%0 Journal Article %A Nicole Allison Kain %A Kathryn Hodwitz %A Wendy Yen %A Nigel Ashworth %T Experiential knowledge of risk and support factors for physician performance in Canada: a qualitative study %D 2019 %R 10.1136/bmjopen-2018-023511 %J BMJ Open %P e023511 %V 9 %N 2 %X Objective To identify, understand and explain potential risk and protective factors that may influence individual and physician group performance, by accessing the experiential knowledge of physician-assessors at three medical regulatory authorities (MRAs) in Canada.Design Qualitative analysis of physician-assessors’ interview transcripts. Telephone or in-person interviews were audio-recorded on consent, and transcribed verbatim. Interview questions related to four topics: Definition/discussion of what makes a ‘high-quality physician;’ factors for individual physician performance; factors for group physician performance; and recommendations on how to support high-quality medical practice. A grounded-theory approach was used to analyse the data.Setting Three provinces (Alberta, Manitoba, Ontario) in Canada.Participants Twenty-three (11 female, 12 male) physician-assessors from three MRAs in Canada (the College of Physicians & Surgeons of Alberta, the College of Physicians and Surgeons of Manitoba and the College of Physicians and Surgeons of Ontario).Results Participants outlined various protective factors for individual physician performance, including: being engaged in continuous quality improvement; having a support network of colleagues; working in a defined scope of practice; maintaining engagement in medicine; receiving regular feedback; and maintaining work-life balance. Individual risk factors included being money-oriented; having a high-volume practice; and practising in isolation. Group protective factors incorporated having regular communication among the group; effective collaboration; a shared philosophy of care; a diversity of physician perspectives; and appropriate practice management procedures. Group risk factors included: a lack of or ineffective communication/collaboration among the group; a group that doesn’t empower change; or having one disruptive or ‘risky’ physician in the group.Conclusions This is the first qualitative inquiry to explore the experiential knowledge of physician-assessors related to physician performance. By understanding the risk and support factors for both individual physicians and groups, MRAs will be better-equipped to tailor physician assessments and limited resources to support competence and enhance physician performance. %U https://bmjopen.bmj.com/content/bmjopen/9/2/e023511.full.pdf