Implementation of an agreed system of revalidation for doctors, informed by face-to-face colleague appraisal is planned for implementation by the GMC later this year.
However, the Dundee researchers say that a newly published research study suggests that this could be made more robust if a level of anonymous assessment were introduced. In this study outcomes were informed by a system based on professionals’ ‘insightful practice’, which measured doctors’ appropriate response to independent feedback. The study found face-to-face assessment of general practitioners’ ‘insightful practice’ to be unreliable, but assessment by colleagues blinded to the identity of the doctor proved reliable in discriminating between doctors’.
“Understandably, the public and Government want clinically effective, safe and person-centred care delivered by competent and, ideally, excellent doctors,” said Dr Douglas Murphy, Senior Clinical Research Fellow with the Quality, Safety and Informatics Research Group at University of Dundee Medical School.
“The question of revalidation of practising doctors is something which has prompted worldwide interest and remains a high-stakes challenge. Our research has shown that insightful practice, a system which makes use of anonymous assessment involving a panel of experts, offers a promising and innovative new platform to improve on the validity and reliability of what is currently proposed for revalidation.
“This system would significantly help keep our doctors’ professionalism `on-track’ and aid their professional development. This is about quality assurance and giving the profession and the public a system in which they can have confidence.”
Dr Murphy and a team at Dundee carried out a study involving 60 general practitioners and 12 GP appraisers in the Tayside region. The results are published in the journal BMJ Quality & Safety.
For each GP a suite of data was collected including colleague opinion, patient opinion, clinical governance feedback (e.g. prescribing safety measures), patient complaints and a self-evaluated knowledge test. The data was reflected on by GPs and their engagement, insight into the data and levels of appropriate action or ‘insightful practice’ assessed subsequently by their face-to-face appraiser and then by an anonymous three-person panel. GPs were supported in their reflection by their face-to-face appraiser, a GP appointed colleague as used by the current appraisal system.
“Face-to-face appraisal serves an important purpose.” said Dr Murphy. “Our study found that the face-to-face appraisers’ role can be important as coach, educational advocate or supporter. However, our findings also suggest that a single face-to-face appraiser is unlikely to be able to make a valid or reliable judgement about fitness for revalidation. This suggests the role for the appraiser within revalidation which is currently proposed by the GMC may not be able to reconcile the twin aims of encouragement and identifying significant concerns. This study found anonymous measurement of insightful practice by external peers offers additional value that potentially could be developed and implemented with more accurate and trustworthy revalidation decisions as a result.”
“A significant challenge for revalidation is finding a system which benefits all doctors by helping them keep their professionalism on track throughout their career, while still identifying those at risk of poor performance. If adopted, this system of insightful practice could possibly meet this challenge by early and reliable identification of doctors’ level of, and progress with, improvements in care, as well as allowing the monitoring of progress towards satisfactory revalidation.”
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