Medical revalidation: trauma, trivia, triumph

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?

We 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 our most recent report, published today, 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.

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Comments

#41798 Nick Lynn
Research Fellow
CAMERA Plymouth University Peninsula Schools of Medicine & Dentistry

Yep, the 'when no one is watching' bit is at the heart of it I think. Nice piece.
Nick

#41800 Vijaya Nath
Assistant Director
The King's Fund

Thank you for leaving this feedback , Becky , Mandip & I were motivated to include this as one of the main areas in which leaders at all levels individual, designated bodies, Royal Colleges, FMLM ,GMC,HEE have responsibility for addressing .The hallmark of great professionals is what they are motivated to do when the spotlight is not in them.

#41807 Dr Alfa Sa'adu
Medical Director
Ealing Hospital NHS Trust

Vijaya,
Keep up the good work! The feedback from doctors about their experience of Medical Revalidation is one that is really important if we are to get the most out of the process, not only for doctor, but also for patient, their friends and relatives!
Alfa.

#41808 Ieuan Ellis

"What matters most is what Drs are motivated to do when no one is watching". ... Is the re-validation process driving behavioural change in current practices of CPD through promoting reflective practice and / or by forcing compliance to record and evidence CPD. Or is it simply capturing current good CPD Practices ?

#41809 David Bell
Transition Director of HR
NHS England

This is a really valuable report with a lot of very useful insights, so thank you very much, Vijaya. It has many implications for other professional groups, such as nurses and midwives, as similar arrangements for revalidation are being developed. It also stresses the crucial role of listening to the workforce and responding to issues raised when new initiatives are being implemented and of senior leaders and HR practitioners in making revalidation of real benefit to patients and clinicians.

#41811 Stephen Webb
Papworth Hospital Cambridge

As both appraiser and appraisee, the 3Ts have all been evident in my own experience. Certainly the requirement to produce 'supporting evidence' for clinical effectiveness, clinical audit, CPD, and patient experience has actually become an opportunity to really focus on these areas, both personally and through encouraging colleagues to do so. Revalidation is well and truly up and running - in a few years time we may reap the benefits of a more effective, more reflective and more patient-centred medical workforce.

#41815 Vijaya Nath
Assistant Director
The King's Fund

Doctors participating in evaluating the process early on and input into making it more meaningful is vital. We hope our paper is useful in stimulating improvement to the existent process and for improving communication and leadership needed to make change happen.

#41816 Vijaya Nath
Assistant Director
The King's Fund

Leuan, your questions are central to current snapshot, if we want Revalidation to gain commitment from those it has been set up to evaluate , then we need to make it possible to encourage behaviour change where needed / reinforce great practise as appropriate.

#41817 Vijaya Nath
Assistant Director
The King's Fund

Change processes like these across professions require great HR professional support and sponsorship if they are to succeed . Thank you David for taking the time to read the report and for noticing the valuable contribution that HR professionals can make especially in encouraging and directing leaders to listen to how the process is for those on the receiving end as opposed to' the theory of how it should work'.

#41818 Vijaya Nath
Assistant Director
The King's Fund

Stephen the three T's are a good vehicle for measuring where we get to with Revalidation within our own organisations /designated bodies .
As a leader knowing what impact the process has is critical, revalidation as you say' is up and running' it is up to Drs and others to communicate on what is working well and what will enable the process to deliver a more patient centred medical workforce, and to make the change. Thank you for commenting.

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