The outcomes/effectiveness of revalidation in the United Kingdom:evaluating the regulatory impact of medical revalidation

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This document outlines the purpose and work packages of an evaluation of medical revalidation in the United Kingdom. The evaluation aims to address 30 research questions across 6 core regulatory aims, including whether revalidation is consistently bringing all doctors under governance and evaluation of fitness to practice. The work is organized into 7 packages, including literature reviews, analysis of existing data, surveys, analysis of appraisal captures, stakeholder interviews, documentary analysis, and root cause analysis of appraisal documents related to fitness to practice referrals. The growing evidence base may help inform regulatory approaches in other countries like Australia.

The outcomes/effectiveness of
revalidation in the United Kingdom:
evaluating the regulatory impact
of medical revalidation
Julian Archer, Niall Cameron, Katie Laugharne,
Martin Marshall, Sam Regan de Bere,
Kieran Walshe, Richard Wright

Acknowledgements
• I would like to thank the General Medical
Council (GMC)
– Funding hotel for conference period
– Contribution to flights from the UK

Outline
• Purpose of the evaluation
• Work packages
• Progress so far

Purpose of the evaluation
• 30 research questions, addressing 6 core regulatory aims for
medical revalidation:
o Is the GMC’s objective of bringing all doctors into a governed system that
evaluates their fitness to practise on a regular basis being consistently
achieved?
o How is the requirement for all doctors to collect and reflect upon supporting
information (SI) about their whole practice through appraisal being
experienced by revalidation stakeholders?
o Is engagement in revalidation promoting medical professionalism by
increasing doctors’ awareness and adoption of the principles and values set
out in Good Medical Practice?
o Are revalidation mechanisms facilitating the identification and remedy of
potential concerns before they become safety issues or FTP referrals?
o How do ROs fulfil their statutory function of advising the GMC about doctors’
fitness to practise and what support do they have in this role?
o Are patients being effectively and meaningfully engaged in revalidation
processes?

Seven work packages
• Research organised into seven work packages, by
methods:
1. Literature reviews
2. Secondary analysis of existing data
3. National and strategic surveys
4. Appraisal capture
5. Interviews with stakeholders
6. Documentary analysis
7. Root cause analysis of documentation when FTP referral

WP 1: Literature reviews
• Appraisal
• PPI
• Supporting Information
• Responsible Officer (RO) judgement-making

WP 2: Secondary analysis of data
• GMC
• MARS & SOAR
• Combination of above

WP 3: National & Strategic Surveys
• Doctors
o Appraisees
o Appraisers
o ROs
• Patient interest groups

WP 4: Appraisal capture
• Audio-recording 90 appraisals a year for 2 years
o Flexible approach to capture
o Thematic analysis
o Mapping analysis to the framework centrally
o Categorisation of levels of reflection

WP 5: Stakeholder interviews
• Appraisees (90 per year)
• Appraisers (90 per year)
• ROs (12 per year)
• ELAs (6 per year)
• Regional thematic analysis and central mapping

WP 6: Documentary analysis
• Portfolio analysis (20 of the 90 interviewees over 2
years)
• Doctors in Scotland or Wales only
o Based on existing quality assurance models
• Data triangulated with the findings of WP 4 and 5

WP 7: Root cause analysis of appraisal
documents in FTP referrals
• Aspirational, shaped on the basis of the RO / ELA
interviews and discussions with the GMC
• Based in Scotland and Wales
• Prospective PAPC FTP referrals
• Root cause analysis of previous appraisals
• Issues around ethics, consent and recruitment

Seven work packages
1. Literature reviews
2. Secondary analysis of existing data
3. National and strategic surveys
4. Appraisal capture
5. Interviews with stakeholders
6. Documentary analysis
7. Root cause analysis of documentation when FTP
referral

Growing evidence base
• CAMERA report for Medical Board of Australia
– The evidence and options for medical revalidation
in the Australian context
– http://www.medicalboard.gov.au/Registration/Re
validation.aspx
– julian.archer@plymouth.ac.uk

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The document discusses revalidation in the Australian context, noting that mandatory continuing professional development (CPD) has been in place since 2010 but varies by field of practice. It outlines the Medical Board of Australia's progress, including commissioning research on options and community expectations and establishing expert advisory groups. Pilot models of revalidation will be tested from 2016-2017 before potential adoption and implementation in 2017-2018. Key challenges for Australia include that legislation currently mandates CPD not revalidation, determining the purpose of revalidation, and deciding on universal or risk-based approaches while considering feasibility, acceptability and cost.

How can ePortfolios contribute to the revalidation efforts and support the co...

This document discusses how ePortfolios can contribute to physician revalidation and support the continuing competence of the medical profession. It defines ePortfolios and different types, and explores how they can support learning, assessment, and the demonstration of continuing competence for revalidation purposes. Specifically, ePortfolios allow physicians to document professional learning and its impact on practice, align activities with competencies and scope of practice, and demonstrate the achievement of important education and clinical outcomes over time.

Value and Impact of CME Accreditationin the ACCME System

This document discusses the value and impact of continuing medical education (CME) accreditation through the Accreditation Council for Continuing Medical Education (ACCME) system. It provides an overview of the ACCME's mission to ensure CME is linked to quality/safety, improves practice, is independent of commercial bias, and is evidence-based. Statistics on accredited providers and CME activities are presented. The document also outlines accreditation requirements and challenges/opportunities in CME to engage health leaders, clinicians, learners, and demonstrate value to health systems.

Tests of Knowledge: How Can They Contribute to Maintenance of Certification ...

Tests of knowledge can contribute to maintenance of certification (MoC) and revalidation in two ways: assessment of learning and assessment for learning. Assessment of learning uses high-stakes knowledge tests summatively to identify doctors with performance problems, while assessment for learning takes a longitudinal approach through frequent, low-stakes tests to provide feedback and assist doctors in keeping knowledge up to date. There are challenges to the use of knowledge tests, such as determining relevant content and preventing tests from being seen as irrelevant facts, that different assessment approaches aim to address.

Multisource feedback & its utility

This document discusses multisource feedback (MSF) and its use in physician assessment and revalidation. It provides evidence from various studies that MSF can reliably and validly assess physician competencies. However, it also notes limitations in terms of its ability to consistently change physician behavior and the high costs associated with MSF programs. Overall, the document presents both sides of the debate around using MSF as an essential component of physician revalidation.

The outcomes & effectiveness of revalidation in New Zealand for non-certified...

This document discusses revalidation in New Zealand for non-certified general practitioners. It defines key terms and explains why revalidation was implemented, including ensuring doctor competence and standardizing continuing professional development. The revalidation program includes requirements like an e-portfolio, annual and triennial activities, and a Regular Practice Review involving practice visits. Early results found most doctors viewed the review positively and many reported immediate practice changes. Follow-up surveys found later participants saw greater benefits including improved patient care. As the program continues, results are expected to provide firmer conclusions about its effectiveness and value.

Outcomes/Effectiveness of revalidation in the UK