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Family physicians' reactions to performance assessment feedback.

OBJECTIVE
To explore and describe family physicians' personal and professional responses to performance assessment feedback.


DESIGN
Qualitative study using one-on-one semistructured interviews after feedback on performance.


SETTING
Fee-for-service family practices in eastern Ontario.


PARTICIPANTS
Eight physicians out of 25 physicians in the control group of a previous randomized controlled trial who received performance assessment feedback were purposefully selected using maximum variation sampling to represent various levels of performance. Five female physicians (2 part-time and 3 full-time) and 3 male physicians (all full-time) were interviewed. These physicians had practised family medicine for an average of 18.5 years (range 9 to 32 years).


METHOD
Semistructured one-on-one interviews were conducted to determine what physicians thought and felt about their private feedback sessions and to solicit their opinions on performance assessment in general. Information was analyzed using an open coding style and a constant comparative method of analysis.


MAIN FINDINGS
Two major findings were central to the core elements of medical professionalism and perceived accountability. Physicians indicated that the private feedback they received was a valuable and necessary part of medical professionalism; however, they were reluctant to share this feedback with patients. Physicians described various layers of accountability from the most important inner layer, patients, to the least important outer layer, those funding the system.


CONCLUSION
Performance feedback was viewed as important to family physicians for maintaining medical professionalism and accountability.