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

Williams, Stephanie; Holmes, Sarah; Laugharne, Katie

doi:10.1080/14739879.2016.1149957

Cited by 6 publications

(12 citation statements)

References 1 publication

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“…Negative feelings about the process obtained here are in keeping with findings of previous work looking at appraisal and revalidation (Middlemass & Siriwardena 2003;Dale, Potter, Owen & Leach, 2016;Williams, Holmes & Laugharne, 2016; The Uk Medical Revalidation Evaluation CoLLAboration (UMbRELLA), 2016).…”

Section: Discussionsupporting

confidence: 87%

So much more than a necessary evil? Lessons from a study following the implementation of recognition of trainers

Crichton¹,

Jones²

2018

MedEdPublish

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Background: The UK General Medical Council (GMC) now requires that trainers in specified roles be "recognised" by evidencing training (General Medical Council, 2012), with wide variation across the UK in implementation. This study aimed to understand the impact on established local educators of this mandatory requirement but also to investigate how our faculty development programme (the Clinical Educator Programme-CEP) can optimise this process for future trainers. Literature review found little published work on the Framework Standards used for this process. Methods: From a pragmatic stance, case study methodology was used allowing for mixed methods of data collection (online survey and focus groups) and "insider research" (Unluer, 2012). Consultants holding a named role (n=875) as defined by the GMC (2012, p.15) were sampled. Results: Of the 28% who responded, the majority (83.3%) were clinical supervisors (n=204). 77.6% were registered on the Faculty Development Programme (CEP, n=190), most stating they registered because of Recognition of Trainers (RoT) (n=107). Demonstrable differences were found between CEP participants and others and between those registered for personal developmental reasons when compared to those who gave RoT as their only reason. This included potential benefits and risks of the process. Ten themes emerged including "a necessary evil". Support for CEP contributing to a community of practice (Lave & Wenger, 1991) was found. Mandatory requirements should not detract from professionalization of medical education, yet this study found just over half of respondents were supportive of the implemented process (51.8%). Conclusion: Further support is needed to help clinical educators understand the potential benefits of ongoing educational CPD.

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Section: Discussionsupporting

confidence: 87%

So much more than a necessary evil? Lessons from a study following the implementation of recognition of trainers

Crichton¹,

Jones²

2018

MedEdPublish

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“…However, the programme has been criticised as being too time‐consuming and intrusive . Other, perhaps less controversial, models exist to accomplish the same ends …”

Section: Discussionmentioning

confidence: 99%

Patients of doctors further from medical school graduation have poorer outcomes

et al. 2017

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CONTEXT There is an apparent contradiction between the findings of studies indicating that patient outcomes are better when physicians have a greater volume of practice and those that find outcomes to be worse with increased time since training, which implies greater volume.OBJECTIVES This study was designed to estimate the adjusted relationships between physicians' characteristics, including recent practice volume and time since medical school graduation, and patient outcomes.METHODS This is a retrospective observational study based on all Pennsylvania hospitalisations over 7 years for acute myocardial infarction, congestive heart failure, gastrointestinal haemorrhage, hip fracture and pneumonia. It refers to 694 020 hospitalisations in 184 hospitals attended by 5280 internists and family physicians. Patient severity of illness at admission and in-hospital mortality, hospital location and volume, and the physician's recent practice volume, time since medical school graduation, board certification, and citizenship or medical school location were analysed. RESULTSAfter adjustment, recent practice volume did not have a statistically significant association with in-hospital mortality for all of the conditions combined. By contrast, each decade since graduation from medical school was associated with a 4.5% increase in relative risk for patient mortality.CONCLUSIONS Recent practice volume does not mitigate the increase in patient mortality associated with physicians' time since medical school graduation. These findings underscore the need to finds ways to support and encourage learning.

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“…This echoes other findings: a survey of ROs found that they considered participation in QI and responses to significant events as the most effective methods of improving doctor performance; 28 the large online survey conducted by UMbRELLA found CPD was the most commonly reported change as a result of appraisal; 17 another survey of GPs also cited QI and SEAs as important in prompting changes, with colleague feedback also regarded as important in helping deeper reflection on their work (though it should be noted that they valued patient feedback almost as much). 29 The latest GMC guidance emphasises the central role of reflection in appraisal and describes it in terms of a twin process, stating that: "your appraiser can facilitate further reflection, as needed but it is your responsibility to demonstrate examples of your reflective practice." 11 So firstly, each doctor needs to produce written reflective accounts and then there is an expectation that this will be reflected upon further in the appraisal -both to increase the depth of the learning and satisfy the appraiser that meaningful reflection has taken place.…”

Section: Discussionmentioning

confidence: 99%

Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland

Wakeling

Holmes

Boyd

et al. 2019

J Contin Educ Health Prof

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Introduction: Reflective practice has become the cornerstone of continuing professional development for doctors, with the expectation that it helps to develop and sustain the workforce for patient benefit. Annual appraisal is mandatory for all practising doctors in the UK as part of medical revalidation. Doctors submit a portfolio of supporting information forming the basis of their appraisal discussion where reflection on the information is mandated and evaluated by a colleague, acting as an appraiser. Methods: Using an in-depth case study approach, eighteen online portfolios in Scotland were examined with a template developed to record the types of supporting information submitted and how far these showed reflection and/or changes to practice. Data from semi-structured interviews with the doctors (n=17) and their appraisers (n=9) were used to contextualise and broaden our understanding of the portfolios. Results: Portfolios generally showed little written reflection and most doctors were unenthusiastic about documenting reflective practice. Appraisals provided a forum for 2 2 verbal reflection, which was often detailed in the appraisal summary. Portfolio examples showed that reflecting on continued professional development, audits, significant events and colleague multi-source feedback were all felt to be useful. Reflecting on patient feedback was seen as less valuable because feedback tended to be uncritical. Conclusion: The written reflection element of educational portfolios needs to be carefully considered, since it is clear that many doctors do not find it a helpful exercise. Instead, using the portfolio to record topics covered by a reflective discussion with a facilitator would not only prove more amenable to many doctors, but would also allay fears of documentary evidence being used in litigation.

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

Cited by 6 publications

References 1 publication

So much more than a necessary evil? Lessons from a study following the implementation of recognition of trainers

So much more than a necessary evil? Lessons from a study following the implementation of recognition of trainers

Patients of doctors further from medical school graduation have poorer outcomes

Reflective Practice for Patient Benefit: An Analysis of Doctors' Appraisal Portfolios in Scotland

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