How should proctors be trained and oriented?

Most hospitals and their medical staffs do little or nothing to prepare a staff member to proctor. This is a serious deficiency that can have numerous adverse consequences. For example, an aggressive proctor might make judgmental state­ments that unnecessarily push the practitioner he is observing into an angry and defensive posture. This makes the peer review process feel adversarial rather than collegial. Proctors should be instructed that they are observers, and their opinions of those they proctor should be shared only through the formal mechanisms of the peer review process.

Proctors must also be taught to appreciate the fact that every practitioner has his or her own biases. These biases about clinical practice are typically formed in a doctor’s training years and reflect the particular mentors who taught that physician. In the hospital world, there are real microenvironments in medical practice and individual variation in techniques. A good proctor must be willing to allow for this reality and be able to discern the difference between a variation and a defi­ciency. This is not always easy, and untutored proctors often fail to consider the difference. Proctors should also be alerted to the dangers of hindsight bias (“Mon­day-morning quarterbacking”), which is the tendency for people with knowledge of the actual outcome of an event to believe falsely that they would have predicted the outcome.

When a medical staff uses only a small group of individuals to perform proctoring, it can ask these individuals to participate in formal training. This is usually done on-site and only need take an hour or so. When a large cross section of the medi­cal staff may be tapped to serve as proctors, a combination of written orientation materials and just-in-time training from a department chair or physician executive can serve. This orientation can instruct on good and bad proctoring practices and familiarize them with the relevant reporting forms. In addition, it is an opportunity to reinforce with proctors that all participants in medical staff peer review activ­ities must maintain appropriate confidentiality.

Source: Proctoring, FPPE, and Practitioner Competency Assessment: A Clinical Leader’s Guide