Revalidation, Relicensing, Revalidation, Relicensing, RecertificationRecertification

The KnowledgeThe Knowledge

ObjectivesObjectives

Discuss continuing professional Discuss continuing professional development (CPD)development (CPD)

Know some useful educational theoryKnow some useful educational theory Understand Revalidation, Understand Revalidation,

Relicensure, RecertificationRelicensure, Recertification Know your learning styleKnow your learning style Discuss RCGP proposalsDiscuss RCGP proposals What you need to do now you’re on What you need to do now you’re on

your own!your own!

Relicensing, Recertification, Relicensing, Recertification, RevalidationRevalidation

The 3 R’sThe 3 R’s

RelicensureRelicensure via GMC for all practicing via GMC for all practicing doctorsdoctors

RecertificationRecertification by relevant royal college by relevant royal college Both processes done simultaneously every Both processes done simultaneously every

5 years. 5 years.

If successful = If successful =

Revalidation!Revalidation! simplessimples

How do I get there?How do I get there?

Reflect and improve and Reflect and improve and record!record!

Now for some background…Now for some background…

What is CPD?What is CPD?

CPDCPD

GMC:GMC:

““A A continuous learning processcontinuous learning process that complements formal that complements formal undergraduate and postgraduate undergraduate and postgraduate education and training. CPD requires education and training. CPD requires doctors to doctors to maintain and improvemaintain and improve their standards across all areas of their standards across all areas of practice.”practice.”

Why is it important?Why is it important?

Individual:Individual: job satisfaction, job satisfaction, decreased burnout, develop PDP, decreased burnout, develop PDP, revalidationrevalidation

Patient:Patient: trust, increased Dr trust, increased Dr knowledge, ?better Rxknowledge, ?better Rx

Profession:Profession: trust trust Society:Society: Changes to medical Changes to medical

regulation, rapid increase in medical regulation, rapid increase in medical knowledge, Janet Smith inquiryknowledge, Janet Smith inquiry

How do I do it?How do I do it?

You probably are!You probably are!1.1. Choosing what to learn (Educational Choosing what to learn (Educational

needs assessment)needs assessment)2.2. Choosing how we learn (Learning Styles)Choosing how we learn (Learning Styles)3.3. Time to think about what you learned Time to think about what you learned

(Reflection)(Reflection)4.4. Making the learning work (Application)Making the learning work (Application)5.5. Studying the effects of what we have Studying the effects of what we have

learned (Evaluation)learned (Evaluation)(Write it down!)(Write it down!)

Educational Needs AssessmentEducational Needs Assessment

Educational Needs AssessmentEducational Needs Assessment

We tend to focus on comfortable, We tend to focus on comfortable, familiar, fun topicsfamiliar, fun topics

BUT, knowledge gaps lay hiddenBUT, knowledge gaps lay hidden Johari’s windowJohari’s window Identify using various techniques: Identify using various techniques:

PUNS, questionnaires, talking, PUNS, questionnaires, talking, feedback, MCQs, Audit, guidelines feedback, MCQs, Audit, guidelines etc. etc.

Doing the LearningDoing the Learning

What skill / knowledge do I want to What skill / knowledge do I want to have after the activity?have after the activity?

SMARTERSMARTER objectives objectives Learning Styles (Honey and Learning Styles (Honey and

Mumford)Mumford)• ActivistActivist• ReflectorReflector• TheoristTheorist• PragmatistPragmatist

Prioritising LearningPrioritising Learning

Most Impact – personal/patientsMost Impact – personal/patients Urgency – clinical, time, resourceUrgency – clinical, time, resource Team needsTeam needs National / local importanceNational / local importance Own desires (care!)Own desires (care!) Easiest – time, travelEasiest – time, travel Least resourcesLeast resources Which fits best with PDP?Which fits best with PDP?

EvaluationEvaluation

Kirkpatrick’s Hierarchy of Kirkpatrick’s Hierarchy of evaluation:evaluation:

1.1. Own sense of achievementOwn sense of achievement

2.2. You actually learned something!You actually learned something!

3.3. Your behaviour changed and you Your behaviour changed and you use the learninguse the learning

4.4. Your patients have benefitted from Your patients have benefitted from your learningyour learning

The Cycle of LearningThe Cycle of Learning

Honey and Mumford’s Honey and Mumford’s learning cycle and learning cycle and

learning styleslearning styles

(Honey and Mumford, 1992)

Learning Style TypesLearning Style Types

What is the “normal”What is the “normal”

-30

-25

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-15

-10

-5

0

5

10

15

20

25

30

-30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30

REFLECTOR

PRAGMATIST

ACTIVIST THEORIST

Reflector TheoristReflector Theorist

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-15

-10

-5

0

5

10

15

20

25

30

-30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30

REFLECTOR

PRAGMATIST

ACTIVIST THEORIST

Reflector - TheoristReflector - Theorist

Commonest variant styleCommonest variant style ““Analysis to paralysis”Analysis to paralysis”

Activist - PragmatistActivist - Pragmatist

-30

-25

-20

-15

-10

-5

0

5

10

15

20

25

30

-30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30

REFLECTOR

PRAGMATIST

ACTIVIST THEORIST

Activist - PragmatistActivist - Pragmatist

2nd commonest variant style2nd commonest variant style but they do things too quickly!!!but they do things too quickly!!!

Activist - TheoristActivist - Theorist

-30

-25

-20

-15

-10

-5

0

5

10

15

20

25

30

-30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30

REFLECTOR

PRAGMATIST

ACTIVIST THEORIST

Activist - TheoristActivist - Theorist

Not a common styleNot a common style jump to conclusionsjump to conclusions

Activist - ReflectorActivist - Reflector

-30

-25

-20

-15

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-5

0

5

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15

20

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-30 -25 -20 -15 -10 -5 0 5 10 15 20 25 30

REFLECTOR

PRAGMATIST

ACTIVIST THEORIST

Activist - ReflectorActivist - Reflector

uncommonuncommon But depending on the proportions, But depending on the proportions,

have the ability to reflect before have the ability to reflect before they act = a good thingthey act = a good thing

The Knowledge Part 2The Knowledge Part 2

Appraisal NowAppraisal Now Started April 2003, all GPs appraised yearlyStarted April 2003, all GPs appraised yearly Formative processFormative process Mixed responses from GPs, depends on areaMixed responses from GPs, depends on area Aim to discuss previous year and plan learning Aim to discuss previous year and plan learning

objectives for the nextobjectives for the next Produce PDP at end of the processProduce PDP at end of the process Review each PDP at next appraisalReview each PDP at next appraisal You can choose appraiser from a listYou can choose appraiser from a list Documents in 2 weeks prior to appraisalDocuments in 2 weeks prior to appraisal Meet and discuss for 2-3 hoursMeet and discuss for 2-3 hours Post appraisal documents to be signed offPost appraisal documents to be signed off Paid full day if a locum by PCTPaid full day if a locum by PCT

The Near Future…The Near Future…

RevalidationRevalidation

= The process by which a regulated = The process by which a regulated professional periodically has to professional periodically has to demonstrate their fitness to practicedemonstrate their fitness to practice

Professional regulation is all about Professional regulation is all about patient safetypatient safety

Three purposes of Three purposes of revalidation?revalidation?

Purposes of RevalidationPurposes of Revalidation

Minimally acceptable careMinimally acceptable care Reassure patients and the publicReassure patients and the public Improve quality of careImprove quality of care

RevalidationRevalidation

MORI survey 2005: half thought MORI survey 2005: half thought regular assessments already!regular assessments already!

Much delayed; 2005 proposed – now Much delayed; 2005 proposed – now due launch April 2011!due launch April 2011!

20% Drs revalidated each year, five 20% Drs revalidated each year, five year cycle per Dryear cycle per Dr

Some revalidated on 1 years work Some revalidated on 1 years work initiallyinitially

Why now?Why now?

Good Doctors, Safer Patients, CMO Good Doctors, Safer Patients, CMO 20062006

Dame Janet Smith report - ShipmanDame Janet Smith report - Shipman Public pressurePublic pressure International examples USA, NZ, OzInternational examples USA, NZ, Oz Revalidation for every health Revalidation for every health

professional proposedprofessional proposed

RelicensureRelicensure License issued every 5 years by GMCLicense issued every 5 years by GMC You should be registered now! Starts officially You should be registered now! Starts officially

16/11/0916/11/09 Standards for relicensing based strongly on Good Standards for relicensing based strongly on Good

Medical PracticeMedical Practice New GP version of GMP out (July 2008) – new New GP version of GMP out (July 2008) – new

focus on CPDfocus on CPD Relicensure will only be problematic if fitness to Relicensure will only be problematic if fitness to

practice concernspractice concerns Local GMC affiliates and “responsible officers” Local GMC affiliates and “responsible officers”

can raise concernscan raise concerns Mostly seems a paper exercise if no concernsMostly seems a paper exercise if no concerns

RecertificationRecertification

Every 5 yearsEvery 5 years For all on any specialist registerFor all on any specialist register Run by relevant CollegeRun by relevant College Based on standards in GMPBased on standards in GMP Each college has different CPD plans Each college has different CPD plans

and requirementsand requirements Annual appraisal forms bulk of Annual appraisal forms bulk of

evidenceevidence

RevalidationRevalidation Satisfactory recertification and relicensure Satisfactory recertification and relicensure

= = RevalidationRevalidation - simples! - simples! UnsatisfactoryUnsatisfactory

• Appraisal feedbackAppraisal feedback• PCO Responsible officer PCO Responsible officer • Local group (RO, College member, layperson)Local group (RO, College member, layperson)• National Adjudication PanelNational Adjudication Panel• GMC affiliatesGMC affiliates• National Clinical Assessment ServiceNational Clinical Assessment Service• GMC fitness to practice proceduresGMC fitness to practice procedures• Council for Healthcare and Regulatory Council for Healthcare and Regulatory

ExcellenceExcellence

RCGP Proposals for GPsRCGP Proposals for GPs

From Revalidation for GPs v3From Revalidation for GPs v3 Pilots 2009/10 MerseysidePilots 2009/10 Merseyside Enhanced AppraisalEnhanced Appraisal will form basis will form basis Collect evidence across 12 GMC Collect evidence across 12 GMC

attributesattributes Greater role for appraisers in Greater role for appraisers in

validating supporting documentsvalidating supporting documents Additional compulsory elements e.g. Additional compulsory elements e.g.

SEA, MSF, Complaints, AuditSEA, MSF, Complaints, Audit

DocumentationDocumentation

ePortfolio for GPs!ePortfolio for GPs! Currently annual Currently annual

appraisals/PDPs appraisals/PDPs form evidenceform evidence

GMP for GP’s will GMP for GP’s will form standards – form standards – exemplary Vs exemplary Vs UnacceptableUnacceptable

Revalidation PortfolioRevalidation Portfolio

1.1. Basic detailsBasic details2.2. Exceptional CircumstancesExceptional Circumstances3.3. Evidence of appraisalsEvidence of appraisals4.4. PDP’s from each appraisalPDP’s from each appraisal5.5. Review of PDP and reflectionReview of PDP and reflection6.6. Learning credits Learning credits 7.7. MSFMSF8.8. Feedback from patientsFeedback from patients

Revalidation PortfolioRevalidation Portfolio

9.9. Causes for concern / complaintsCauses for concern / complaints

10.10. SEASEA

11.11. AuditsAudits

12.12. Statement on probity and healthStatement on probity and health

13.13. Evidence from extended practiceEvidence from extended practice

RCGP Learning creditsRCGP Learning credits

RCGP managed CPD schemeRCGP managed CPD scheme Members free, non members chargedMembers free, non members charged Credit system for CPDCredit system for CPD Scored by time and impactScored by time and impact Double credits if followed learning cycleDouble credits if followed learning cycle Includes reflections/reading etcIncludes reflections/reading etc 250 credits needed over 5 years 250 credits needed over 5 years

for recertificationfor recertification

Essential Knowledge UpdatesEssential Knowledge Updates

Knowledge updates for credits Knowledge updates for credits released every 6 months by RCGPreleased every 6 months by RCGP

Linked essential knowledge Linked essential knowledge challenge, voluntary, 70% pass ratechallenge, voluntary, 70% pass rate

Online nowOnline now Based on curriculum for GP and Based on curriculum for GP and

latest developmentslatest developments

Role of AppraiserRole of Appraiser

Effective delivery of appraisalEffective delivery of appraisal Maintenance of standardsMaintenance of standards Develop and analyse PDPsDevelop and analyse PDPs Validation of creditsValidation of credits Feedback on MSFFeedback on MSF Feedback concerns to GP and RO if Feedback concerns to GP and RO if

neededneeded

Role of Responsible OfficerRole of Responsible Officer Senior doctor in healthcare organisation e.g. Medical DirectorSenior doctor in healthcare organisation e.g. Medical Director Advised by GP assessor and lay personAdvised by GP assessor and lay person Access performance data about each Dr and assess revalidation portfolioAccess performance data about each Dr and assess revalidation portfolio Appears satisfactory Vs Needs discussion Vs Substantial issues raisedAppears satisfactory Vs Needs discussion Vs Substantial issues raised National Adjudication PanelNational Adjudication Panel GMCGMC

Money!Money!

Remediation will be biggest costRemediation will be biggest cost RCGP think DOH should payRCGP think DOH should pay Government thinking about itGovernment thinking about it

Minimum RequirementsMinimum Requirements

3 appraisals, 150 credits, 200 3 appraisals, 150 credits, 200 sessions over 5 years – 100 of which sessions over 5 years – 100 of which in previous 2 years before in previous 2 years before revalidationrevalidation

Essentially Essentially 1 day a week over 2 years 1 day a week over 2 years Absence from work more than 2 Absence from work more than 2

years – re-entry course and years – re-entry course and assessmentsassessments

Sessional GPsSessional GPs

1/31/3rdrd of the workforce and growing of the workforce and growing Most will manage fineMost will manage fine Some leeway allowed in extreme Some leeway allowed in extreme

circumstancescircumstances Usually means doing video / CSA / Usually means doing video / CSA /

MCQ instead of some elementsMCQ instead of some elements

LudditesLuddites

Paper submissions not allowed!Paper submissions not allowed!

What do you need to do now?What do you need to do now?

Protected by VTS/MRCGP until nowProtected by VTS/MRCGP until now Plenty of material to date, all in ePortfolioPlenty of material to date, all in ePortfolio Read GMP for GPsRead GMP for GPs Record your learningRecord your learning and prepare well for and prepare well for

appraisalsappraisals Ideally, write Ideally, write reflective commentsreflective comments after after

each learning activityeach learning activity Consider doing an audit, SEA etc.Consider doing an audit, SEA etc. Take care if locuming – CPD trickier but Take care if locuming – CPD trickier but

revalidation still applies!revalidation still applies!

The good news!The good news!

Passing MRCGP counts as your first Passing MRCGP counts as your first Revalidation!Revalidation!

SummarySummary

CPD to be much more scrutinisedCPD to be much more scrutinised Get used to learning cycles, Get used to learning cycles,

reflecting/evaluating your learningreflecting/evaluating your learning Record everything!Record everything! Annual appraisal the cornerstoneAnnual appraisal the cornerstone Recertification/Relicensure and Recertification/Relicensure and

hence Revalidation should follow hence Revalidation should follow easily for most good GPseasily for most good GPs

Questions?Questions?