Research highlights – 4 November 2011

Research questions“Research highlights” is a weekly round-up of research papers appearing in the print BMJ. We start off with this week’s research questions, before providing more detail on some individual research papers and accompanying articles.

Variability in the assessment of UK doctors’ professionalism
Revalidation—the process by which doctors licensed in the UK will have to show that they are up to date and fit to practise—will be rolled out early next year. Interviewed recently by Helen Jacques for BMJ Careers, Niall Dickson, chief executive of the General Medical Council, said, “I hope that it will encourage and support self reflection and reflection within teams, on ‘how well are we doing,’ ‘what are the data around our practice,’ and so on.”

Assessment using 360 degree feedback as part of annual appraisal and performance review is standard practice in many careers, but in medicine the proposed introduction of such multisource feedback has proved highly controversial. In business, doing badly in such assessments might mean you lose your annual bonus or even your job; in medicine, it could lead to a doctor’s being struck from the medical register. Mr Dickson sees annual appraisal, however, more as a way to “identify and support struggling doctors earlier, before things get to the point where they might need to be referred to a fitness to practise panel.”

The tools for appraising doctors have been scrutinised closely to see if they are valid, reliable, and fair, and much of that research has been conducted by John Campbell and colleagues from Exeter. Now the team has used statistical modelling to look for systematic biases related to the characteristics of the patients and colleagues assessing doctors, or of the doctors themselves. More than 1000 non-training grade doctors from 11 clinical settings in England and Wales took part, and they were assessed by around 17, 000 of their colleagues and 30, 000 of their patients. The study did find some possible systematic biases, and although the low participation rate among doctors (43%) and the lack of a gold standard hampered interpretation of the findings, the authors advise caution when using such a tool.

They “advise careful consideration of the evidence which doctors might submit relating to their professionalism, and caution in developing judicious and appropriate responses to evidence which suggest a doctor’s performance to be unusual. Use of multisource feedback to support revalidation should at least initially be largely formative in nature and intent, and undertaken within the context of strengthened systems of appraisal.”

To hear more about the research and revalidation, listen to an interview with Campbell at

Mobile phones and risk of brain tumours
It’s good to see Patrizia Frei and colleagues’ report of updated results from a nationwide Danish cohort study finding no increased risks of tumours of the central nervous system associated with mobile phone use. The authors linked adults who had subscribed to mobile phone contracts with tumours of the central nervous system recorded in the Danish Cancer Register, and even among those with the longest mobile phone use (≥13 years’ subscription) there was no hint of increased incidence of tumours.

The authors admit the study has limitations, such as using mobile subscription as a proxy for mobile phone use and no individual information on the amount of phone use (and the forceful manner in which these weaknesses are reiterated in some online responses to the full paper suggests the subject is still emotionally charged).  However, the study also has some very important strengths—avoiding the problems of non-response and selection bias and of recall bias that have bedevilled other studies.

In their linked editorial, Anders Ahlbom and Maria Feychting set the results in the context of previous studies on mobile phones and cancer and are largely reassured. They conclude: “Continued monitoring of health registers and prospective cohorts is warranted, but more case-control or other studies with built in selection and recall bias are not needed.”

Comprehensive geriatric assessment for older adults admitted to hospital
Graham Ellis and colleagues’ meta-analysis concluded that comprehensive assessment for older people admitted to hospital as an emergency meant patients were more likely to return home and less likely to die or be admitted to residential care.

Receptionist input to quality and safety in repeat prescribing in UK general practice
Reception and administrative staff make important “hidden” contributions to repeat prescribing in general practice, according to a case study of urban UK practices by Deborah Swinglehurst and colleagues.