Factors Associated with Performance Among Optometrists in Alberta, Canada:

Background: Risk and protective factors influencing the performance of health professionals are of significant interest to regulators and the public. We aimed to develop a predictive model to identify factors influencing optometrist performance, providing insights for improving regulatory oversight and supporting targeted interventions.Methods: In our retrospective cohort study, we analyzed data from optometrists registered between 1987 and 2019 in the Alberta College of Optometrists Continuing Competence (CC) program to develop a predictive model for CC practice review outcome. We evaluated reviews using self-assessments, onsite visits, and clinical evaluations, with pass or fail status as the primary outcome. Key covariates included sex, age, training location, and previous review scores. We used a generalized additive model with a logit link and assessed its performance using five-fold cross-validation. Sensitivity and specificity were assessed with a holdout testing set.Results: We analyzed 2,075 CC reviews of 916 optometrists. Of these reviews, 75.6% received a passing grade. Practitioners were primarily male (51.7%, 48.3% female) and trained in the United States (49.8%) or Canada (46.2%). Significant predictors of review outcome were sex, training location, previous review score, follow-up score, age (included as a nonlinear effect varying by sex), and years since last review. In developing a selection tool for future assessments, we replaced age with years since graduation and removed training location. Among the 388 practitioners selected for assessment since 2021, practitioners flagged as high risk had significantly higher failure rates (16.1%) compared with practitioners selected randomly (3.0%).Discussion: Male sex, years since graduation, and poor outcomes on previous reviews emerged as significant predictors of failing an assessment. The developed selection tool effectively identified high-risk practitioners for reassessment, supporting fair and efficient resource allocation in the CC program.Conclusions: Key factors influencing CC review outcomes were identified and a selection tool was developed to ensure fairness across subgroups defined by age and sex.