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Volume 31 (4)

Volume 31, Issue 4, Fall 2011line
J Contin Educ Health Prof 2011; 31(4):258-264
ORIGINAL RESEARCH

Physician self-audit: A scoping review
Anna R. Gagliardi, Melissa C. Brouwers, Antonio Finelli, Craig E. Campbell, Bernard A. Marlow, Ivan L. Silver

A b s t r a c t

Introduction:
Self-audit involves self-collection of personal performance data, reflection on gaps between performance and standards, and development and implementation of learning or quality improvement plans by individual care providers. It appears to stimulate learning and quality improvement, but few physicians engage in self-audit. The purpose of this study was to identify how self-audit has been operationalized; factors influencing self-audit conduct and outcomes, including program design; and issues warranting further research.
Methods:
A systematic review of quantitative and qualitative studies was undertaken. Two individuals independently reviewed searches of indexed literature databases, tables of contents, and references of eligible studies. Data were extracted and tabulated to describe the nature and impact of self-audit programs.
Results:
Six studies evaluated the impact of self-audit programs. No program was based on a model or theory that informed its design. All studies showed improved compliance with care delivery guidelines and/or improved patient outcomes, although these findings were largely self-reported. Programs varied so features associated with benefit could not be identified.
Discussion:
Overall there is a need for guidance on all aspects of self-audit for both participants and leaders. This guidance would be useful to educators, professional associations, and medical certification bodies to plan, develop, implement, evaluate, and support self-audit programs. Further research should aim at developing training programs and tools that address and evaluate a variety of competencies across different disciplines using more rigorous research designs, including both quantitative and qualitative approaches.

Lessons For Practice
  • Six observational studies evaluated the impact of self-audit on care delivery and outcomes.
  • None of the self-audit programs were based on an explicit model or theory that informed their design.
  • Three self-audit how-to guides were identified by literature search.
  • There is a need for guidance on all aspects of self-audit for both participants and leaders, including tools and training.
  • Self-audit may stimulate learning and quality improvement; further research using mixed quantitative and qualitative approaches is needed to more rigorously evaluate the impact of self-audit programs on clinical practice and patient outcomes and identify optimal strategies for supporting self-audit.

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