Developing and Implementing the Mini-Practice Audit Model to Support Rheumatologist Self-Assessment in Clinical Practice

Objectives Implementation of new clinical guidelines in routine medical practice is often suboptimal,[1] with rheumatologists facing challenges in self-assessing and identifying care gaps.[2] This pilot project aimed to develop and implement a Mini-Practice Audit Model (mPAM) [3] as a structured, self-directed framework to enhance awareness and uptake of the 2022 Canadian Rheumatology Association (CRA) Rheumatoid Arthritis (RA) guidelines. The mPAM was designed to facilitate guided self-reflection, enabling practitioners to identify knowledge gaps, documentation inconsistencies, and opportunities for improving patient care within a feasible, low-burden audit process. Methods An online survey based on the 2022 CRA RA guidelines assessed participants’ knowledge, attitudes, and practices, informing the creation of a modified mPAM tool. Participants invited to participate in the pilot project were sampled from current members of the CRA Education and Guidelines Committees. The mPAM guided rheumatologists through a structured mini-audit of their own patient charts, focusing on disease remission rates, medication use, tapering discussions, flare management, and shared decision-making. Each participant received individualized feedback and educational resources, followed by an invitation to complete a re-audit several months later. Quantitative results were analyzed descriptively, and qualitative reflections underwent thematic analysis to identify trends. Results Eleven CRA members participated in the pilot; 8 completed both the audit and re-audit. In the initial audit, 60% of patients were in remission, predominantly managed with conventional synthetic DMARDs (69%), while biologic or targeted synthetic therapies accounted for 23%. Identified guideline gaps included documentation of tapering (45%), flare discussions (38%), and shared decision-making (38%). Thematic analysis highlighted inconsistent documentation and limited detail regarding medication and patient communication. Re-audit reflections demonstrated increased awareness of documentation practices, improved incorporation of guideline elements, and reported adoption of strategies such as explicit patient communication on management plans. Participants described the mPAM as relevant, practical, and aligned with Maintenance of Certification (MOC) objectives. Conclusion The Mini-Practice Audit Model (mPAM) provides a feasible, effective approach to engage rheumatologists in self-assessment and continuing professional development aligned with disease specific treatment guidelines. By promoting reflective practice through personalized feedback and iterative auditing, the mPAM enhanced participants’ awareness of clinical documentation and guideline adherence. The pilot demonstrated potential for broader application across rheumatology and other specialties. References [1.] Yates M. Rheumatology (Oxford) 2020;59;8:2035-42. [2.] Eva KW. Acad Med 2005;80:S46-54. [3.] Wooster D. JVU 2007;31:207-10. Practice Reflection Award