Ethics approval and consent to participate
Ethics approval was granted by the University of Toronto Research Ethics Board (#00032455) and the Women’s College Hospital Research Ethics Board (#2016–0122-E) for the trial and the Ottawa Health Science Network Research Ethics Board (#20160934-01H) for the process evaluation. Ethics approval included approval of a departure from the general principles of consent, in a manner concordant with the minimal risks involved. Further rationale for this is provided in the published trial protocol. For physicians who had already consented to receive the audit and feedback reports, upon their usual sign-in to download their report, a notice explaining the general goals of this program appeared, with an invitation to seek further information by contacting the program team. This met the Canadian Tri-Council Policy Statement-2 on Ethical Conduct for Research Involving Humans requirements for departures from the general principles of consent procedures and is aligned with the Ottawa Guidance on Ethics for Cluster Trials. Process evaluation participants were informed that by responding that they would like to participate in the process evaluation, they were giving their consent for participation, as approved in our original protocol.