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The outcomes/effectiveness of revalidation in the United Kingdom:
evaluating the regulatory impact of medical revalidation
Julian Archer, Niall Cameron, Katie Laugharne, Martin Marshall, Sam Regan de Bere,
Kieran Walshe, Richard Wright
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Acknowledgements
• I would like to thank the General Medical Council (GMC)– Funding hotel for conference period – Contribution to flights from the UK
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Project delivery
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Outline
• Purpose of the evaluation
• Work packages
• Progress so far
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Purpose of the evaluation• 30 research questions, addressing 6 core regulatory aims for
medical revalidation:o Is the GMC’s objective of bringing all doctors into a governed system that
evaluates their fitness to practise on a regular basis being consistently achieved?
o How is the requirement for all doctors to collect and reflect upon supporting information (SI) about their whole practice through appraisal being experienced by revalidation stakeholders?
o Is engagement in revalidation promoting medical professionalism by increasing doctors’ awareness and adoption of the principles and values set out in Good Medical Practice?
o Are revalidation mechanisms facilitating the identification and remedy of potential concerns before they become safety issues or FTP referrals?
o How do ROs fulfil their statutory function of advising the GMC about doctors’ fitness to practise and what support do they have in this role?
o Are patients being effectively and meaningfully engaged in revalidation processes?
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Purpose of the evaluation
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Seven work packages• Research organised into seven work packages, by
methods:
1. Literature reviews2. Secondary analysis of existing data3. National and strategic surveys4. Appraisal capture5. Interviews with stakeholders6. Documentary analysis7. Root cause analysis of documentation when FTP referral
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WP 1: Literature reviews
• Appraisal
• PPI
• Supporting Information
• Responsible Officer (RO) judgement-making
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WP 2: Secondary analysis of data
• GMC
• MARS & SOAR
• Combination of above
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WP 3: National & Strategic Surveys
• Doctorso Appraiseeso Appraiserso ROs
• Patient interest groups
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WP 4: Appraisal capture
• Audio-recording 90 appraisals a year for 2 years
o Flexible approach to captureo Thematic analysiso Mapping analysis to the framework centrallyo Categorisation of levels of reflection
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WP 5: Stakeholder interviews
• Appraisees (90 per year)• Appraisers (90 per year)
• ROs (12 per year)• ELAs (6 per year)
• Regional thematic analysis and central mapping
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WP 6: Documentary analysis
• Portfolio analysis (20 of the 90 interviewees over 2 years)
• Doctors in Scotland or Wales only o Based on existing quality assurance models
• Data triangulated with the findings of WP 4 and 5
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WP 7: Root cause analysis of appraisal documents in FTP referrals
• Aspirational, shaped on the basis of the RO / ELA interviews and discussions with the GMC
• Based in Scotland and Wales
• Prospective PAPC FTP referrals
• Root cause analysis of previous appraisals
• Issues around ethics, consent and recruitment
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Seven work packages
1. Literature reviews2. Secondary analysis of existing data3. National and strategic surveys4. Appraisal capture5. Interviews with stakeholders6. Documentary analysis7. Root cause analysis of documentation when FTP
referral
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Growing evidence base
• CAMERA report for Medical Board of Australia– The evidence and options for medical revalidation
in the Australian context– http://
www.medicalboard.gov.au/Registration/Revalidation.aspx
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The outcomes/effectiveness of revalidation in the United Kingdom:
evaluating the regulatory impact of medical revalidation
Julian Archer, Niall Cameron, Katie Laugharne, Martin Marshall, Sam Regan de Bere,
Kieran Walshe, Richard Wright