Designing a system for performance appraisal: balancing physicians' accountability and professional development

BACKGROUND

In many healthcare systems, physicians are accustomed to periodically participate in individual performance appraisals to guide their professional development. For the purpose of revalidation, or maintenance of certification, they need to demonstrate that they have engaged with the outcomes of these appraisals. The combination of taking ownership in professional development and meeting accountability requirements may cause undesirable interference of purposes. To support physicians in their professional development, new Dutch legislation requires that they discuss their performance data with a non-hierarchical (peer)coach and draft a personal development plan. In this study, we report on the design of this system for performance appraisal in a Dutch academic medical center.

METHODS

Using a design-based research approach, a hospital-based research group had the lead in drafting and implementing a performance appraisal protocol, selecting a multisource feedback tool, co-developing and piloting a coaching approach, implementing a planning tool, recruiting peer coaches and facilitating their training and peer group debriefings.

RESULTS

The system consisted of a two-hour peer-to-peer conversation based on the principles of appreciative inquiry and solution-focused coaching. Sessions were rated as highly motivating, development-oriented, concrete and valuable. Peer coaches were considered suitable, although occasionally physicians preferred a professional coach because of their expertise. The system honored both accountability and professional development purposes. By integrating the performance appraisal system with an already existing internal performance system, physicians were enabled to openly and safely discuss their professional development with a peer, while also being supported by their superior in their self-defined developmental goals. Although the peer-to-peer conversation was mandatory and participation in the process was documented, it was up to the physician whether or not to share its results with others, including their superior.

CONCLUSIONS

In the context of mandatory revalidation, professional development can be supported when the appraisal process involves three characteristics: the appraisal process is appreciative and explores developmental opportunities; coaches are trustworthy and skilled; and the physician has control over the disclosure of the appraisal output. Although the peer-to-peer conversations were positively evaluated, the effects on physicians' professional development have yet to be investigated in longitudinal research designs.

Update and Revalidation of Ghose's Cellulase Assay Methodology

New studies on cellulolytic enzymes aiming to improve biofuels production lead to a concern over the assaying methods commonly applied to measure their activity. One of the most used methods is Ghose's cellulase and endoglucanase assay, developed by the International Union of Pure and Applied Chemistry in 1987. Carrying out this method demands high volumes of reagents and generation of high amounts of chemical residues. This work aimed to adapt Ghose's methodology to reduce its application cost and residue generation and validate the adjustments. To do so, International and Brazilian laws were applied to validate methodologies. Method's modifications were successfully validated according to all institutions and were considered linear, accurate, precise, and reproducible. It was possible to reduce the volume of reagents and residues in 12 times. Considering the routine work of most laboratories, it is a great reduction on material costs and residue treatment, which reflects in sustainability and environmental impacts.

Reviving clinical governance? A qualitative study of the impact of professional regulatory reform on clinical governance in healthcare organisations in England

BACKGROUND

Until recently, processes of professional regulation and organisational clinical governance in the UK have been largely separate. However, the introduction of medical revalidation in 2012 means that all doctors have to demonstrate periodically to the regulator that they are up to date and fit to practise, and as part of this process doctors must engage with clinical governance activities in the organisations in which they work.

OBJECTIVE

To explore how the recent implementation of medical revalidation has affected the arrangements for clinical governance in healthcare organisations in England.

DESIGN

Thematic analysis of interviews with 62 senior clinicians and non-clinicians in management or senior administrative roles, from a range of healthcare organisations in England.

RESULTS

Revalidation has engendered changes to clinical governance systems, resulting in: increased doctor engagement with clinical governance activities; new or improved systems for access to clinical governance data for doctors and leaders within healthcare organisations; and more leverage - through the Responsible Officer role - to enforce engagement with clinical governance. Organisational context has been an important mediator of the impact of revalidation on clinical governance.

CONCLUSION

Revalidation has increased alignment between systems for organisational and professional oversight and accountability, resulting in increased scrutiny of clinical practice. However, it is still a matter of conjecture whether this will in turn lead to improvements in medical performance.

Is Collecting Patient Feedback "a Futile Exercise" in the Context of Recertification?

OBJECTIVE

Patient feedback is considered integral to maintaining excellence, patient safety, and professional development. However, the collection of and reflection on patient feedback may pose unique challenges for psychiatrists. This research uniquely explores the value, relevance, and acceptability of patient feedback in the context of recertification.

METHODS

The authors conducted statistical and inductive thematic analyses of psychiatrist responses (n = 1761) to a national census survey of all doctors (n = 26,171) licensed to practice in the UK. Activity theory was also used to develop a theoretical understanding of the issues identified.

RESULTS

Psychiatrists rate patient feedback as more useful than some other specialties. However, despite asking a comparable number of patients, psychiatrists receive a significantly lower response rate than most other specialties. Inductive thematic analysis identified six key themes: (1) job role, setting, and environment; (2) reporting issues; (3) administrative barriers; (4) limitations of existing patient feedback tools; (5) attitudes towards patient feedback; and (6) suggested solutions.

CONCLUSIONS

The value, relevance, and acceptability of patient feedback are undermined by systemic tensions between division of labor, community understanding, tool complexity, and restrictive rule application. This is not to suggest that patient feedback is "a futile exercise." Rather, existing feedback processes should be refined. In particular, the value and acceptability of patient feedback tools should be explored both from a patient and professional perspective. If issues identified remain unresolved, patient feedback is at risk of becoming a "futile exercise" that is denied the opportunity to enhance patient safety, quality of care, and professional development.

The 'Reality of Revalidation in Practice' (RRiP) project - Experiences of registrants and preparation of students in nursing and midwifery in the United Kingdom: A descriptive exploratory survey

BACKGROUND

Renewal of healthcare registration or license to practise is becomingly increasingly common, worldwide. Evidence regarding the experience of nursing and midwifery revalidation in the United Kingdom is limited. Preparation of students for the process has not yet been considered in the literature.

OBJECTIVES

To explore registrants' experiences of undertaking or supporting colleagues through revalidation. To consider preparation of pre-registration students for this future professional requirement.

DESIGN

A descriptive exploratory study comprising an on-line survey.

SETTING

A university in the southwest of England and associated clinical placements.

PARTICIPANTS

Nursing and Midwifery Council registrants, comprising 40 university staff and 40 clinicians; 36 pre-registration nursing and midwifery students.

METHODS

Participation in an anonymous on-line survey was invited via university databases. Descriptive statistical analysis of quantitative data used a combination of software and manual methods. Qualitative data were manually coded and categorised into themes through inductive reasoning.

FINDINGS

Most experiences of revalidation were positive. Reflective discussions resulted in mutual learning, particularly if partners were chosen by the registrant. External scrutiny was welcomed. Some registrants questioned involvement of line managers and alignment with performance review, seeking to avoid a 'tick-box exercise' and conflicts of interest. University staff felt better prepared and more positive than clinicians. Pre-registration curriculum activities preparing students included writing reflections, maintaining portfolios, practice assessment and discussions about the revalidation process. Midwifery students seemed better prepared than nursing peers. Key themes of 'Professional values', 'Preparation', 'Process' and 'Purpose' and a range of positive influences and potential hazards informed development of a conceptual model.

CONCLUSIONS

The purpose and process of revalidation is enhanced if confirmation is undertaken by a registered nurse or midwife of the individual's choice. Preparation of students for future revalidation is facilitated by role-modelling of positive attitudes and explicitly linking relevant pre-registration curriculum activities to this process and purpose.

Doctors' attitudes to, beliefs about, and experiences of the regulation of professional competence: a scoping review protocol

BACKGROUND

Historically, individual doctors were responsible for maintaining their own professional competence. More recently, changing patient expectations, debate about the appropriateness of professional self-regulation, and high-profile cases of malpractice have led to a move towards formal regulation of professional competence (RPC). Such programmes require doctors to demonstrate that they are fit to practice, through a variety of means. Participation in RPC is now part of many doctors' professional lives, yet it remains a highly contested area. Cost, limited evidence of impact, and lack of relevance to practice are amongst the criticisms cited. Doctors' attitudes towards RPC, their beliefs about its objectives and effectiveness, and their experiences of trying to meet its requirements can impact engagement with the process. We aim to conduct a scoping review to map the empirical literature in this area, to summarise the key findings, and to identify gaps for future research.

METHODS

We will conduct our review following the six phases outlined by Arksey and O'Malley, and Levac. We will search seven electronic databases: Academic Search Complete, Business Source Complete, CINAHL, PsycINFO, PubMed, Social Sciences Full Text, and SocINDEX for relevant publications, and the websites of medical regulatory and educational organisations for documents. We will undertake backward and forward citation tracking of selected studies and will consult with international experts regarding key publications. Two researchers will independently screen papers for inclusion and extract data using a piloted data extraction tool. Data will be collated to provide a descriptive summary of the literature. A thematic analysis of the key findings will be presented as a narrative summary of the literature.

DISCUSSION

We believe that this review will be of value to those tasked with the design and implementation of RPC programmes, helping them to maximise doctors' commitment and engagement, and to researchers, pointing to areas that would benefit from further enquiry. This research is timely; internationally existing programmes are evolving, new programmes are being initiated, and many jurisdictions do not yet have programmes in place. There is an opportunity for learning across different programmes and from the experiences of established programmes. Our review will support that learning.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO does not register scoping reviews.

Social media participatory CPD for nursing revalidation, professional development and beyond

BACKGROUND

In 2016 the Nursing and Midwifery Council in the UK introduced revalidation, which is the process nurses are required to follow to renew their registration. This provides an opportunity for nurses to shape, develop and evolve social media to meet their professional requirements.

AIMS

to examine different ways nurses can use social media tools for continuous professional development (CPD) and revalidation.

METHODS

using a qualitative reflective design, data were gathered from content on the @WeNurses platform and activities organised with other leading health organisations in England. These data were analysed using the social media relationship triangle developed by the authors with a thematic analysis approach.

FINDINGS

analysis revealed that social media was used in six categories: publishing, sharing, messaging, discussing, collaborating, and networking. Organised social media events such as: blogs, tweetchats, Twitter storms, webinars, infographics, podcasts, videos and virtual book clubs can support nurses with revalidation and professional development.

CONCLUSION

Through using a participatory CPD approach and embracing professional social media applications nurses have moved social media from the concept of a revolution to an evolution.

Preliminary codesign and testing of a feedback tool to improve the quality of peer appraiser documentation for medical revalidation

Medical appraisal and associated revalidation are mandatory for doctors in the United Kingdom. However, the quality of appraisal documentation, which informs the revalidation process on a doctor's fitness-to-practise, is known to be variable. This preliminary study aimed to develop and test a formative educational tool that could be used, as part of routine appraiser training in the general practice setting, to review and provide evidence and feedback on the quality of documentation completion. A mixed-methods study was undertaken based on codesign principles, which elicited the views and opinions of medical appraisers, appraisal leads and medical managers on the content of an educational tool designed to reduce variation in appraisal paperwork completion. The study team created a 24-item educational tool covering six domains of the appraisal process. Domains included 'reflection on practice', 'knowledge, skills and performance' and 'quality and safety'. The tool was piloted amongst appraisers and received positive feedback. This study contributes practical knowledge to help reduce variation in appraisal documentation. The tool can be used to streamline the completion of appraisal documentation by appraisers. It may provide a level of quality assurance and contribute to providing fair, objective and measurable grounds for revalidation.

Policing the profession? Regulatory reform, restratification and the emergence of Responsible Officers as a new locus of power in UK medicine

Doctors' work and the changing, contested meanings of medical professionalism have long been a focus for sociological research. Much recent attention has focused on those doctors working at the interface between healthcare management and medical practice, with such ‘hybrid’ doctor-managers providing valuable analytical material for exploring changes in how medical professionalism is understood. In the United Kingdom, significant structural changes to medical regulation, most notably the introduction of revalidation in 2012, have created a new hybrid group, Responsible Officers (ROs), responsible for making periodic recommendations about the on-going fitness to practise medicine of all other doctors in their organisation.

Using qualitative data collected in a 2015 survey with 374 respondents, 63% of ROs in the UK, this paper analyses the RO role. Our findings show ROs to be a distinct emergent group of hybrid professionals and as such demonstrate restructuring within UK medicine. Occupying a position where multiple agendas converge, ROs' work expands professional regulation into the organisational sphere in new ways, as well as creating new lines of continuous accountability between the wider profession and the General Medical Council as medical regulator. Our exploration of ROs' approaches to their work offers new insights into the on-going development of medical professionalism, pointing to the emergence of a distinctly regulatory hybrid professionalism shaped by co-existing professional, managerial and regulatory logics, in an era of strengthened governance and complex policy change.

•

Responsible Officers are a new governance elite group in the UK medical profession.

•

They work at the nexus of professional, managerial and regulatory spheres.

•

Differ from other doctor-managers due to accountability for medical performance.

•

Organisational context shapes experiences of this new role.

•

Regulatory reform has engendered a new form of hybrid professionalism.

Self-tracking, governmentality, and Nursing and Midwifery Council's (2016) revalidation policy

In April 2016 the Nursing and Midwifery Council (NMC) introduced a new revalidation continuous professional development (CPD) policy. This policy states that revalidation is the responsibility of nurses, and although employers are urged to support the revalidation process, the NMC clearly states that employers have no legal requirement to provide either time or funds for the CPD activities of nurses and midwives (NMC, 2014, 2016; Royal College of Nursing, 2016). The aim of this professional development policy is to ensure that nurses and midwives maintain their professional competency and to promote public safety and confidence in nurses and midwives. A closer look at the process of revalidation suggests that several measures have been introduced to ensure that nurses and midwives conform to the CPD policy, and this paper examines the influence of governmentality and neoliberalism on the NMC's self-tracking revalidation policy. It will be recommended that the responsibility for the revalidation process should be shared by nurses, midwives, and their employers, and that time and money should be allocated for the professional development of nurses and midwives.

Which resources are most helpful to support development of an ePortfolio?

AIM

To identify which resources BSc Nursing students found most beneficial in developing and maintaining their ePortfolio.

DESIGN

This study evaluates the benefit of resources available in developing and maintaining an undergraduate nursing student ePortfolio. A mixed-methods approach was taken during 2016, using an internet polling tool. The polling tool was available for 3 months before closing and was available to all fields of BSc Nursing student from any year of their 3-year nursing programme.

FINDINGS

The qualitative data was coded thematically and generated three themes: student workshops, textual guidance and pre-recorded video support. The quantitative data identified that the most beneficial resource was the student workshops facilitated by student academic mentors (SAMs).

CONCLUSION

SAMs provide an invaluable service to students, by sharing their knowledge and experiences, while enhancing a student's perceptions of self-efficacy.

The implementation of medical revalidation: an assessment using normalisation process theory

Background

Medical revalidation is the process by which all licensed doctors are legally required to demonstrate that they are up to date and fit to practise in order to maintain their licence. Revalidation was introduced in the United Kingdom (UK) in 2012, constituting significant change in the regulation of doctors. The governing body, the General Medical Council (GMC), envisages that revalidation will improve patient care and safety. This potential however is, in part, dependent upon how successfully revalidation is embedded into routine practice. The aim of this study was to use Normalisation Process Theory (NPT) to explore issues contributing to or impeding the implementation of revalidation in practice.

Methods

We conducted seventy-one interviews with sixty UK policymakers and senior leaders at different points during the development and implementation of revalidation: in 2011 (n = 31), 2013 (n = 26) and 2015 (n = 14). We selected interviewees using purposeful sampling. NPT was used as a framework to enable systematic analysis across the interview sets.

Results

Initial lack of consensus over revalidation’s purpose, and scepticism about its value, decreased over time as participants recognised the benefits it brought to their practice (coherence category of NPT). Though acceptance increased across time, revalidation was not seen as a legitimate part of their role by all doctors. Key individuals, notably the Responsible Officer (RO), were vital for the successful implementation of revalidation in organisations (cognitive participation category). The ease with which revalidation could be integrated into working practices varied greatly depending on the type of role a doctor held and the organisation they work for and the provision of resources was a significant variable in this (collective action category). Formal evaluation of revalidation in organisations was lacking but informal evaluation was taking place. Revalidation had not yet reached the stage where feedback was being used for improvement (reflexive monitoring category).

Conclusions

Requiring all organisations to use the same revalidation model made revalidation easy to integrate into existing work for some but problematic for others. In order for revalidation to be fully embedded and successful, impeding factors, such as a lack of resources, need to be addressed.

Country of qualification is linked to doctors' General Medical Council performance assessment rate, but is it linked to their clinical competence?

Mehdizah and colleagues recently described the prevalence of General Medical Council regulatory performance assessments by doctors' country of primary medical qualification. This article has caused anger within the UK-international medical community because it identifies graduates of certain countries with significantly raised prevalence.The present article comments on evidence from published Royal College of General Practitioners' data that support these conclusions. However, in an increasingly international age of medical education, the ambiguity of attributions of qualifying from a certain country needs addressing. Some medical students of British nationality, for example, who fail to obtain a place at a UK medical school, train in medical schools abroad, and thus may be identified as international medical graduates.Please see related article: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-017-0903-6 .

Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial

PURPOSE

Functional weight-bearing mobilization may improve repair of Achilles tendon rupture (ATR), but the underlying mechanisms and outcome were unknown. We hypothesized that functional weight-bearing mobilization by means of increased metabolism could improve both early and long-term healing.

METHODS

In this prospective randomized controlled trial, patients with acute ATR were randomized to either direct post-operative functional weight-bearing mobilization (n = 27) in an orthosis or to non-weight-bearing (n = 29) plaster cast immobilization. During the first two post-operative weeks, 15°-30° of plantar flexion was allowed and encouraged in the functional weight-bearing mobilization group. At 2 weeks, patients in the non-weight-bearing cast immobilization group received a stiff orthosis, while the functional weight-bearing mobilization group continued with increased range of motion. At 6 weeks, all patients discontinued immobilization. At 2 weeks, healing metabolites and markers of procollagen type I (PINP) and III (PIIINP) were examined using microdialysis. At 6 and 12 months, functional outcome using heel-rise test was assessed.

RESULTS

Healing tendons of both groups exhibited increased levels of metabolites glutamate, lactate, pyruvate, and of PIIINP (all p < 0.05). Patients in functional weight-bearing mobilization group demonstrated significantly higher concentrations of glutamate compared to the non-weight-bearing cast immobilization group (p = 0.045).The upregulated glutamate levels were significantly correlated with the concentrations of PINP (r = 0.5, p = 0.002) as well as with improved functional outcome at 6 months (r = 0.4; p = 0.014). Heel-rise tests at 6 and 12 months did not display any differences between the two groups.

CONCLUSIONS

Functional weight-bearing mobilization enhanced the early healing response of ATR. In addition, early ankle range of motion was improved without the risk of Achilles tendon elongation and without altering long-term functional outcome. The relationship between functional weight-bearing mobilization-induced upregulation of glutamate and enhanced healing suggests novel opportunities to optimize post-operative rehabilitation.

The general practitioner workforce crisis in England: a qualitative study of how appraisal and revalidation are contributing to intentions to leave practice

Background

The general practice (GP) workforce in England is in crisis, with declining morale and job satisfaction, increasing early retirement and declining interest in training to become a GP. We recently reported on factors that are influencing this, with appraisal and revalidation emerging as an unexpected finding; 28.6 % of GPs stating an intention to leave general practice within the next 5 years included this as ‘very important’ or ‘important’ to their decision. In this study we undertook a secondary analysis to identify how the experience of appraisal and revalidation might be influencing intentions to leave general practice.

Methods

Qualitative analysis of free text comments made by GPs in a survey of career intentions. All comments that included mention of appraisal or revalidation were extracted. Emergent themes were identified and a coding framework devised.

Results

Forty-two participants made comments that related to appraisal and revalidation. Compared to all 1192 participants who completed the main survey, they were older (76.2 % compared to 46.2 % aged 50 years and older), with more years’ general practice experience (80.0 % compared to 48.0 % with >20 years’ experience) and more likely to state an intention to retire within 5 years (72.2 % compared to 41.9 %).

Key themes were appraisal and revalidation as: a bureaucratic, inflexible exercise that added to an already pressured workload; an activity that has little educational value, relevance to professional development or quality of care; and an issue that contributes to low morale, work-related distress and intentions to leave general practice. Revalidation was depicted as a cumbersome tick-box exercise that had little to do with quality of care or protecting patients. There were no comments that countered these negative views.

Conclusions

While the representativeness of these comments to the experience of GPs as a whole cannot be judged, it is likely that that they reflect the concerns of GPs whose experience of appraisal and revalidation is influencing their intention to leave general practice. Through its impact on GP morale and burnout, the current appraisal and revalidation system in England appears to be contributing to the workforce crisis. The findings indicate that the appraisal system may be in urgent need of re-design to increase its relevance to individual GPs’ experience and seniority, clinical activities being undertaken and professional development needs.

Impact of revalidation on appraisal in primary care: an initial evaluation of the experience of Welsh GPs

BACKGROUND

While appraisal is a well-established process and has been a contractual obligation for GPs in Wales since 2004, revalidation is a new requirement for all doctors practising in the UK. Appraisal is an essential component of revalidation. However as appraisal is developmental, and revalidation is summative, there is concern over the potential impact revalidation may have on the appraisal process itself.

METHODS

This study, carried out among GPs in Wales, aimed to capture participants' perspectives of the initial impact of revalidation on appraisal. The study was commenced by conducting a basic literature review, building on existing research in this area. We employed a mixed method approach (an online survey and focus groups). The online survey was disseminated via Bristol Online Survey. Focus groups were carried out to examine the perspectives of both GP Appraisers and GPs on the study subject matter.

RESULTS

The majority of respondents felt that revalidation had had a medium-sized effect on the appraisal process. Respondents were fairly evenly divided on the nature of that impact. Some reported collecting GMC-specified information had increased time costs. Others found that collecting this information had sparked reflection and changes to their practice. GPs were fairly evenly divided on the precise extent to which the GMC data collection offered an accurate picture of their work and learning. The majority felt that it did, with 20-23% reporting a negative impact.

CONCLUSION

The study participants reported that revalidation had impacted on appraisal, bringing increased time and costs alongside some increased individual reflection and Quality Improvement (QI) activity. The impact was felt more by appraisers than appraisees. Overall, of those GPs revalidated in 2013, 62% reported it was a positive experience.

Revalidation: a university health board's learning from pilot partner engagement

This article aims to share organisational experiences and learning from the largest Nursing and Midwifery Council (NMC) revalidation pilot partner. The purpose of revalidation is to improve public and patient protection through career-long professional updating. Pilot participation enabled Aneurin Bevan University Health Board (ABUHB) to contribute significantly to system and process testing, underpinning revalidation across a range of nursing and midwifery settings. An action plan was developed providing a structured approach to the revalidation pilot, detailed actions were identified and progress against actions mapped and reported. While revalidation is the individual registrant's responsibility, there is an organisational obligation to create a supportive enabling environment. A strategic plan incorporating revalidation into organisational objectives and structured leadership roles assisted registrants to successfully meet the NMC's requirements. With 813 registrants completing the pilot process, ABUHB has an enhanced understanding of the revalidation process and an appreciation of its impact on associated professional issues. This level of learning has increased readiness for revalidation commencement for all UK nurses and midwives.

How do medical doctors in the European Union demonstrate that they continue to meet criteria for registration and licencing?

This paper reviews procedures for ensuring that physicians in the European Union (EU) continue to meet criteria for registration and the implications of these procedures for cross-border movement of health professionals following implementation of the 2005/36/EC Directive on professional qualifications. A questionnaire was completed by key informants in 10 EU member states, supplemented by a review of peer-reviewed and grey literature and a review conducted by key experts in each country. The questionnaire covered three aspects: actors involved in processes for ensuring continued adherence to standards for registration and/or licencing (such as revalidation), including their roles and functions; the processes involved, including continuing professional development (CPD) and/or continuing medical education (CME); and contextual factors, particularly those impacting professional mobility. All countries included in the study view CPD/CME as one mechanism to demonstrate that doctors continue to meet key standards. Although regulatory bodies in a few countries have established explicit systems of ensuring continued competence, at least for some doctors (in Belgium, Germany, Hungary, the Netherlands, Slovenia and the UK), self-regulation is considered sufficient to ensure that physicians are up to date and fit to practice in others (Austria, Finland, Estonia and Spain). Formal systems vary greatly in their rationale, structure, and coverage. Whereas in Germany, Hungary and Slovenia, systems are exclusively focused on CPD/CME, the Netherlands also includes peer review and minimum activity thresholds. Belgium and the UK have developed more complex mechanisms, comprising a review of complaints or compliments on performance and (in the UK) colleague and patient questionnaires. Systems for ensuring that doctors continue to meet criteria for registration and licencing across the EU are complex and inconsistent. Participation in CPD/CME is only one aspect of maintaining professional competence but it is the only one common to all countries. Thus, there is a need to bring clarity to this confused landscape.

Is the patient satisfaction questionnaire an acceptable tool for use in a hospice inpatient setting? A pilot study

Background

The Patient Satisfaction Questionnaire (PSQ) is an assessment tool used to evaluate patients’ perspectives of their doctor’s communication and interpersonal skills. The present pilot study investigated whether the PSQ could be administered successfully in a hospice inpatient setting and if it is an acceptable tool for completion by patients and relatives in this context.

Methods

The study was conducted in two phases. A first phase was undertaken to establish the process of PSQ administration in a hospice inpatient ward. A second phase of questionnaire administration followed by semi-structured interviews explored inpatient experiences of the questionnaire process.

Results

Overall, 30 inpatients and one relative were invited to complete the PSQ across both phases of data collection, representing 53% of all inpatients at the time of data collection. The remaining 47% were deemed unsuitable to ask due to a diagnosis of dying (24%), confusion (17%), distress (3%) or lack of availability (2%). The average response rate across both phases of data collection was 87%. Qualitative interview data suggested that the PSQ was considered clear, easy to understand and not burdensome in terms of time or effort for this population.

Conclusions

The PSQ appears an acceptable tool to use in a hospice inpatient setting. Many patients welcomed the opportunity to be involved and give feedback. Using a greater proportion of relatives as an alternative source of feedback could be considered in future studies.

Using orthopaedic journals for continuing professional development

Continuing professional development (CPD) refers to the ongoing participation in activities that keep a doctor up to date and fit to practise once they have completed formal training. It is something that most will do naturally to serve their patients and to enable them to run a safe and profitable practice. Increasingly, regulators are formalising the requirements for evidence of CPD, often as part of a process of revalidation or relicensing. This paper reviews how orthopaedic journals can be used as part of the process of continuing professional development.

Continuing professional development: best practices

Continuing professional development (CPD) involves not only educational activities to enhance medical competence in medical knowledge and skills, but also in management, team building, professionalism, interpersonal communication, technology, teaching, and accountability. This paper aims at reviewing best practices to promote effective CPD. Principles and guidelines, as already defined by some professional societies and world organizations, are emphasized as core actions to best enhance an effective lifelong learning after residency. The personal learning plan (PLP) is discussed as the core of a well-structured CPD and we describe how it should be created. Fundamental CPD principles and how they are integrated in the framework of every physician's professional life will be described. The value of systematic and comprehensive CPD documentation and assessment is emphasized. Accreditation requirements and professional relationships with commercial sponsors are discussed.

Revalidation: A world first in medical regulation

The revalidation of doctors was introduced in the UK in December 2012, and means that all licensed doctors must demonstrate periodically that they are up-to-date and fit to practise. Regular appraisals, based on the General Medical Council’s core guidance for doctors, will be used by responsible officers to evaluate a doctor’s practice based on six types of supporting information, including feedback from patients and colleagues. In this commentary, as the Chair of the General Medical Council and Consultant Physician, I provide an overview of the history of revalidation and discuss the role of the new system of checks (which is being watched with interest by regulators around the world) ensuring that medical practice is of a high quality, that doctors are supported in their professional development and, most importantly, that patients can have confidence in the doctors they consult.

Competence assurance - who cares?

The provision of clinical care in the United Kingdom now requires the acquisition of a licence to practise from the regulatory authority. A review process-revalidation has been put in place to ensure that standards of care are maintained by the medical workforce, and that all doctors remain up-to-date and fit for purpose so that this licence can be retained. This article outlines how this new statutory requirement pertains to paediatric surgery and highlights those areas where adjudication of competence remains imprecise and where progress in this process of revalidation needs to be made.

Revalidation: Patients or process? Analysis using visual data

Revalidation is a significant recent regulatory policy reform from the UK General Medical Council and being considered elsewhere around the world. The policy aims to regulate licensed doctors to ensure that they are 'up-to-date and fit-to practise'. Fundamental to the policy is that the revalidation of doctors should benefit patients and improve doctor-patient relationships. As part of an evaluation of the development of revalidation, 31 policy makers involved in its development were interviewed in 2010-2011 and were asked to draw what revalidation meant to them. From this, 29 drawings were produced and this article focuses on their analysis. The drawings emphasised abstract systems and processes, with a distinct lack of interpersonal interactions or representation of individual patients and doctors. Only 3 of the 29 images included individual patients and doctors. This depersonalisation of policy is examined with respect to the purported key objective of revalidation to benefit patients. Using a distinctively different modality, the drawings serve to confirm the two key discourses of regulation and professionalism prevalent in the interview data, while highlighting the notable absence of the patient. The benefits and limitations of using drawings as a research method are discussed for a health policy context.

Revalidation for trainees and the annual review of competency progression (ARCP)

Revalidation for doctors in the UK began in December 2012. Doctors in training need to revalidate every 5 years after obtaining their licence to practice and also at the point of achieving their certificate of completion of training. The annual review of competency progression (ARCP) is the vehicle for revalidation discussions. Postgraduate deans are the responsible officers for trainees and there are new processes in place, including responsibilities for educational supervisors and ARCP panels to ensure that postgraduate deans can fulfil their General Medical Council obligations. In this article, I give examples of how this might work in practice.