not happened. Is everyone going to be being reviewed?
A: To date, all pharmacists in Part A have completed the Phase I Self-Assessment Survey. Additionally, about 240 pharmacists are selected each year to participate in Phase II — the Peer Review Weekend.

Now that the Peer Review is completing its tenth year, more than 2000 pharmacists have been assessed through the Peer Review Weekend. With over 10,000 pharmacists in Part A of the Register, it will be some time before all pharmacists participate in Phase II. Note: Pharmacists who passed the PEBC Qualifying Exam with the OSCE component will not be selected for the Peer Review Weekend for the first five years from the date of their success on the Qualifying Exam.

Q: I am a clinical pharmacist working in a teaching hospital. I think, to be relevant, the Peer Review needs to take into account whether one works in a community or hospital setting.
A: The majority of pharmacists who have participated in the Peer Review weekend state that the content is relevant and reflective of pharmacy practice in both community and hospital practice. Most also add that they find the process unfamiliar (as the review is held at College offices) - regardless of their primary place of practice.

These comments are related to the standardized patient interviews which take place in a setting similar to a private consulting room. During each interview a patient presents a prescription or problem to be addressed by the pharmacist. While this format may be most familiar to pharmacists who practice in the community, it is important to keep in mind that the skills being assessed (ability to gather information, manage an interview and provide education and demonstrate effective communication skills) are critical to pharmacists in all settings and all interactions — whether it be with patients, physicians or other allied health providers.

Q: I prefer to gain education credits each year to maintain a learning portfolio. When are we going to return to the credit system?
A: Ontario has never had an education credit system. Although there used to be an optional program that awarded pharmacists (who submitted evidence of 20 continuing education hours each year) with a certificate, this program was ended in 1997 upon the introduction of the Quality Assurance Program and new requirements for pharmacists to maintain a record of learning for College submission.

While it takes effort to set up, a record of your personal learning activities is a more accurate reflection of the various ways you gain professional development. As practising pharmacists we receive both formal, structured learning as well as informal independent learning (such as when a patient or allied practitioner asks questions that require referencing). The College's expectations are broad and flexible and we encourage you to find the most effective and efficient way to document your learning activities. The electronic Learning Portfolio (on our website) is one tool you may use.

Keep in mind that an essential aspect of professional learning is the way in which you implement changes in your practice as you learn. While it may take considerable reflection to determine how to best accomplish this, learning portfolios are designed to help you accomplish this goal.

You may maintain your record of learning in any format. The Ontario College of Pharmacists has provided a model of a Learning Portfolio, which is available for you. Click here to download a PDF or or Word file of the Learning Portfolio.

For more information regarding the Learning Portfolio, Peer Review, Self-Assessment Survey or the Ontario College of Pharmacist’s Two Part Register, please contact the Continuing Competency Programs.