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Frequently Asked Questions

How does the Practice Enhancement Program work?

The Practice Enhancement Program includes:

Professional Learning Plan

Physicians who have a high level of protective factors that will enhance quality in practice may be provided with an opportunity to develop a Professional Learning Plan with the assistance of a peer support representative.

Off-Site Review

Physicians whose practice profiles include protective factors known to promote quality in practice, may be initially directed to have an off-site review. Off-site reviews will include a review of your patient records and an assessment of the quality of care you provide.

On-Site Review

A trained peer reviewer will visit your practice and follow a standardized process using a selection of practice review tools.

A Reflective Approach to Continuing Professional Development

You will be asked to consider your approach to professional development and challenged to adopt best practices for quality improvement in your practice.  The approach is aligned with a Physician Practice Improvement (PPI) framework developed by the Federation of Medical Regulators of Canada (FMRAC).


For those physicians who go through the off-site or on-site practice enhancement program process you will receive both a written report and one-on-one feedback by telephone from your peer reviewer. At this time, you can ask questions or clarify things found in the review. The focus is on understanding and moving forward with practice improvements.

For those physicians who are streamed to the Professional Learning process, you may discuss your plan with a coach or peer.

What are the guiding principles of the Practice Enhancement Program?

There are 6 principles that guide the Practice Enhancement Program. They are the following:

  • Universality – all doctors can benefit from some form of practice enhancement activity. Even the best doctors can improve their practice.
  • Quality improvement – after a review, you will get specific and meaningful feedback to help you to improve your practice.
  • Directive, when necessary – in limited circumstances, such as a review uncovering a safety issue, the program can direct you to take certain actions to improve your practice.
  • Best use of resources – program resources will be more heavily focused on those doctors most likely to benefit from peer review.
  • Fairness, openness and transparency – we will explain the processes, tools, and standards used by our peer reviewers and ensure they are applied consistently.
  • Highly confidential – information gathered during your review will not be shared with other areas of the College (such as Professional Conduct or Licensing) and will be carefully safeguarded by practice enhancement staff.

Why must I participate in the Practice Enhancement Program?

Any physician in Nova Scotia in an active clinical practice must participate in some level of practice enhancement.

The practice enhancement program:

  • promotes a culture of continuous quality improvement; and
  • improves your ability to do your job well by linking your practice enhancement to your professional development activities.

If called upon to participate in practice enhancement, you have a duty to comply. Except in a limited number of circumstances, participation is not optional. The Nova Scotia Medical Act requires us to conduct practice enhancement and practice assessment.

Is practice enhancement confidential and anonymous?

Practice enhancement information is strictly confidential but not completely anonymous. Only those directly involved in your practice enhancement activities will have access to the information gathered during the process. This information will be fully protected and will not be shared with other parts of the College.

How often can I expect to be reviewed?

You will be eligible to participate at least once every 7 years.

If I am the custodian of my patient records, do I have the responsibility to notify patients that their charts have been reviewed as part of the peer review process?

No. However, as part of your office systems, you are required to maintain the ability to respond to patient requests about who has reviewed their medical records. When going through an off-site review or an on-site review, our peer reviewers will access and review a selected number of your charts as part of the practice enhancement process.

In the case of paper charts, we advise you to keep a copy of the Record Review Grid that includes the patient records reviewed as part of your review.

In the case of electronic medical records (EMRs), you can use the audit trail function in your EMR to determine the charts accessed by your assigned peer reviewer. If you are unsure how to use this function, please contact your EMR supplier directly for instructions.

For specific details regarding your responsibilities as the custodian of your patient health information please consult the “Duties of a Custodian” section within Toolkit for Custodians: A Guide to the Personal Health Information Act.

Can I plan to see patients and access my electronic medical records on the day that an off-site review of my practice is being conducted?

You can plan to see patients during an off-site review of your practice. In rare instances where your peer reviewer is not able to remotely access the charts you identified, you may be contacted by practice enhancement staff to ensure the administrative settings and permissions to your EMR are set correctly to allow the peer reviewer proper access.