title: SMART, SMARTER, SMARTEST: the influence of peer groups compared to practice visits on the quality of action plans.
abstract: BACKGROUND
  It has been reported that appraisal by peers can be effective.
  
  
  OBJECTIVE
  To investigate whether feedback from a peer group (PG) compared to that by a staff member during a practice visit (PV) is as effective in improving the quality of action plans.
  
  
  METHODS
  Seventy-three general practitioner (GP) trainers randomized into either a PG or PV were instructed to draw up action plans using the SMART criteria to realize the goals set in their personal development plans (PDPs). To improve action plans, feedback was given in either PG or PV. Quality of baseline and follow-up action plans, operationalized as the SMARTness with which plans were formulated, was assessed using a study-specific instrument.
  
  
  RESULTS
  Response rate for submitting both baseline and follow-up action plans was 89% in the PG versus 79% in the PV. It was feasible to determine scores on all SMART criteria, except for the criterion 'Acceptability'. Significant improvement was made on the remaining four criteria irrespective of the feedback setting.
  
  
  CONCLUSIONS
  PGs cost less and seem equally effective in improving the SMARTness of the action plans. Moreover, they also seem to stimulate GP trainers more to write a PDP. Therefore, they may be favoured over PVs.
authors.affiliation: Academic Medical Center, Department of General Practice, University of Amsterdam, Amsterdam, The Netherlands. j.m.vanes@amc.uva.nl
authors.forename: Judith M
authors.initials: JM
authors.lastname: van Es
authors.forename: Mechteld R M
authors.initials: MR
authors.lastname: Visser
authors.forename: Margreet
authors.initials: M
authors.lastname: Wieringa-De Waard
mesh_terms: D004502:Education, Medical, Continuing; D005246:Feedback; D030141:Feedback, Psychological; D005260:Female; D058006:General Practice / Q000193:education*; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010379:Peer Group; D058996:Quality Improvement; D013192:Staff Development