The peer and practice review (PPR) is a mandatory component of CRPO’s Quality Assurance program and is a normal part of being a regulated health professional in Ontario. The objective of a peer and practice review is to help CRPO registrants assess their knowledge, skill and judgment in key areas of professional practice and identify ways to improve and maintain quality of care.

The PPR is an assessment and coaching process that guides registrants on where to focus their professional development efforts. PPR activities include the following:

  • case-based assessment (CBA);
  • self-directed professional development; and
  • peer-assisted review activities with a peer coach.

The first stage of the PPR for all registrants is to complete the CBA. Depending on the CBA result, registrants will receive guidance for professional development that is one of the following:

  • self-directed;
  • self-directed with suggested resources and reporting requirements; or
  • peer-assisted with support from a peer coach or College staff

The CBA is intended to provide registrants with evidence-based feedback that will assist them in engaging with the Professional Practice Standards and continuing to think critically about their practice, professional growth, and obligations as a regulated health professional. The CBA supports reflective practice and life-long learning, both of which are critical components of providing safe and effective care.

Registrants with low scores on the CBA might be at risk of not understanding or demonstrating the Standards in their practice. These registrants will proceed to the second stage of the PPR and participate in a peer-assisted practice review.

Peer-assisted reviews will be conducted by peer coaches. Peer coaches are CRPO registrants who have been trained to conduct practice assessments and provide peer coaching. They, and the CRPO, are committed to collaborating with registrants and supporting them to meet their professional obligations, many of which are laid out in the Professional Practice Standards for Registered Psychotherapists.

If you have any questions or concerns regarding your requirements, or your capacity to complete them on time, please contact QA staff.

PPR Stage 1: CBA process

All registrants are required to undergo a PPR when selected. The first step in a PPR is to complete the case-based assessment (CBA).

Step 1: Notification
CRPO will notify you when you are randomly selected to write the CBA (approximately 3 months before the scheduled administration).

Step 2: Confirmation
Complete the ‘confirmation to write’ form by the specified deadline.

Step 3: Preparation
Review the Professional Practice Standards and other Quality Assurance Program resources on the CRPO website (see How do I prepare for the CBA?)

College staff will also send you a series of emails to help you prepare for the CBA.

Step 4: Login instructions and unique code
College staff will send you login instructions as well as a unique code to access the CBA.

Step 5: Complete the CBA
The CBA online platform will be open for a 10-day window. You will need to set aside a 4-hour block of time to complete the CBA within the 10-day window.

Step 6: Results
College staff will send you your results by email approximately six weeks after the CBA administration window closes. Your result will determine your CBA outcome and next steps, if any, in the PPR process.

CBA outcomes

The CBA is designed to be an educational tool to help you identify potential gaps in your knowledge, skill and judgment and make effective use of your professional development activity hours. You will receive a feedback report on your results. Depending on the CBA result, you will receive guidance for professional development that is either self-directed or peer-assisted.

Data collected during the QA Enhancement Project supports an expectation that most registrants will be successful on the CBA.

Successful
If you are successful on the CBA, you will continue your professional development by engaging in any relevant activities that meet your learning needs and goals and can expect to complete the CBA again in approximately 5 years.

Your CBA results will outline your performance in each area of the Standards. With this information, you will be able to identify and address any potential gaps in your knowledge, skill and judgement and make decisions about where to direct your professional development activities.

Self-directed professional development
If your CBA results are not successful but close, you will be required to complete self-directed professional development. You can expect to complete the CBA again in approximately 5 years.

Your CBA results will outline your performance in each area of the Standards, and you will receive resources and recommendations on where to direct your professional development efforts during your next PD reporting cycle.

 

At the end of your PD reporting cycle, you will be asked to submit a self-assessment and your professional portfolio for review. (For information about these requirements, see Professional development requirements and FAQs.)

Peer-assisted review activities with a peer coach
If you have low scores on the CBA, you might be at risk of not understanding or applying the Standards in your practice. Your CBA results will outline your performance in each area of the Standards, and QA staff will offer you an appointment to discuss your results and assessment strategies. You will be given an opportunity to write the CBA again at the next administration.

If you continue to have low scores after writing the CBA again, you will proceed to a peer-assisted practice review with a peer coach.

 

The peer coach will further assess your practice, collaborate with you to come up with a meaningful learning plan, and support you with meeting your professional obligations.

After you have completed the learning plan created with your peer coach, you will be required reassess your knowledge by completing the CBA at the next available administration.

 

If you continue to have low scores on the CBA, you will be referred to a panel of the Quality Assurance Committee for review and further direction.

PPR Stage 2: Peer coaching

If you have been identified for peer coaching (i.e., your CBA results indicate potential gaps in knowledge, skill, and judgement), you will receive further support and assessment. This happens through a peer-assisted review with a peer coach.

All registrants identified for peer-assisted review must do the following:

  • Complete a pre-questionnaire.
  • Submit examples of professional advertising and self-representation materials.
  • Submit five clinical records and corresponding financial and clinical record checklists.
  • Collaborate to coordinate dates and times to participate in peer coaching sessions conducted by a peer coach.

The PPR is designed to engage you in the process of identifying your areas of strength as a health care professional, as well as any areas that may benefit from enhancement.

Like all other components of the QA Program, your participation in peer coaching is one of your mandatory obligations as a CRPO registrant.

If you have any questions or concerns regarding the PPR process, please contact QA staff.

What is the case-based assessment (CBA)?

The case-based assessment (CBA) is an online, risk-based screening tool. The CBA consists of a series of 30 situational judgement scenarios (“cases”). The cases have been developed by members of the profession and are based on the CRPO Professional Practice Standards. Each case has five answer options. Registrants are asked to rank the options from most aligned to least aligned with the Standards.

CRPO’s intention is to engage registrants with the Standards, help registrants reflect on their practice, and identify where registrants might need to focus some of their professional development (learning) activities. The CBA will also help identify which registrants might be at risk of not understanding or applying the Standards in their practice. Registrants at risk will be provided with supportive coaching and guidance from a peer to address potential gaps in their knowledge, skill, and judgment before the gaps develop into a risk that might result in harm to the public.

The CBA is the first stage of a peer and practice review (PPR). All registrants are expected to participate in a PPR and complete the CBA approximately once every five years.

When do I complete the CBA?

There are two assessment periods each year.

Those registered on or before December 31, 2022, will be randomly assigned to complete the CBA in one of the next five years (2023-2027).

Registrants registered on or after January 1, 2023, will be assigned to complete the CBA in the fifth year after their initial year of registration.

CRPO will notify registrants approximately 6 months in advance when they have been selected to take the case-based assessment.

What do I do if I am unable to complete the CBA or other PPR activity when selected?

We understand that registrants may have extenuating circumstances which might prevent them from completing the CBA when selected.

If you are unable to participate in a PPR activity when selected, you might be eligible for a deferral. To request a deferral, please contact QAassessments@crpo.ca before the CBA administration window begins.

Is the CBA available in my CRPO user account?

No. The CBA is hosted on an external platform and is only available to selected registrants twice a year.

Other elements of CRPO’s QA Program (e.g., the self-assessment and attestation form) are available in your CRPO user account. Please see Professional development requirements and FAQs for information.

How do I prepare for the CBA?

The CBA is intended to be a low-stress, educational experience that inspires reflective practice. The CBA is an  “open book” assessment, which means RPs will be able to refer to the CRPO Professional Practice Standards and other resources they might want to use. The CBA is online and not proctored (i.e., monitored or supervised).

The CBA consists of 30 situational judgment cases. Each case has five answer options numbered from A to E. You are asked to rank each option from most aligned with the applicable Standard to the least aligned. The current version of the CBA platform requires you to type your answers in an answer field. For example, if you determine the correct rank is ABCDE, you will need to type “ABCDE” in the answer field.

You may wish to review the following in preparation for the assessment:

  • CRPO Professional Practice Standards
  • Try sample questions (clicking this link will lead you away from the CRPO website).
  • Think about possible assessment-taking strategies and how you might approach the questions. For example,
    • Consider approaching the question using the process of elimination. First determine which answer option is the least aligned with the Standards and which is the most aligned. Then look at ordering the remaining three answer options.
    • Consider having a scrap piece of paper beside you where you can jot down any notes as you work through your answer.
    • If you get stuck, consider leaving it to come back to later. The assessment platform allows you to navigate back and forth between questions and to review your answers before submitting, so you can return to a case any time up until the point where you click “I AM DONE.”
    • Take a moment to review the options you entered (ABCDE) and ensure you have each response entered once (i.e., no letters are repeated, and all five options are ranked).

In addition to the Practice Standards, you may wish to review the following resources:

What does “open book” mean?

We have used the term “open book” to indicate that CBA takers will be able to refer to the Professional Practice Standards and other resources they might want to use during the assessment. See “How do I prepare for the assessment” above.

The CBA is on-line and is not proctored (i.e., supervised or monitored). Registrants will be able to complete the CBA at any point during the 10 days of each assessment sitting and are encouraged to have whatever materials they wish available to them.

How many situational judgement cases are included in the CBA?

The case-based assessment (CBA) consists of 30 situational judgment cases.

The number of cases was reduced from 40 to 30 after reviewing data and feedback from registrants who participated in standard-setting workshops and the November 2022 pilot assessment.

30 is the minimum number of cases needed to assess registrants across all areas of the Professional Practice Standards. (See “What is the blueprint?” below.)

Who creates the situational judgement cases?

The cases are written, reviewed, and tested by members of the profession. CRPO aims to include and represent multiple perspectives and communities of practice. To date, over 50 RPs have been involved in various stages of the Quality Assurance Enhancement Project.

CRPO has taken an iterative approach to case development. This means each case goes through several stages including writing, revising, and testing before being finalized and added to the CBA.

How is the case-based assessment (CBA) scored?

The case-based assessment (CBA) consists of 30 situational judgment cases. Each case has five answer options. RPs are asked to rank all five options from the most aligned to the least aligned with the relevant CRPO Professional Practice Standard.

The current version of the CBA platform requires you to type your answers in an answer field. For example, if you determine the correct rank is ABCDE, you will need to type “ABCDE” in the answer field.

All possible answer combinations on the assessment are assigned a score. Since partial marks are awarded for each answer position, the assigned score depends on how close the answer is to the most and least aligned options.

This type of ranking is typical of “situational judgement scenarios,” which are designed to recognize that in many situations, there is more than one correct answer. For example, this means that if an RP selects the top two answers, but has them in a different order, they will still do very well on the assessment.

What do I need to score in order to “pass” the CBA?

The College has adopted an 80% mastery level as the cut score for registrants completing the CBA.

The online CBA will be used by the College to identify risks in practice and direct resources where they are most needed to help registrants provide safe and effective care. The cases in the CBA are based on the CRPO Professional Practice Standards.

Practice standards for any regulatory body represents essential foundational knowledge that members of the profession must be aware of and uphold. Therefore, the required assessment score of 80% is in the interest of the public and the profession itself.

Accordingly, registrants achieving a score of 80% or higher on the assessment will be classified as “successful”.

How does CRPO determine which Standards to focus on when developing and selecting cases for the CBA? What is the blueprint?

The Quality Assurance Committee established a blueprint for the CBA using a risk register (risk frequency and risk severity) based on data as described below:

Risk frequency is based on how often the issue arises within:

  • College committees (e.g., complaints, applications for registration)
  • Practice advisory inquiries
  • Stakeholder input (e.g., reports of ‘horizon’ issues or emerging risks)

Risk severity is determined by reviewing:

  • Significance of outcomes (e.g., referring complaints to the Discipline Committee, refusing applications for registration)
  • The priorities of stakeholders (e.g., the public, government, registrants, Council and committees)

Registrants completing the case-based assessment are presented with proportionally more cases corresponding to “high-risk” Practice Standards. The number of cases for each section of the Standards corresponds to the level of risk identified by the risk register.

The blueprint below outlines the Professional Practice Standards that are being assessed in the 2023 CBA:

What happens with my CBA results? Will my CRPO registration be affected?

Approximately six weeks after completing the CBA, you will receive information about your result. See CBA Outcomes above.

The CBA is part of CRPO’s Quality Assurance Program and differs significantly from the Entry-to-Practice Registration Examination, which is offered by the COMPASS Centre for Examination Development, a national body established to develop and administer the exam.

The CBA does not affect your registration status. The CBA is designed to be an educational tool to help you identify potential gaps in your knowledge, skill and judgment and make effective use of your professional development activity hours.

In addition, the CBA is intended as a tool to help CRPO identify potential risks in practice and determine where and how to direct College resources in a way that ensures registrants are providing safe and effective care to Ontarians.

Information shared through participation in the QA Program is confidential and, with limited exceptions, the information provided can only be used for QA purposes. CRPO will not post CBA or other PPR activity results on the Public Register or share your information with current or future employers.

If the QA Committee believes that a registrant may have committed a serious act of professional misconduct, or may be incompetent or incapacitated, the QA Committee may disclose only the registrant’s name and the allegation against the registrant to the Inquiries, Complaints and Reports Committee (ICRC). The ICRC may carry out an independent investigation if it elects to do so.  However, in cases where a registrant knowingly gave false information to the QA Committee, QA staff, or a peer coach, the QA Committee may disclose this information to the relevant College Committee that is dealing with the matter.

Is the CBA mandatory?

Yes. As part of the College’s QA program under the Regulated Health Professions Act, 1991 (RHPA), starting in 2023, CRPO will begin assigning approximately 20% of registrants to complete the case-based assessment (CBA) each year. The CBA is the first stage of a peer and practice review (PPR). Being selected to participate in a PPR is a normal part of being a regulated health professional in Ontario.

The CBA will help determine which registrants would benefit most from engaging in peer coaching.

How often will registrants need to take the case-based assessment (CBA)?

CRPO aims to assess all registrants over a 5-year period.

Registrants with low CBA scores may be re-assessed in fewer than 5 years. For example, registrants with low CBA scores will be offered support and an opportunity to complete the CBA a second time. Registrants whose second CBA results are in the peer-assisted review category after a second CBA will be assigned a peer coach. Once a registrant has completed peer coaching and any associated learning plan, they are required to complete the CBA again for reassessment.

Once a registrant is placed in a cohort, they will be assessed approximately every 5 years, subject to any reassessment as described above.

How long will I have to complete the assessment? Can the CBA be completed over several sittings or days?

The CBA is an online, open-book format and will be available 24-hours a day for 10 days.

When selected to complete the CBA, registrants are required to sign in once during the 10-day period and complete the assessment in one 4-hour window. In other words, the CBA cannot be completed over several days or in multiple sittings.

After taking the assessment, how soon will I receive my results?

CRPO will send you your results by email approximately six weeks after the CBA administration window closes.

Why and how did the College create the online assessment?

The College is gradually eliminating the random selection process for registrants to participate in peer and practice reviews. Instead, all registrants will be required to complete the CBA, an online, “open-book” assessment, on a regular and recurring basis, approximately every five years. The CBA will be used by CRPO to identify risks in practice and direct resources where they are most needed to help registrants provide safe and effective care.

As the cornerstone of CRPO’s QA Program, the CBA is a sustainable resource that assists CRPO with identifying risks in practice and directing resources where they are most needed to help registrants provide safe and effective care.

The CBA is intended to provide evidence-based feedback that will encourage registrants to engage with the Practice Standards and continue to think critically about their practice, their professional growth, and their obligations as regulated health professionals. The CBA supports reflective practice and life-long learning, critical components of providing safe and effective care.

To date, CRPO has engaged with over 50 RPs in various stages of the Quality Assurance Enhancement Project. These registrants attended training workshops and contributed their time as case writers, reviewers, standard setters.

CRPO has taken an iterative approach to case development. This means each case goes through several stages with different groups of RPs, including writing, revising, and testing, before being finalized and added to the CBA.

Will there be an opportunity to provide feedback after completing the CBA?

Yes. We will send you a link to a feedback survey after you have received your CBA results. CRPO welcomes respectful, constructive feedback.

Is there a cost to the CBA? Do I have to pay for peer coaching?

There is no cost to RPs participating in the case-based assessment or in peer-assisted reviews. These activities are a core part of CRPO’s work of public protection. Registrants who receive coaching from a trained peer coach will not be charged a fee. As well, since RPs will continue to be able to choose which educational activities they undertake as part of the existing required biennial 40 hours of professional development, it will be up to the individual registrant to decide whether they want to engage in activities that have an associated cost.

Do other colleges whose registrants practice psychotherapy have this type of case-based assessment program?

All regulated health professionals are expected to participate in their regulatory college’s Quality Assurance (QA) Program, as required by the Regulated Health Professions Act, 1991 (RHPA).

CRPO’s QA Program includes the following activities:

  • professional development (self-assessment and 40 hours of learning activities every two years);
  • peer and practice review; and
  • professional improvement.

The case-based assessment is an early stage of the peer and practice review activity. It is a risk-assessment activity that has been developed with members of the profession and is based on the CRPO Professional Practice Standards. The intention is to engage registrants with the Standards, help them reflect on their practice, and identify where they might need to focus some of their professional development (learning activities). It will also help identify which registrants might be at risk of not understanding or applying the Standards in their practice. Registrants at risk will be provided with supportive coaching and guidance from a peer to address potential gaps in their knowledge, skill, and judgment before the gaps develop into a risk that might result in harm to the public.

All registrants are expected to participate in a peer and practice review approximately once every five years.

What were the pilot results?

In November 2022, 178 registrants volunteered to take the CBA. The results supported our assumptions that most registrants who complete the CBA will be successful.

In addition, after reviewing data and feedback from participants, we increased the assessment time from 3 to 4 hours.

Confidentiality

Information shared because of participation in the Quality Assurance (QA) Program is confidential and, with limited exceptions, the information provided can only be used for QA purposes. CRPO will not post QA review results on the public register or share your information with current or future employers.

You, as a registrant, are therefore strongly urged to provide honest responses that are an accurate reflection of your current level of knowledge, skill and judgment.

If the QA Committee believes that a registrant may have committed a serious act of professional misconduct, or may be incompetent or incapacitated, the QA Committee may disclose only the registrant’s name and the allegation against the registrant to the Inquiries, Complaints and Reports Committee (ICRC). The ICRC may carry out an independent investigation if it elects to do so.  However, in cases where a registrant knowingly gave false information to the QA Committee or a peer assessor, the QA Committee may disclose this information to the relevant College Committee that is dealing with the matter.

Remedial education as directed by the Quality Assurance committee

The remedial education component of the QA Program engages registrants who, as determined by a panel of the QA Committee, require additional support to address identified learning needs. Only those registrants who have been identified in the Peer and Practice Review process who require directed remediation will engage in this component. Directives from the QA Committee may include remediation or specified continuing education.

In certain circumstances, the QA Committee may direct the Registrar to impose terms, conditions and limitations on a registrant’s Certificate of Registration, for example:

  • if a registrant’s Peer and Practice Review demonstrates egregious gaps in knowledge, skill or judgment; or
  • if the registrant did not successfully complete a program of specified continuing education or remediation.

If you have further questions that are not addressed here, please email QA staff.