Dr Susi Caesar is a GP in Weymouth, Dorset, and the Royal College of GPs’ Lead for Revalidation. She has recently been elected the Academy of Medical Royal Colleges’ (AoMRC) Chair of the Revalidation and Professional Development Committee.
Here, Susi talks about her role on the GMC’s Revalidation Oversight Group, where she is using her frontline experience to make revalidation more valuable for doctors.
Revalidation is the process by which we demonstrate our continued competence at what we do as doctors, both to ourselves and to others.
The UK leads the world in giving doctors themselves the professional responsibility to provide appropriate supporting information that is relevant to their work, and linking it to the annual appraisal process, rather than requiring them to sit a periodic high stakes exam.
Is the appraisal that doctors are getting as good as they deserve?
Sir Keith Pearson’s report: Taking revalidation forward (2017) says that one of the main benefits of the introduction of revalidation in 2012 so far, is that it finally brought about an almost 100% engagement with appraisal. So far so good… But is the appraisal that doctors are getting as good as they deserve?
I facilitate about 30 medical appraisals a year as an individual, and lead a team of around 200 appraisers who provide over 2,500 appraisals a year. I am responsible for engaging, training, supporting and quality assuring. This background puts me firmly at the centre of the grassroots experience which is where the regulatory environment is perceived, by many, as a real burden.
I was asked to share my experiences as an appraiser as part of the Taking revalidation forward report and feel proud that the resulting document reflects such a wide range of contributions.
Sir Keith’s report highlighted that there were some significant inconsistencies in the way that the GMC requirements for revalidation were implemented by different people with operational responsibilities. In my opinion, this was often done with the best of intentions to make things simple and clear, without realising that the playing field was getting less and less level.
I am enjoying the chance to keep speaking truth to power and pointing out where a sensible sounding proposal is actually going to be unworkable on the ground.
I’m now a member of the GMC’s Revalidation Oversight Group (ROG) – set up to drive forward the areas of work identified as key priorities [PDF] by Sir Keith and to bring about quality improvements in appraisal and revalidation as a result.
On the ROG, I am enjoying the chance to keep speaking truth to power and pointing out where a sensible sounding proposal is actually going to be unworkable on the ground. I think that is what I am here for.
At the RCGP, my aim has been to ensure that we increase the value of appraisal and reduce the burden of revalidation. Those priorities will remain at the forefront for me, while we tackle the various challenges Sir Keith has presented us with.
The priorities that have been pulled out for this group to focus on have a lot of face validity: we all recognise that the patient voice in revalidation needs to be strengthened, and that we need to give a wider range of patients a voice in the first place.
We want doctors who have no connection, or who move around the system very fast and are hard to keep track of, to be able to demonstrate clearly at any time that they are able to practise safely.
We all recognise that the patient voice in revalidation needs to be strengthened.
Most importantly, we need to work out how to demonstrate and measure the impact of revalidation – not just the easily measurable (what percentage of doctors have had an appraisal?) but the important and harder to measure (how valuable was the appraisal to their personal and professional development?).
The ‘Holy Grail’ is always to be able to demonstrate that any medical intervention has a positive impact on the quality of patient care. I believe that appraisal and revalidation do contribute positively but I am not complacent that it is going to be easy to prove!
The GMC is currently reviewing its revalidation guidance for doctors to make the requirements clearer – find out more here.