This document discusses medical revalidation for histopathologists in the UK. It provides an overview of the objectives, history, and requirements of the revalidation process. Revalidation aims to ensure doctors remain fit to practice through annual appraisals that evaluate a doctor's scope of work, continuing professional development, quality improvement activities, feedback, and other documentation. The appraisal results in recommendations to regulatory bodies about a doctor's fitness to practice. While revalidation may help assure quality of care, its effectiveness is still debated as it places significant administrative burden on physicians.

1. Medical Revalidation for Histopathologists
By
Dr. Varughese George
Department of Pathology, MGMCRI

2. Objectives
• Introduction
• Appraisal & Revalidation
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

3. Introduction

4. Medical Revalidation
• The term Medical Revalidation used to describe:
“the regular demonstration by registered doctors
that they remain fit to practice in their chosen
field(s)”
Source: General Medical Council. (2000). Revalidating Doctors: Ensuring standards, securing the future.
London, General Medical Council.

5. The Forms of Revalidation
The forms of revalidation in different places -
• Doctors should prove their participation in a
Continuing Professional Development
activities.
• Doctors sit for professional examinations
every few years.
• In some, the issue has not yet been
addressed.

6. The History of Revalidation
• The General Medical Council has been discussing
how to implement a system to check on the
performance of doctors since the early 1990s.
• Proposals based mainly on a requirement to
undertake CPD were well advanced, but had not
been implemented.
• Dame Janet’s report identified the need for a system
to check up on the performance of doctors every few
years.
• Chief Medical Officer Sir Liam Donaldson suggested
proposals for regular checks on the performance of
doctors

7. The Proposals – The 3 ‘R’s
The whole process was called ‘revalidation’, initially split into
two components.
• ‘Relicensing’ – to check that a doctor remained competent
at the level of basic registration with the GMC as a medical
practitioner.
• ‘Recertification’ - to check that specialists were operating
at an appropriate level for their specialty by a relevant
Medical Royal College.
Both processes done simultaneously periodically
If successful = Revalidation!

8. The downfalls of the proposals
• Did not specify how doctors would be evaluated.
• Assumed that doctors would have to give
examinations comparable to those which the
Colleges already delivered.
• Ignored the high level of medical specialisation in the
UK.
• For the Colleges, examinations had become
increasingly complex and expensive to run.
• Legal challenges by unsuccessful candidates were
becoming increasingly common and expensive.

9. Post discussions
• Doctors should be expected to prove their worth only in
relation to their own individual scope of practice.
• Huge diversity of individual medical practice excluded the
option of sitting examinations at intervals.
• Revalidation should be based on an annual review of the
whole of a doctor’s individual practice gained ground.
• The process of an annual medical appraisal would have to
be enhanced and made more formal if it was to satisfy the
requirements of the GMC.

10. It was recognised that if revalidation was to be
based on appraisals of a doctor’s actual
practice, the division into ‘relicensing’ and
‘recertification’ was unhelpful, so those terms
were dropped.

11. • Appraisals would have to fulfil two tasks :
1. The ‘summative question’ –
Is this doctor fit to practise?
2. The ‘formative question’ –
Can this competent doctor be helped to
improve his/her performance even more?

12. Objectives
• Introduction
• Appraisal & Revalidation
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

13. Purpose of Medical Revalidation
 Evaluates doctors’ practice through appraisal so as to affirm
good practice.
 Assures patients , the public, employers, other healthcare
professionals & providers, licensed doctors are practising to
the appropriate professional standards.
 Complements other systems that exist within organisations
and at other levels for monitoring standards of care and
recognising and responding to concerns about doctors’
practice.

14. Requirements for Revalidation
• Doctors must be taking part in an annual
appraisal process.
• Doctors must have completed at least one
appraisal based on good medical practice.
• Doctors must have collected and reflected on
all six types of supporting information.

15. Six types of supporting information
1. continuing professional development (CPD).
2. quality improvement activity.
3. significant events .
4. feedback from colleagues.
5. feedback from patients.
6. review of complaints and compliments.

16. With the system in place
• When the system is established, revalidation will
be required every 5 years.
• The core requirement is that each year every
doctor either must have an appraisal to GMC
standards, or must have a valid reason for not
having such an appraisal.
• Every doctor now has a ‘Prescribed Connection’
to a ‘Designated Body’ which will provide a
• ‘Responsible Officer’ (RO).

17. Recommendations made by ROs
• ROs have a considerable number of responsibilities
beyond that of making revalidation recommendations to
the GMC.
• Most of these relate to ensuring the quality of medical
care, including monitoring and responding to adverse
clinical incidents and complaints.
• The outcome of appraisals is only one of the factors that
ROs are expected to consider when making a
recommendation.

18. Recommendations made by ROs
• ROs only have three options when making a
recommendation to the GMC :
1. Recommend revalidation.
2. Recommend deferral.
3. Failure to engage.

19. Objectives
• Introduction
• Appraisal & Revalidation
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

20. The ‘Scope’ of Work
• Sets out ‘everything’ the doctor does as a doctor.
• Not limited to work done for one organisation.
• Not concerned with when or how much each type of work is done.
• Unpaid work should be included.
• The level of responsibility is important.
• Must provide sufficient detail for an appraiser to assess the relevance of
all the other information provided & to identify any important omissions.
• Delivering a complete scope of work is important.

21. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

22. Documentation from previous
appraisals
• This is important to facilitate continuity of the
process across the whole revalidation cycle.
• The Personal Development Plan (PDP) agreed
at last year’s appraisal must be reviewed to
ensure progress is being made.

23. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

24. Continuing professional development
• It is not sufficient to confirm that the
minimum acceptable number of CPD points
has been delivered.
• The appraiser’s task includes checking that the
CPD activities undertaken cover the whole
spread of a doctor’s practice.

25. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

26. Quality improvement activities
• For most specialties, this heading primarily
means audit and outcome data.
• In histopathology, measuring patient outcomes is
problematic.
• Participation in appropriate external quality
assessment (EQA) schemes is essential.
• Detailed reports from EQA schemes should be
discussed in confidence with the appraiser.
• A variety of other sources of information may be
relevant

27. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

28. Colleague and patient feedback
• Questionnaires must be carefully constructed,
validated and administered by a third party, to
allow responses to be confidential.
• Spontaneous compliments and complaints,
whether from patients or colleagues, should also
be considered at appraisal.
• Patient feedback poses an obvious difficulty for
histopathologists and the GMC accepts that there
are circumstances where this may be omitted.

29. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

30. Significant events
• Any serious mishap in the previous year must
be discussed.
• wrong diagnosis.
• a misplaced specimen.
• seriously delayed report.
• accident in the laboratory.
• In medical appraisal, the negative implications
of something going wrong can be turned into
a very positive affirmation.

31. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

32. Statement of health
• All doctors are expected to ensure that their
own health does not compromise the care of
other patients.
• The GMC expects a standard statement to be
signed to confirm that this is happening.

33. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

34. Statement of probity
• Another standard GMC statement in which a
doctor formally declares they are telling the
truth.
• If any of the other information provided at an
appraisal is found to be deliberately incorrect, or
incomplete, this probity statement is
demonstrably false.
• The consequence could be a very rapid referral to
the GMC’s disciplinary procedures.

35. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

36. Information relevant to other
activities
• Supporting Information has to relate to
everything a doctor does as a doctor.
• Doctors who are not clinical academics but
nevertheless undertake some research will be
expected to provide information relevant to
that role.

37. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation
• Is the new system effective?
• Summary

38. The Documentation after appraisal
The appraiser and appraisee must agree a PDP
for the coming year, with personal objectives
that are SMART -
• Specific
• Measurable
• Achievable
• Relevant
• Time-limited

39. - The appraiser must complete a summary of the appraisal.
- The appraiser is then asked to make a series of yes/no statements for the
benefit of the RO.
- Any serious concerns or trivial problem should be escalated by the
appraiser to the RO.
- Statements the appraiser is asked to confirm to the Responsible Officer -

40. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
documentation.
• Is the new system effective?
• Summary

41. The Recommendation after Documentation
• ROs are entitled to review, in confidence, the whole
of a doctor’s appraisal record.
• The revalidation recommendation is made largely on
the appraiser’s responses.
• There is no right of appeal at this stage if an RO
refuses to make a positive recommendation.
• The GMC takes the actual decision, if necessary after
having held a full and separate ‘Fitness to Practise’
hearing.

42. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
appraisal
• Is the new system effective?
• Summary

43. Is this new system effective?
Maybe or maybe not
• Forces every doctor to consider, at least once each year,
whether there could be ways in which they can deliver
even better care for their patients.
• It provides reassurance to the public that their doctors
are competent and are keeping up to date.

44. Objectives
• Introduction
• Appraisal & Revalidation
• The Appraisal Process
• The Scope of Work
• Documentation from
Previous Appraisals
• Continuing Professional
Development.
• Quality Improvement
Activities
• Colleague and patient
feedback
• Significant Events
• Statement of Health
• Statement of Probity
• Information relevant to other
activities
• The Documentation after
appraisal
• The Recommendation after
appraisal
• Is the new system effective?
• Summary

45. Summary

46. References
1. P Furness. Medical revalidation for histopathologists,
Recent Advances in Histopathology Volume 23:
Chapter 11 : 149-157
2. V Nath, B Seale ,M Kaur. Medical Revalidation: From
Compliance to Commitment, King’s Fund, March
2014:1–32.