Niall Cameron1 picEarlier this month the General Medical Council published the final report of the independent evaluation of revalidation, which was carried out by UK Medical Revalidation Evaluation Collaboration’s (UMbRELLA). The research saw more than 85,000 people take part in a series of surveys, 44 appraisals were recorded and analysed, 156 doctors and patient representatives interviewed and 24 doctors’ portfolios reviewed.

The report was a culmination of a three-year study into revalidation. Dr Niall Cameron, a GP in an inner-city practice in Glasgow, speaks about how he came to be involved in the research and some of its interesting findings.

Background

I have been an appraiser, a lead appraiser and am currently NHS Education for Scotland (NES) National Appraisal Adviser for Medical Appraisal.

NES provides appraiser training for all appraisers in Scotland and provides resources including the online Scottish Online Appraisal Resource (SOAR) platform to support the process for all doctors participating in appraisal in Scotland.

Why appraisal?

My involvement with appraisal began in 2003 and was motivated by both an interest in medical education and a conviction that for a ‘caring’ profession medicine was often very poor in supporting colleagues who were struggling in their role. Not surprisingly I will happily argue that appraisal can not only contribute to professional development and excellence but can also help colleagues who for whatever reason are at risk of drifting into the realms of underperformance.

North of the Border…

In Scotland even before the introduction of revalidation we had managed to achieve a consistently high level of engagement with appraisal across all specialities and could claim with some certainty that the ethos and the mechanics of appraisal were reasonably consistent whether you were a single-handed GP in Shetland or a specialist in a large teaching hospital.

All change? 

Revalidation has had a fairly long gestation but when it arrived like many others I was very interested to see how revalidation would influence the appraisal process; would there be positive outcomes or could the explicit link to revalidation damage the process?

Involvement in research

UMbRELLA represented an ideal opportunity to work with colleagues from across the UK to evaluate the impact of revalidation. This was the largest and undoubtedly the most comprehensive and complex piece of work I have been involved with, involving the collection and analysis of a huge amount of material.

Although daunting this was hugely important providing an opportunity to analyse how revalidation is impacting across all sections of the medical workforce. My personal impression was that many of the existing governance type processes whilst worthy were designed for a working environment that does not exist anymore and don’t reflect the demographics of the current workforce. In my experience the views of traditional stakeholders often hold sway in these discussions whereas UMbRELLA has allowed individuals to describe their own experience of revalidation and to contribute to how it develops. The breadth of the responses received means that the UMbRELLA results do reflect a truly representative sample of the profession.  There was also a consistency across the UK in the benefits and concerns that were identified.

A clear benefit of revalidation has been that it has extended the appraisal process to groups of our colleagues who may have been previously regarded as hard to engage with or perhaps ‘easy to ignore’. Non-consultant grade doctors and locums in both primary and secondary care are a vital part of the NHS and it would collapse without their contribution. However given the demands on the service it is easy to see how they may not have been offered the same opportunity as other colleagues to participate in appraisal. The introduction of revalidation has clearly resulted in a more equitable and inclusive system where all doctors regardless of role have to be offered an appraisal by their employer and there is evidence from UMbRELLA that these groups see the process of revalidation as providing them with meaningful validation.

What next?

The research and findings published in the final UMbRELLA report has highlighted a number of questions and opportunities for further research. In Scotland we focussed on analysis of portfolios of supporting information (SI) presented. Interviews with doctors and their appraisers added context to our understanding of these portfolios. The aim was to explore the types of SI submitted, what reflection on this information took place and the role of different types of SI in prompting changes to practice. Given the emphasis on reflective practice and the issues this raises I think this work will be very relevant.

I have a very familiar refrain that if appraisal is to be effective then appraisers and appraisees need meaningful support. So it appears appropriate to end by highlighting that UMbRELLA reiterates that the skills of the appraiser and the resources available for appraisees are key to enhancing the experience of the appraisal and revalidation process.