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Vijaya Nath: Medical revalidation: trauma, trivia, triumph

17 Mar, 14 | by BMJ

The United Kingdom is the first country in the world to introduce the mandatory revalidation of its medical workforce. How does this process feel for those engaged in it?

The King’s Fund have been exploring this question with doctors on development programmes, in masterclass events, and in a recent qualitative study and have found some variation in the answer.

For The King’s Fund’s most recent report, published last week, we focused on the views of doctors. Perhaps unsurprisingly, discussion of revalidation reflected the “trauma” associated with a major change including significant fear and anxiety. They expressed anxiety about issues such as the number of hours the documentation took to prepare, with one doctor stating that they “felt guilty, felt like a poor parent/partner as four weekends in one month have been spent on writing up reflective practice for all of the continuous professional development (CPD) events they had attended.” Some—particularly locum doctors—expressed concern that they were often not accorded time to take revalidation seriously and others felt that obtaining peer and patient feedback was not actively encouraged, and that the process of gathering this feedback needed improvement.

Some perceived a high level of “trivia” related to the number of statutory/mandatory activities involved in revalidation, which were felt to detract from activities such as quality improvement on which they would prefer to focus.

Conversely the process has revealed some “triumphs.” Some doctors believed that reflective practice had received increased attention and that the requirement to demonstrate attention to CPD had led to more doctors participating in online and distance learning programmes, which in turn was encouraging them to scrutinise options when diagnosing rare conditions.

Other triumphs noted included the establishment of the responsible officer role (doctors appointed to make recommendations to the General Medical Council about doctors’ fitness to practice) and the development of doctors as appraisers—”the creation of a culture where doctors are investing in continued medical education and reflection, and that this would have a positive impact on patient care.”

In relation to the wider culture of care, some doctors reported a shift in behaviour to awareness of patient feedback gathered through the revalidation process.

Our view is that medical revalidation with the right conditions can be a valuable driver of behaviours and cultures that nurture and support sustained quality improvement. What is required now is for leaders to step up and co create with doctors the processes and measures of success that will be valued by all including patients.

The skills and behaviours that we see being called for from doctors undertaking revalidation include—but are not limited to—understanding the genuine fears that it has raised for certain groups who are looking to comply and who are genuinely worried about “gathering the evidence.” We believe that employing organisations (designated bodies) need to appraise and review their own strategies and plans for implementing revalidation and to demonstrate a willingness to listen to and consult with doctors. They should also be open to receiving feedback on what went well during the first cycle of revalidation and what could be done to make it better. They could model leadership of change by assimilating feedback gathered by the responsible officers and other parties and making minor amendments where necessary. Investment in appropriate development for doctors and everyone involved in delivering care—especially those that relate to enabling the creation of compassionate and safe cultures in which high quality care is a priority for all—will enable revalidation to move from a tick box exercise to part of longer term quality improvement and better patient outcomes.

As we stated in the paper, what matters most is what individual doctors are motivated to do when no one is watching. We need to demonstrate trust in our medical professionals and encourage them to raise the bar on demonstrating, setting, and delivering a quality service to patients.

Vijaya Nath is assistant director, Leadership at the King’s Fund.

This blog also appears on the King’s Fund website at http://www.kingsfund.org.uk/blog/

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