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

Project delivery

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 consistentlyachieved?

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?

Purpose of the evaluation

Seven work packages• Research organised into seven work packages, by

methods:

1. Literature reviews2. Secondary analysis of existing data3. National and strategic surveys4. Appraisal capture5. Interviews with stakeholders6. Documentary analysis7. 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

• Doctorso Appraiseeso Appraiserso ROs

• Patient interest groups

WP 4: Appraisal capture

• Audio-recording 90 appraisals a year for 2 years

o Flexible approach to captureo Thematic analysiso Mapping analysis to the framework centrallyo 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 reviews2. Secondary analysis of existing data3. National and strategic surveys4. Appraisal capture5. Interviews with stakeholders6. Documentary analysis7. 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

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