Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

The delivery of safe patient care requires competent healthcare providers (HPs). To achieve this, an assessment system must be in place that can 1) accurately diagnose unsafe providers and 2) provide guidance on how to improve on the essential competencies required for high quality patient care. Performance assessments for HPs are usually conducted by a rater (peer or supervisor) who observes and appraises the performance on multiple competencies of practice. The distinctiveness of each competency is very useful for pinpointing specific areas of weakness the HP may have. However, contrary to expectations, there tends to be a lack of variation in the ratings across different competencies. This phenomenon, called the Halo Effect, has been attributed most often to rater error and causes concern about whether raters can make accurate performance judgements. It is also possible, however, that raters can detect performance differences across competencies when they truly exist, but that clinical performance in practice does not generally vary across individual competencies. The cause of the Halo Effect needs to be clarified in order to decide whether rater-based assessment can be trusted to accurately detect unsafe HPs. In order to help HPs improve their performance, they are usually given numerical ratings from their assessments. However, improvements do not always result because numerical ratings are often not precise enough to direct HPs towards how to improve their practice. Research has shown that HPs find qualitative comments to be more useful to guiding improvements. However, it is currently unclear how to optimally collect these comments. A better understanding of how to best collect qualitative feedback is crucial to help ensure that feedback given to HPs actually results in practice improvements and thus, safer patient care. A better understanding of both areas will help enhance the performance of HPs and thus, improve the health of Canadians.