See one, do one, teach one: Do you have a peer review training program?

“See one, do one, teach one.” That is the medical school adage that formed the basis for much of our training. While many medical students felt this was an abrupt introduction to patient care activities, at least we got to see a procedure before we did one.

Many physicians, when they are appointed to a peer review committee, are pushed right into doing without the luxury of seeing. The committee may assume that because physicians are looking at medical records during the course of patient care, there is no need to instruct them on how to conduct peer review. Thus, most hospitals do not have a peer review orientation or training program for new members.

The main goal of a peer review committee orientation program is not just to teach a physician how to review a chart. The larger goal is to help new members understand the peer review process by helping them see the “big picture,” explaining how the committee functions, and defining their roles and responsibilities. To achieve this goal, consider creating a peer review committee orientation packet that contains the following information:

• Background reading (such as bylaws pertaining to peer review and articles from newsletters)
• Committee charter
• Sample committee agenda/minutes/data
• Case review process 
• Case rating form and explanation
• Guide for chart review
• Explanation of indicators types
• Current indicator list and targets
• Conflict of interest and confidentiality statement

We have also found that providing new members with sample cases that the committee has already viewed is an excellent way to begin the process of establishing inter-rater reliability among your reviewers. (See “Ask the Expert: What is inter-rater reliability?” for more information.)

Once the members have received the orientation packet and conducted their sample reviews, the next step is for the committee chair to meet with them for a brief orientation session. During this session, the chair should review the key steps involved in the peer review process, how meetings are run, and the committee’s expectations of its members regarding timeliness of reviews and meeting attendance. In addition, the chair should review the new committee member’s performance on the sample cases and explain the committee's rationale for its rating.

Just because you have a peer review committee orientation program, you are not guaranteed an efficient and effective peer review committee. There is no question that the most important element of a great peer review committee is having credible clinicians who are dedicated to this work. What a peer review orientation program does, however, is help good people function better.

Robert Marder, MD, CMSL, is vice president of The Greeley Company, a division of HCPro, Inc. in Marblehead, MA.