Medical Revalidation for Histopathologists By

Dr. Varughese GeorgeDepartment of Pathology, MGMCRI

Objectives• Introduction• Appraisal & Revalidation• The Scope of Work• Documentation from

Previous Appraisals• Continuing Professional

Development.• Quality Improvement

Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Introduction

Medical Revalidation

• The term Medical Revalidation used to describe:

“the regular demonstration by registered doctors that they remain fit to practice in their chosen field(s)”

Source: General Medical Council. (2000). Revalidating Doctors: Ensuring standards, securing the future. London, General Medical Council.

The Forms of Revalidation

The forms of revalidation in different places - • Doctors should prove their participation in a

Continuing Professional Development activities.

• Doctors sit for professional examinations every few years.

• In some, the issue has not yet been addressed.

The History of Revalidation• The General Medical Council has been discussing how

to implement a system to check on the performance of doctors since the early 1990s.

• Proposals based mainly on a requirement to undertake CPD were well advanced, but had not been implemented.

• Dame Janet’s report identified the need for a system to check up on the performance of doctors every few years.

• Chief Medical Officer Sir Liam Donaldson suggested proposals for regular checks on the performance of doctors

The Proposals – The 3 ‘R’sThe whole process was called ‘revalidation’, initially split into two

components.

• ‘Relicensing’ – to check that a doctor remained competent at the level of basic registration with the GMC as a medical practitioner.

• ‘Recertification’ - to check that specialists were operating at an appropriate level for their specialty by a relevant Medical Royal College.

Both processes done simultaneously periodically

If successful = Revalidation!

The downfalls of the proposals

• Did not specify how doctors would be evaluated.• Assumed that doctors would have to give examinations

comparable to those which the Colleges already delivered.

• Ignored the high level of medical specialisation in the UK.

• For the Colleges, examinations had become increasingly complex and expensive to run.

• Legal challenges by unsuccessful candidates were becoming increasingly common and expensive.

Post discussions• Doctors should be expected to prove their worth only in relation to

their own individual scope of practice.

• Huge diversity of individual medical practice excluded the option of sitting examinations at intervals.

• Revalidation should be based on an annual review of the whole of a doctor’s individual practice gained ground.

• The process of an annual medical appraisal would have to be enhanced and made more formal if it was to satisfy the requirements of the GMC.

It was recognised that if revalidation was to be based on appraisals of a doctor’s actual practice, the division into ‘relicensing’ and ‘recertification’ was unhelpful, so those terms were dropped.

• Appraisals would have to fulfil two tasks :1. The ‘summative question’ – Is this doctor fit to practise?2. The ‘formative question’ –

Can this competent doctor be helped to improve his/her performance even more?

Objectives• Introduction• Appraisal & Revalidation• The Scope of Work• Documentation from

Previous Appraisals• Continuing Professional

Development.• Quality Improvement

Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Purpose of Medical Revalidation Evaluates doctors’ practice through appraisal so as to affirm

good practice.

Assures patients , the public, employers, other healthcare professionals & providers, licensed doctors are practising to the appropriate professional standards.

Complements other systems that exist within organisations and at other levels for monitoring standards of care and recognising and responding to concerns about doctors’ practice.

Requirements for Revalidation

• Doctors must be taking part in an annual appraisal process.

• Doctors must have completed at least one appraisal based on good medical practice.

• Doctors must have collected and reflected on all six types of supporting information.

Six types of supporting information

1. continuing professional development (CPD).2. quality improvement activity.3. significant events .4. feedback from colleagues.5. feedback from patients.6. review of complaints and compliments.

With the system in place

• When the system is established, revalidation will be required every 5 years.

• The core requirement is that each year every doctor either must have an appraisal to GMC standards, or must have a valid reason for not having such an appraisal.

• Every doctor now has a ‘Prescribed Connection’ to a ‘Designated Body’ which will provide a

• ‘Responsible Officer’ (RO).

Recommendations made by ROs• ROs have a considerable number of responsibilities beyond

that of making revalidation recommendations to the GMC.

• Most of these relate to ensuring the quality of medical care, including monitoring and responding to adverse clinical incidents and complaints.

• The outcome of appraisals is only one of the factors that ROs are expected to consider when making a recommendation.

Recommendations made by ROs

• ROs only have three options when making a recommendation to the GMC :

1. Recommend revalidation.2. Recommend deferral.3. Failure to engage.

Objectives• Introduction• Appraisal & Revalidation• The Scope of Work• Documentation from

Previous Appraisals• Continuing Professional

Development.• Quality Improvement

Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

The ‘Scope’ of Work• Sets out ‘everything’ the doctor does as a doctor.

• Not limited to work done for one organisation.

• Not concerned with when or how much each type of work is done.

• Unpaid work should be included.

• The level of responsibility is important.

• Must provide sufficient detail for an appraiser to assess the relevance of all the other information provided & to identify any important omissions.

• Delivering a complete scope of work is important.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Documentation from previous appraisals

• This is important to facilitate continuity of the process across the whole revalidation cycle.

• The Personal Development Plan (PDP) agreed at last year’s appraisal must be reviewed to ensure progress is being made.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Continuing professional development

• It is not sufficient to confirm that the minimum acceptable number of CPD points has been delivered.

• The appraiser’s task includes checking that the CPD activities undertaken cover the whole spread of a doctor’s practice.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement

Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Quality improvement activities

• For most specialties, this heading primarily means audit and outcome data.

• In histopathology, measuring patient outcomes is problematic.

• Participation in appropriate external quality assessment (EQA) schemes is essential.

• Detailed reports from EQA schemes should be discussed in confidence with the appraiser.

• A variety of other sources of information may be relevant

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Colleague and patient feedback

• Questionnaires must be carefully constructed, validated and administered by a third party, to allow responses to be confidential.

• Spontaneous compliments and complaints, whether from patients or colleagues, should also be considered at appraisal.

• Patient feedback poses an obvious difficulty for histopathologists and the GMC accepts that there are circumstances where this may be omitted.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Significant events

• Any serious mishap in the previous year must be discussed.

• wrong diagnosis.• a misplaced specimen.• seriously delayed report.• accident in the laboratory.

• In medical appraisal, the negative implications of something going wrong can be turned into a very positive affirmation.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Statement of health

• All doctors are expected to ensure that their own health does not compromise the care of other patients.

• The GMC expects a standard statement to be signed to confirm that this is happening.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Statement of probity

• Another standard GMC statement in which a doctor formally declares they are telling the truth.

• If any of the other information provided at an appraisal is found to be deliberately incorrect, or incomplete, this probity statement is demonstrably false.

• The consequence could be a very rapid referral to the GMC’s disciplinary procedures.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

Information relevant to other activities

• Supporting Information has to relate to everything a doctor does as a doctor.

• Doctors who are not clinical academics but nevertheless undertake some research will be expected to provide information relevant to that role.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after

appraisal• The Recommendation after

documentation• Is the new system effective?• Summary

The Documentation after appraisal

The appraiser and appraisee must agree a PDP for the coming year, with personal objectives that are SMART -

• Specific• Measurable• Achievable• Relevant• Time-limited

- The appraiser must complete a summary of the appraisal.

- The appraiser is then asked to make a series of yes/no statements for the benefit of the RO.

- Any serious concerns or trivial problem should be escalated by the appraiser to the RO.

- Statements the appraiser is asked to confirm to the Responsible Officer -

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

documentation.• Is the new system effective?• Summary

The Recommendation after Documentation

• ROs are entitled to review, in confidence, the whole of a doctor’s appraisal record.

• The revalidation recommendation is made largely on the appraiser’s responses.

• There is no right of appeal at this stage if an RO refuses to make a positive recommendation.

• The GMC takes the actual decision, if necessary after having held a full and separate ‘Fitness to Practise’ hearing.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

appraisal• Is the new system effective?• Summary

Is this new system effective?

Maybe or maybe not

• Forces every doctor to consider, at least once each year, whether there could be ways in which they can deliver even better care for their patients.

• It provides reassurance to the public that their doctors are competent and are keeping up to date.

Objectives• Introduction• Appraisal & Revalidation• The Appraisal Process• The Scope of Work• Documentation from Previous

Appraisals• Continuing Professional

Development.• Quality Improvement Activities• Colleague and patient

feedback

• Significant Events• Statement of Health• Statement of Probity• Information relevant to other

activities• The Documentation after appraisal• The Recommendation after

appraisal• Is the new system effective?• Summary

Summary

References

1. P Furness. Medical revalidation for histopathologists, Recent Advances in Histopathology Volume 23: Chapter 11 : 149-157

2. V Nath, B Seale ,M Kaur. Medical Revalidation: From Compliance to Commitment, King’s Fund, March 2014:1–32.