Peer group activities are part of the requirement to review and reflect on practice.  Peer review groups meet regularly to discuss case management and clinical problems, with the aim of improving the performance of individuals within the group. 

A minimum of 6 hours of peer review group activities must be performed each year.

Rules

  • At least three doctors will be present and participating.  
  • At least one person present will be an RNZCUC Fellow or senior registrar. The Education Committee may waive this rule for registrars working in a location where a RNZCUC Fellow or senior registrar is not available. 
  • The group discusses urgent care cases or clinical challenges with the aim of improving clinical performance. 
  • RNZCUC accepts video conference peer group meetings but meetings should be in-person if possible. 
  • Peer review must take place in an environment conducive to the confidentiality of the patients being discussed, and the privacy of the doctor whose work is being reviewed. 

Examples 

As long as the rules above have been satisfied, examples of peer review might include: 

  • difficult or interesting cases
    • Clinically challenging
    • Those where there was a challenge providing culturally appropriate care*
    • Those where achieving an equitable health outcome was challenging*
  • learning points from the training programme 
  • journal articles relevant to a recent case 
  • joint review of cases 
  • critique of a video review of consultation.

*when the peer group activity covers cultural safety or health equity (a high-value activity), an additional point for each hour may be claimed as triennial CPD points, but the minimum requirement of 6 hours per year of peer group activity remains.

For clinicians, peer review does not include the following, which may, instead, be claimed as triennial CPD activities: 

  • practice management 
  • matters relating to practice premises or systems 
  • non-clinical research 
  • non-clinical education 
  • participation in College or other committees that are not of a clinical nature 

 Finding a peer group 

A list of peer groups in NZ is available here. 

Registrars should check first with their supervisor for their recommendation for a peer group. When access to an RNZCUC Fellow or senior registrar is not possible, registrars should communicate with the Director of Clinical Training to seek dispensation. 

Getting the most from the peer group 

Many doctors report that the best discussions only eventuate after several meetings when participants become comfortable with the group and feel free to be frank. Some keys to facilitating this atmosphere are: 

  • An attitude that all members of the group are equals (peers). 
  • No direct criticism or threatening attitudes. 
  • Keep time limits. 
  • Encourage participation by all members. 
  • Encourage and plan for socialisation. The end of the meetings is a good time for this. 

Guidance on peer review in ED 

Any RNZCUC registrar working in an ED with no RNZCUC Fellow or senior registrar should first seek dispensation. 

ED often run training events or symposia with multiple foci.  Peer review may be part of this.  If the event includes feedback, guidance, or critique of your clinical performance and is in a group format, it may be classed as peer review for the purposes of RNZCUC recertification.  Record your peer review activities on ePortfolio using the template below. 

Examples of ED activities include: 

  • Those listed above 
  • interactive radiology conferences 
  • mortality and morbidity meetings. 

Otherwise, it may be claimed as an educational or triennial CPD activity.  Whichever option you choose, you cannot claim both peer review and CPD points for the same activity (ie no “double-dipping”). 

Recording 

Nominate one person to be responsible for writing minutes and sharing them with everyone present.  An example of meeting minutes is shown below. This table can be downloaded as a word document here. 

RNZCUC allocates points for interaction time only, not preparation. 

The future IS supporting recertification will allow for one person to upload minutes to be uploaded, tagging everyone who was present. In the meantime individuals should record their attencance themselves, and keep a copy of the minutes in case of audit.

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Description and purpose

  • Peer review is an evaluation of the performance or practice of individuals or groups by members of the same profession or team.
  • This includes any activities where doctors are reviewing, reflecting and learning about their practice with others.
  • It should include the presence of a senior clinician (ie vocationally registered doctor or senior registrar) to provide senior oversight and direction.
  • This may include attendance at regular Peer discussion meetings or groups but is not limited to this format alone.
  • Peer review must take place in an environment conducive to the confidentiality of the patients being discussed, and the privacy of the doctor whose work is being reviewed.

CPD requirement
A minimum of 10 peer review points per annum made up of one compulsory Structured Annual Conversation (SAC), combined with other peer review formats.

Claiming points
Use ePortfolio to maintain a record of your Peer review activities.  Remember to load supporting documentation. We recommend keeping a copy safe.

Standard activities:
Unless otherwise stated, claim 1 point per hour spent in peer review activities.

High value activities:
RNZCUC recognises Regular practice review or Clinical Practice Visits as high value peer review activities. These activities will be eligible for 6 Peer review points for the doctor being reviewed. Note the reviewing doctor may claim CME points as a high value activity.

Structured Annual Conversation
Doctors must have a structured conversation with a peer, supervisor, colleague or employer (at least annually) to discuss outcome data from activities already undertaken (e.g. CPD, educational activities, audit, etc), the doctor’s personal reflection on their practice, learning aspirations, professional development, wellbeing, and their career stage and intentions. (new per mcnz requirement – need to add mechanism to support in eportfolio + link to template for this – see appendix 2 for suggested template)

Regular Practice Review

This is a voluntary peer review activity which is recognised by the MCNZ as a high value peer review activity.  The RPR is therefore eligible for 6 peer review points.

Regular Practice Review (RPR) is a supportive and collegial review of a doctor’s practice by a peer in the doctor’s usual practice setting.  The RPR is a quality improvement process designed to help maintain and improve the standards of the profession. It provides an assessment across the domains of competence outlined in Good Medical Practice and is informed by a portfolio of information provided by the doctor, which may include audit outcomes and logbooks.

By definition, an RPR meets the requirements for the compulsory Structured Annual Conversation. (new per mcnz – needs thought as to how this would be paid for ?doctor pays if voluntary?? – need mechanism within the eportfolio to support this so don’t claim for SAC too. This template will need to align with our CPV template – at first glance it doesn’t look that would be an issue)

A Clinical Practice visit undertaken as part of other RNZCUC activities is considered equivalent to the RPR and as such is eligible for the same number of peer review points. A SAC cannot be claimed in the same year as an RPR or CPV.

Note, a MSFS within the past 2 years is a pre-requisite for this activity. (NEW per mcnz **needs work/thinking and needs to include content of SAC and align with CPV)

Activities for other vocational colleges
Any peer review activity undertaken while participating in another vocational branch is also eligible peer review points using the 1 point per hour principle above.

Activities as part of your employment or role
Any peer review activities undertaken which are required or provided by your place of work which involve you reviewing/reflecting and learning about your practice also eligible for peer review points using the 1 point per hour principle above.  This includes any performance appraisal process.

An annual performance review or appraisal may also meet the criteria for the compulsory Structured Annual Conversation, providing all elements stipulated by RNZCUC are met. **need more detail around the SAC + templates/guidance etc**

Supervision
Supervision meetings involve registrars reviewing, reflecting and learning about their practice with a senior colleague.  This meets the definition of peer review and as such supervision meetings are eligible for peer review points using the 1 point per hour principle above. Additionally, a supervision meeting may be eligible as a SAC providing all the essential elements are met.

Note: Supervisors may claim 2 CME points per hour to recognise supervision as a high value activity.

Examples
Below are examples of activities that can be claimed as Peer review, along with points guidance.

Note, this is not an exhaustive list – this could include any activity where you are reviewing, reflecting and learning about your practice with others. Be guided by your Professional Development Plan, and annual conversation.

Activity Points guidance
Peer review discussion groups

–           Peer review groups meet regularly to discuss case management and clinical problems, with the aim of improving the performance of individuals within the group.

–           RNZCUC accepts video conference peer group meetings but prefers face-to-face meetings.

1 point per hour
Regular Practice Review (high value activity)

–        Note: MSFS within the past 2years is a pre-requisite for this activity.

–        Note RPR also fulfils the Structured Annual Conversation  requirement. (cannot claim RPR and SAC in the same year** need a mechanism in the eportfolio to support this**).

–        Note: reviewing doctor can claim CME points for a high value activity.

6 Peer review points
Supervision meetings

–        Note: a supervisor meeting may meet the requirements of at SAC. It is expected that this would be the either the first or last supervisor meeting in the year. Note: supervisors can claim CME points as a high value activity for this.

1 point per hour
Structured Annual Conversation

–        Note cannot claim RPR and SAC in the same year

–        Note: peer doctor can claim CME points.

1 point per hour
External professional supervision

–        This is a collaborative professional relationship between a qualified supervisor and clinician which is concerned with enhancing the quality if the practitioners work. This involves regular meetings where reflection on all aspects of the clinician’s work.

1 point per hour
Other meetings with a Peer review component

–        Eg Morbidity and Mortality meetings

–        Formal case review (not usual collegial conversations as part of daily practice)

–        Complaint or incident review

1 point per hour

Peer Groups

Finding a peer group

Check first with supervisor for their recommendation for a peer group.

A list of peer groups in NZ is available here.

When access to an RNZCUC Fellow or senior registrar is not possible, registrars should communicate with the Director of Clinical Training to seek dispensation.

Peer group coordination

If setting up a peer group, please inform the College, who will add your name to the list of peer groups in NZ. When organising a group, the College recommends appointing a coordinator (not necessarily the Fellow/senior registrar) to act as a point of contact, to arrange appropriate venues and meeting dates, and to organise the peer group event (or to arrange for members of the peer group to take the lead in organising an event).

When informing the College, please provide the following information:

  • Peer group location: City and suburb
  • Contact person name, email, mobile number

(We will add these details to the list of peer groups.  You can request that your contact details are not included in the table, in which case we will name the office as contact person. We would provide your contact details (name, email) only when a registrar asks for the contact details of your peer group).

Getting the most from the peer group

Many doctors report that the best discussions only eventuate after several meetings, when participants become comfortable with the group and feel free to be frank. Some keys to facilitating this atmosphere are:

  • An attitude that all members of the group are equals (peers).
  • No direct criticism or threatening attitudes.
  • Keep time limits.
  • Encourage participation by all members.
  • Encourage and plan for socialisation. The end of the meetings is a good time for this.

Recording

Nominate one person to be responsible for writing minutes and sharing them with everyone present.  An example of meeting minutes is shown below. This table can be downloaded as a word document here.

RNZCUC allocates points for interaction time only, not preparation.

Individuals enter their peer group activity on their personal ePortfolio. RNZCUC has requested a tool to allow minutes to be uploaded to ePortfolio, in the meantime individuals should keep a copy of the minutes in case of audit. **aim for this issue to be sorted**

**Example text here**