Revalidation Doctor General practitioner

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Revalidation should be evidence-based

Rigorous evidence-based approach used to create multi-source feedback questionnaires.

The BMA and the GMC have always been keen to ensure that revalidation, like medicine, is evidence-based.

There has been extensive consultation on, and piloting of, the ways in which revalidation might work in practice, identifying the challenges that particular groups of doctors might face and helping organisations prepare for the process. Significant changes have been made to the process as a result.

In-depth testing of the GMC's MSF (multi-source feedback) questionnaires for colleagues and patients has been carried out over a number of years by a revalidation research team at Peninsula medical school, led by clinical senior lecturer in clinical education Julian Archer.

GMC chief executive Niall Dickson explains: 'All research, testing and piloting has been carried out to make sure our proposals for revalidation work in practice, and that the process is simple and straightforward for doctors.

'Looking forward, we do want to evaluate the impact of revalidation and to learn lessons as it rolls out. It will not be perfect and there are bound to be glitches in a programme of this size, but with goodwill the medical profession and the UK health system will have created an assurance system that can be developed and improved over the years.'

If revalidation goes ahead, doctors will be expected to demonstrate they have sought feedback from patients and colleagues at least once in each five-year revalidation cycle.

Peninsula professor of general practice and primary care John Campbell was behind the questionnaire testing programme, which enlisted the help of 1,450 doctors, 44,000 patients and 21,000 colleagues.


Feedback requirements

He concludes the questionnaires for colleagues and patients are robust enough to use for MSF more widely in the NHS, could feed into revalidation and have 'strong formative potential'. The research summary suggests the questionnaires could provide the basis of a useful screening process, which could alert doctors to areas in which remedial action might be taken.

Professor Campbell also suggests that for optimum results, a doctor needs feedback from a minimum of 34 patients and 15 medical and non-medical colleagues.

Doctors' leaders raised concerns about the practicalities of this, particularly for GPs working in small or single-handed practices but, according to Professor Campbell, his research suggest these worries are unfounded.

His summary says: 'Participant doctors from small practices recruited broadly similar numbers of patients and colleagues as doctors from larger practices.'


Research continues

The Peninsula research also identifies that some doctors are more likely to receive more favourable feedback than others. This may depend on factors including which country doctors undertook their medical training, or the characteristics of the patients or colleagues providing the feedback.

This was taken into account by the GMC in its guidance on developing and administering the questionnaires, published in April.

Dr Archer has recently been awarded a National Institute for Health Research career development fellowship to help him continue his work.

The awards are made to those who 'provide evidence of a clear commitment to a research career and success in the form of significant outputs from doctoral and post-doctoral research'.

The fellowship will fund Dr Archer's work for five years, specifically research exploring the impact of revalidation on doctors and the public.