Revalidation – Last Chance for Professionalism
Professor Chris Dodds, Middlesborough
The evening was introduced by Dr Bill Taylor, the current President of the Liverpool Medical Institution, who welcomed everyone to the joint meeting. He handed over to Professor Hunter who introduced the speaker, Professor Chris Dodds, immediate past Vice-President of The Royal College of Anaesthetists, who had travelled from Middlesbrough.
Professor Dodds started his talk by comparing the hype of revalidation to that of the millennium bug at the turn of the century. But, like the millennium bug, revalidation would be accepted as a necessary part of medical practice and not the catastrophe as to which many had labelled it. He talked about the three players in the process. First, there is the GMC which maintains the register, is the only body able to reissue a license to practise and sets the standards and regulations. Second, there is the Department of Health which is the legislative authority. Finally, a responsible officer at Trust level, usually the medical director, who is largely responsible for clinical governance and also makes recommendations to the GMC. He thought that the process of revalidation should be straight forward, robust, equitable across all disciplines in medicine and deliverable in the whole of the UK. Revalidation would strengthen the appraisal process and make the annual CPD review more relevant to the appraisee’s practice. It would also bring in multi-source feedback for all doctors which is already practiced in a few trusts.
Next Professor Dodds went on to speak specifically about revalidation for anaesthetists. He started by looking at CPD. Specialist societies had been consulted in 2008 on the range and levels of CPD that they thought were necessary for practising anaesthetists. A college working party had then refined a draft CPD matrix with a final version available on the RCA website in October 2009. The matrix had three levels, core, higher and advanced. The core part was knowledge based and essential and would be a requirement for all practising anaesthetists to cover in spite of the fact they may have no regular exposure to a particular area of practice. Higher level CPD would be directly related to on-call activity but not in regular job plan service delivery. Finally the advanced level would be directly related to job planned activity and would demonstrate expertise and state of the art skills and knowledge. It would demonstrate an ability to support consultant colleagues with their most complex cases in this specific area. This level of CPD would usually be accessible from specialist society meetings. Professor Dodds then gave an example of the matrix. It would still require 50 points a year. He gave two examples of where anaesthetists had had to deal with particular areas to which they had had no exposure since their days of training. These were both at Great Ormond Street Hospital where a mother had gone into labour and delivered at the hospital and then the 7th July bombings where the nearest hospital had been Great Ormond Street which had taken a significant number of casualties. Doctors will have to archive their CPD data from 2005 against the matrix. Most will have certificates of attendance but no identifiable content of meetings attended. There will soon be an electronic system for the logging of CPD as well as a new approval process for providers of CPD.
Professor Dodds then looked at the appraisal process which he said should be robust, challenging and uniform across the UK. The gold standard for an appraisal should be one performed by someone from their own speciality and this would be mapped against the new GMC good medical practice domains. The four domains included knowledge, skills and performance; safety and quality; communication, partnership and team work and finally maintaining trust. Professor Dodds then looked at ways of providing evidence for each domain. In particular the RCA had recently published a document defining the current specialty specific standards for anaesthesia which will be used by the GMC when assessing an anaesthetist revalidation. There was currently a pilot programme which would shortly be reviewed prior to the proposed wider implementation.
Professor Dodds spoke about multi-source feedback which will be mapped to generic standards. Patient feedback was still at a pilot stage for anaesthesia and would not be required at present.
Professor Dodds then looked at what individuals should start to do. Firstly, appraisal documentation should be in good order along with CPD certificates with content of meetings attended. CPD should be summarised against the matrix and topics should be identified that need to be reviewed as part of future CPD activity.
Professor Dodds finished his talk and took some questions from the floor. Firstly, Professor Hunter commented that her perception that revalidation would mean a huge amount of additional work for individuals and departments. Professor Dodds thought that individuals would only require 20% more time for this new system although delivering multi-source feedback may in some circumstances be considerably more time consuming. Sean Tighe then asked about the cost benefit ratio of this time consuming process where only 0.2% of practising doctors may be identified as being substandard. Professor Dodds said that this was less to do with the identification of bad doctors but was essentially aimed at reassuring the general public that doctors were practising to a high standard. It was also the last chance for doctors to be self-regulated and therefore to protect their professionalism. It also put CPD at the heart of revalidation because without this, there would be great pressure for doctors to organise and pay for their own CPD. This process will be very difficult for locums and practitioners working exclusively in the private sector. James Crook asked whether it just would be simpler to have an exam every 5 years? Professor Dodds answered that this had been trialled in the United States and found to be expensive, far too general and consequently useless in ensuring a high standard of practice. Ann Holden asked whether trainees would have to undergo a similar system. Professor Dodds said firstly that trainees were not on the specialist register and an annual ARCP would be seen as their revalidation event. Bruce Neary asked why patient feedback was not required for revalidation for anaesthetists? Professor Dodds said that patient feedback information had not yet been validated. However, in the future this may change and become part of the revalidation process.
Dr Claire Howard, Clinical Director at University Hospital Aintree and Lead Clinical for Revalidation at that hospital gave the vote of thanks and the meeting finished at 20.15.