Birch DW, Goldsmith CH, Tandan V; Evidence-Based Surgery Working Group. Users’ guide to the surgical literature. Self-audit and practice appraisal for surgeons. Can J Surg 2005;48(1):57-62.


In January 2001, the Royal College of Physicians and Surgeons of Canada (RCPSC) established the first 5-year cycle of the Maintenance of Certification program (MainCert). MainCert certification is now required for admission to the RCPSC and to renew Fellowship privileges. For practising surgeons, involvement in MainCert implies that continuing professional development (CPD) activities must be completed and documented by all surgeons wishing to maintain active Fellowship status. As indicated in Table 1, initial surgeon participation has been encouraging.

A framework for CPD activities has been established. These activities have been divided into 6 sections with different characteristics and achievable “credits.” Of all these activities, the traditional format of continuing medical education (CME) that is offered through meetings and symposia (section 1) is the most convenient and common CPD activity for practising surgeons. Recent data from RCPSC confirm this and illustrate how participation is distributed by section.

Nevertheless, concern has been raised over the effectiveness of CME interventions and their capacity to improve clinical practice. A systematic review of the evidence evaluating CME interventions has identified 3 factors that are most effective in producing a change in physician behaviour: a physician-based needs assessment (recognition of the need to change physician behaviour); interactive learning among physician colleagues (discussion and review with peers); and sequenced or multifaceted learning activities (use of more than 1 CME activity to achieve change). CME interventions incorporating these activities will be more successful in improving physician performance. The expense and inconvenience of CME interventions may also limit their effectiveness.

Section 5 of the framework comprises “practice review and appraisal” activities. This includes the activity of practice audits or self-audit. Self-audit has been described as the most educationally sound and possibly the most effective method for CPD. Currently, only general guidelines exist for surgeons wanting to complete a self-audit. This article will review and discuss an approach to self-audit for the surgeon in practice.

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