Liam Brennan Council member & revalidation lead Royal College of Anaesthetists
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Liam BrennanCouncil member & revalidation lead
Royal College of Anaesthetists
Revalidation for anaesthetists
Update - June 2012
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Introduction Appraisal for revalidation Timetable for revalidation & transitional arrangements Supporting information
CPD
Review of clinical outcomes
Patient & colleague feedback
Doctors in training Remediation Obtaining advice
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Why do we need Revalidation?
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Revalidation: is it really going to happen? Andrew Lansley’s letter to GMC, June 2010
• Full support for revalidation• Extend piloting for a further year
House of Commons Health Select Committee, Feb 2011• GMC required to ensure ‘no further delays to late 2012
implementation of revalidation’
House of Commons Health Select Committee, March 2012• ‘’In the light of the importance of this process to the quality of services
delivered to patients, and of the status of the GMC as an independent regulator, the Committee looks to the GMC to give early and public notice if it concludes that delivery of this timetable is at risk.”
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What is Revalidation?
It’s about providing assurance that all doctors with a GMC license are up to date and fit to practice
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What is Revalidation?
It’s about providing assurance that all doctors with a licence are up to date and fit to practice Based on continuing evaluation of current practice in
the context of everyday working environment Based on local systems of annual appraisal that are
based on the GMC core guidance Good Medical Practice* It is not a “point in time” assessment of knowledge &
skills
* http://www.gmc-uk.org/guidance/good_medical_practice.asp
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What is Revalidation?
It’s about providing assurance that all doctors with a licence are up to date and fit to practice Based on continuing evaluation of current practice
in the context of everyday working environment Based on local systems of annual appraisal that are
based on the GMC core guidance Good Medical Practice
It is not a “point in time” assessment of knowledge & skills
A five year process NOT a fifth year event !
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Appraisal/revalidation…..a continuing cycle
AppraisalAppraisal Appraisal Appraisal Appraisal Appraisal
Appraisal Appraisal Appraisal Appraisal Appraisal
One revalidation cycle
One revalidation cycle
Second revalidatio
n cycle
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Appraisal/revalidation…..a continuing cycle
AppraisalAppraisal Appraisal Appraisal Appraisal Appraisal
Appraisal Appraisal Appraisal Appraisal Appraisal
One revalidation cycle
One revalidation cycle
Second revalidatio
n cycle …..for each and all our professional lifetimes!
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GMC revalidation model
Portfolio of Supporting Information
Five x yearly appraisals
Responsible Officer
Failure to engageRequestdeferral
Employer liaison serviceSpecialty-specific advice
General Medical Council
Recommend revalidation
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What is appraisal?
“A professional process of constructive dialogue, in which the doctor being appraised has a formal structured opportunity to reflect on his/her work and consider how his/her effectiveness might be improved”
“A positive process to give someone feedback on their performance, to chart their continuing progress and to identify developmental needs. It is a forward looking process, essential for the development and educational planning needs of the individual”
DH December 2002
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Appraisal: for revalidation
Existing appraisal practice
Clinical and non-clinical aspects mapped to GMP
CPD reviewed against Core topics Job plan
Match job plan to Trust needs
Increased use of MSF
PDP taking account of the above
Appraisal for revalidation Clinical and non-clinical
mapped to four domains of GMP
Judgements on: Adequacy of supporting
information including: CPD Audit MSF
Clinical risks/safety Progress towards
revalidation Match job plan to Trust needs PDP taking account of the
above
Appraisal remains largely a formativeprocess but with summative components
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Revalidation: anticipated timetable
May/June 2012 Final organisational state of readiness assessment (ORSA)
Summer 2012 Assessment of readiness and business case prepared for Ministers
Sept/Oct 2012 Ministerial decision
By end of 2012 Enablement of necessary legislation
By 31 March 2013 All ROs to have revalidated
By 31 March 2014 ~20% of doctors to have revalidated
By 31 March 2016 The ‘vast majority’ of doctors to have revalidated
By 31 March 2018 All remaining doctors revalidated• Challenge of non-affiliated doctors• GMC ‘ making your connection’ campaign
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Transitional arrangements
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Specialty specific supporting information
www.rcoa.ac.uk/docs/Revalidation_doh_pilots.pdf
Final version publishedlate summer 2012
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Supporting informationGeneral information - providing context about what
you do in all aspects of your professional work Personal details Scope of whole practice (inc NHS, independent, voluntary)
Anaesthetic/ICM/pain medicine caseload data Data on complex procedures e.g. central access, regional blocks
Probity statement Personal declaration of disciplinary, criminal or regulatory sanctions Competing interests e.g. financial or other Any declarations of professional conduct/performance of others
Personal health declaration Self-declaration of health issues that could pose a risk to patients
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Supporting information
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Supporting information
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Continuing Professional Development (CPD)
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GMC principles of CPD • Responsibility for personal learning
Personal responsibility for identifying your CPD needs, planning how they should be addressed and undertaking CPD that will support professional development and practice
• ReflectionGood Medical Practice requires you to reflect regularly on your standards of medical practice
• Scope of practiceYou must remain competent and up-to-date in all areas of your practice
• Individual and team learningCPD activities should aim to maintain and improve the standards of your practice and teams in which you work
• Identification of needsCPD activities should be shaped by assessment of your professional needs and the needs of the service and the people who use it
• OutcomesYou must reflect on what you have learnt through your CPD and record any impact or expected impact on your performance and practice GMC Guidance on CPD (June 2012)
www. gmc-uk.org/education/continuing_professional_development.asp
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How much CPD is required?
Minimum of 50 credits per year; 250 credits in 5 year revalidation cycle is recommended
Internal Minimum 20 credits (NB at least 10 from local clinical governance
meetings) External
Minimum 20 credits
RCoA encourages wide range of CPD activities to reflect your whole practice
Full details of RCoA CPD guidance available at: http://www.rcoa.ac.uk/document-store/guidelines-continuing-
professional- development
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RCoA CPD matrix Resource to assist in planning CPD needs Regard as a menu rather than a tick box list
Level 1 Core knowledge expected of all who received their base
training as anaesthetists Easily achievable by review of clinical activity, local
meetings, e-learning; some topics included in mandatory training
Level 2 Knowledge & skills relevant to an anaesthetist’s whole
practice (inc on call, independent/voluntary practice) Achievable via local meetings, e-learning & some external
CPD activity Level 3
Knowledge & skills required for a ‘special interest’ area of practice*
Will rely heavily on external CPD activity Suggestions via relevant Faculty/specialist society
website*Special interest areas are as defined in advanced level CCT curriculum although other clinical & non-clinical areas may be suitable for Level 3 CPD
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CPD & appraisal
• Achievable amount of CPD from relevant matrix levels agreed at appraisal• Include CPD goals as part of PDP• Review evidence of completion at next appraisal & sign off
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RCoA Online CPD system
Users• Searchable database of
approved events• CPD diary & reflective review• Personal development plan• Breakdown of CPD credits• Integration to eLA• Depository for CPD certificates• End of year CPD activity report• Free to Fellows & Members
Providers• Submit applications for CPD
approval• Dedicated help line for
providers• Addition of event to database• Link to event website for more
information & booking• Learning outcomes review by
users
www.cpd.rcoa.ac.uk
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Clinical outcomes
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Review of clinical outcomes National
NAP projects ♯ NOF network Laparotomy network ICNARC
Local RCoA audit recipe book may be key (new edition published June 2012) One or two audits per year in each anaesthetic department Review areas of core clinical outcome e.g. post op pain relief, PONV,
line related sepsis, ICU readmission Benchmark personal practice against national/local standards whenever possible
New initiative - national ‘sprint’ audits
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Patient & colleague feedback
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Patient & colleague feedback
www.rcoa.ac.uk/docs/peer_patFeedback2011.pdf
• Patient & colleague MSF should be collected at least once in each revalidation cycle• Several validated MSF tools • GMC,RCoA & FICM guidance available
wwwgmcuk.org/doctors/revalidation/colleaguepatient_feedback_resources.asp
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Patient & colleague feedback
www.rcoa.ac.uk/docs/REV-Statement-03.02.12.pdf
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Patient & colleague feedback GMC commissioned survey for feedback showed:
Colleague MSF straightforward 75% >14 questionnaires
Patient feedback more difficult for perioperative anaesthetist 51% >21 questionnaires Difficulties with timing, distribution & collection of patient feedback
Further work by RCoA with patient groups to consider:
Logistical difficulties of patient MSF Quality of care
Despite difficulties RCoA recommend engaging with patient MSF
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Doctors in training
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Doctors in training
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Remediation
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Remediation
Revalidation likely to identify increased numbers of doctors with fitness to practice issues
~ 1000 remediation cases in progress in England
2,800 (~2%) of all doctors in England subjected to investigation annually
Remediation provision will need to be enhanced & increased
DH report on remediation published Dec 2011
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Remediation: what is meant?
‘The overall process agreed with the practitioner to redress identified aspects of underperformance. Remediation is a broad concept varying from informal agreements to carrying out some re-skilling, to more formal programmes including supervised remediation and/or rehabilitation.’
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Remediation: DH report 2011
Highlights lack of: consistency in how organisations tackle doctors with
performance issues clarity about where a PDP stops and remediation starts clarity as to who has responsibility for the remediation
process clarity on what constitutes acceptable clinical
competence and capability clarity about when the remediation process is complete
and successful clarity about when the doctor’s clinical capability is not
remediable capacity to deal with the remediation process
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Remediation: DH report
Key recommendations: Wherever possible, performance problems including clinical
competence and capability issues, should be managed locally
Local processes need to be strengthened to try and avoid performance problems occurring and reduce their severity at the point of identification
The capacity of staff within organisations to deal with performance concerns needs to be increased with access to external expertise as required
A single organisation is required to advise and, when necessary, to co-ordinate the remediation process and case management so as to improve consistency across the service
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Remediation: DH report
Key recommendations (cont’d): The medical royal colleges should produce guidance and
also provide assessment and specialist input into remediation programmes
Postgraduate deaneries and all those involved in training and assessment need to assure their assessment processes so that any problems arising during training are fully addressed
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Remediation: Clinical Directors view
Much should be managed locally College should be involved
‘A supportive rather than driving role’ Setting standards - consistency Providing advice on assessment and processes Help make it happen
Concerns about funding of remediation programmes
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Remediation: Regional advisors view
College should be involved in: Setting standards and establishing framework Assessment: both advice and doing Helping make it happen – organise external
placements Training for specialty needs
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Remediation: General consensus
Preferable to identify performance concerns early Ensure robust local appraisal and clinical
governance processes are in place Act on information obtained Majority of issues should be manageable locally
Work with national organisations e.g. NCAS Work with Academy of Medical Royal
Colleges to produce consistent approach across the profession
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Obtaining information & advice
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Sources of information & advice
GMC website
http://www.gmc-uk.org/doctors/revalidation.asp
RCoA & FICM website
http://www.rcoa.ac.uk/revalidation-cpd
http://www.ficm.ac.uk/cpd-and-revalidation
RCoA Bulletin articles
http://www.rcoa.ac.uk/bulletin
Specialty advisors
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Revalidation specialty advice
• Common model for delivery of specialty advice agreed by AoMRC• Central contact point for all specialty advice via the College:
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Revalidation specialty advice