Medical knowledge and practice must not stagnate. Revalidation is the process of re-evaluating a medical professional’s fitness to practise. It involves reflection, continuous professional development (CPD) and an overall desire to improve. At its core it is about improving patient care and reaffirming your self-confidence as a medical professional, and your patients’ confidence in your competency. It is a requirement for maintaining your licence.
However, this simple explanation is far from simple in practice, not least because jargon has become muddled. Most doctors have found themselves confused regarding revalidation. For this reason, the GMC has recently released updated guidance to help clear the murky waters. This guide will take you through everything you need to understand.
Back to Revalidation Basics
Suspend your current preconceptions and ideas about revalidation for a moment. It is helpful to revisit the fundamentals and ensure your footing is secure.
Revalidation for doctors dates back to December 2012. It now also applies to other healthcare professionals. At the centre of revalidation is a process of annual appraisal: Doctors are required to include six components of information regarding their practice which they must discuss with their appraiser (technically your responsible officer or suitable person for revalidation) at least once every five years.
The areas of information are:
- Continuing Professional Development (CPD)
- Quality Improvement Activity
- Significant Events
- Feedback from patients
- Feedback from colleagues
- Review of complaints and compliments
These must cover your whole practice, specifically multiple settings.
This is where the jargon and the different processes have complicated things. It is further confused by different establishments having their own internal appraisal systems. Everyone must revalidate, but how you do it depends on your revalidation connection type. Doctors fall in to one of three connection types:
- Doctors with a connection: If you have a connection to a responsible officer, as most doctors do, you will have annual appraisals as part of this. These work in conjunction with the recommendation from your responsible officer a minimum of once every five years. The information from your appraisals and clinical governance information is directly used as part of revalidation.
- Doctors without a connection: Doctors who don’t have a connection to a responsible officer submit annual returns to the GMC and then undergo an assessment every five years.
- Doctors in training: Doctors on UK training schemes automatically revalidate as part of their training.
If you are unsure which type applies to you, you can use the GMC tool here.
Revalidation – Your Responsibility
It is your responsibility to make sure that you both meet the requirements for revalidation but also that you understand the GMC’s guidance. This is in addition to your particular setting’s requirements.
At your annual appraisals you use supporting information, from the six categories above, to demonstrate you meet the requirements established in Good Medical Practice.
By providing these different types of information over time, and specifically the 5 year revalidation cycle, you will automatically be demonstrating your practice against the 12 attributes which are outlined in The Good Medical Practice Framework for Appraisal and Revalidation.
Therefore, in many ways, a good appraisal process will ensure you aren’t doubling up on work, or cramming information together on a large scale every five years. However, your appraisal process isn’t just about revalidation.
About Your Supporting Information
It’s important to remember the mantra ‘quality over quantity’ when it comes to your supporting information. You need it to be a springboard to CPD and a catalyst for reflection. For this reason, there is no minimum or maximum amount you need. You should select clear examples from each category which form the basis of your appraisal discussion.
It is not enough to have the information alone. It must be reflected upon. This is a central theme of revalidation. Therefore within the appraisal you should be formulating ways to further your good practice, ultimately also forming part of your CPD plan for the next year.
You must comply with the requirements of revalidation. This involves engaging with your appraisal process and is essential for your licence to practise. You can find out further information within the GMC’s updated guidance.
Continuous Professional Development (CPD)
As a UK doctor you’ll be aware that you must carry out CPD each year. These must cover all aspects of your practice and scope of your work. Your CPD plan should be output driven. This is central to good professional practice and meeting the wider expectations of how you work in an up-to-date manner. CPD plans should be highly tailored to your needs and as such revalidation doesn’t mandate a set number of hours or units.
Quality Improvement Activity
The purpose of reflecting on the Quality Improvement Activity is to see where changes to your practice can be made, what changes have worked, and what else is needed. This will include things such as audits, case reviews, or benchmarking reviews, for example. You’ll need to be able to demonstrate this has occurred at least once in the revalidation cycle. You must demonstrate what action will be undertaken as a response.
Using significant events as a Launchpad for reflective discussion enables you to consider patterns to prevent a repeat. Significant events are those which were unintended or unexpected which either did, or could have, lead to harm.
All significant events within an appraisal period must be declared and used for reflection. The key here is demonstrating what needs to be done differently going forwards and any CPD needs arising from it. A candid and open approach is needed.
Feedback from Patients
Feedback from patients is about identifying both strengths and weaknesses and reflecting on these. The feedback should be broad in scope based on objectivity and anonymity. Your setting may already have the required systems in place which you can use. If you don’t treat patients directly, this feedback can come from others such as clients.
Feedback from Colleagues
Peer-to-peer reflection is a key part of the revalidation information. As with patient feedback, the purpose is to identify strengths and weaknesses and to reflect on these for the purpose of improving. Again it should be broad in scope covering all the types of work you do, and should also include non-healthcare professionals.
Review of Compliments and Complaints
In conjunction with the feedback from patients and colleagues, reviewing compliments and complaints allows you to further identify areas for improvement and strengths to build on. All formal complaints must be declared and reflected on. At your appraisal you should choose key ones which act as facilitators for change and improvement.