Dr. Julian Archer's presentation at the 2015 IAMRA Revalidation Symposium

1. The outcomes/effectiveness of
revalidation in the United Kingdom:
evaluating the regulatory impact
of medical revalidation
Julian Archer, Niall Cameron, Katie Laugharne,
Martin Marshall, Sam Regan de Bere,
Kieran Walshe, Richard Wright

2. Acknowledgements
• I would like to thank the General Medical
Council (GMC)
– Funding hotel for conference period
– Contribution to flights from the UK

3. Project
delivery

4. Outline
• Purpose of the evaluation
• Work packages
• Progress so far

5. Purpose of the evaluation
• 30 research questions, addressing 6 core regulatory aims for
medical revalidation:
o Is the GMC’s objective of bringing all doctors into a governed system that
evaluates their fitness to practise on a regular basis being consistently
achieved?
o How is the requirement for all doctors to collect and reflect upon supporting
information (SI) about their whole practice through appraisal being
experienced by revalidation stakeholders?
o Is engagement in revalidation promoting medical professionalism by
increasing doctors’ awareness and adoption of the principles and values set
out in Good Medical Practice?
o Are revalidation mechanisms facilitating the identification and remedy of
potential concerns before they become safety issues or FTP referrals?
o How do ROs fulfil their statutory function of advising the GMC about doctors’
fitness to practise and what support do they have in this role?
o Are patients being effectively and meaningfully engaged in revalidation
processes?

6. Purpose of the evaluation

7. Seven work packages
• Research organised into seven work packages, by
methods:
1. Literature reviews
2. Secondary analysis of existing data
3. National and strategic surveys
4. Appraisal capture
5. Interviews with stakeholders
6. Documentary analysis
7. Root cause analysis of documentation when FTP referral

8. WP 1: Literature reviews
• Appraisal
• PPI
• Supporting Information
• Responsible Officer (RO) judgement-making

9. WP 2: Secondary analysis of data
• GMC
• MARS & SOAR
• Combination of above

10. WP 3: National & Strategic Surveys
• Doctors
o Appraisees
o Appraisers
o ROs
• Patient interest groups

11. WP 4: Appraisal capture
• Audio-recording 90 appraisals a year for 2 years
o Flexible approach to capture
o Thematic analysis
o Mapping analysis to the framework centrally
o Categorisation of levels of reflection

12. WP 5: Stakeholder interviews
• Appraisees (90 per year)
• Appraisers (90 per year)
• ROs (12 per year)
• ELAs (6 per year)
• Regional thematic analysis and central mapping

13. WP 6: Documentary analysis
• Portfolio analysis (20 of the 90 interviewees over 2
years)
• Doctors in Scotland or Wales only
o Based on existing quality assurance models
• Data triangulated with the findings of WP 4 and 5

14. WP 7: Root cause analysis of appraisal
documents in FTP referrals
• Aspirational, shaped on the basis of the RO / ELA
interviews and discussions with the GMC
• Based in Scotland and Wales
• Prospective PAPC FTP referrals
• Root cause analysis of previous appraisals
• Issues around ethics, consent and recruitment

15. Seven work packages
1. Literature reviews
2. Secondary analysis of existing data
3. National and strategic surveys
4. Appraisal capture
5. Interviews with stakeholders
6. Documentary analysis
7. Root cause analysis of documentation when FTP
referral

16. Growing evidence base
• CAMERA report for Medical Board of Australia
– The evidence and options for medical revalidation
in the Australian context
– http://www.medicalboard.gov.au/Registration/Re
validation.aspx
– julian.archer@plymouth.ac.uk

17. The outcomes/effectiveness of
revalidation in the United Kingdom:
evaluating the regulatory impact
of medical revalidation
Julian Archer, Niall Cameron, Katie Laugharne,
Martin Marshall, Sam Regan de Bere,
Kieran Walshe, Richard Wright