Professor Nigel Sparrow (left) and Dr Cath Jenson of the RCGP outline the functions of the Revalidation ePortfolio, which aims to provide a lifelong learning portal for GPs
Revalidation for GPs is now likely to be introduced at the end of 2012.1 The Royal College of General Practitioners (RCGP) has developed an ePortfolio for appraisal and revalidation (see: www.rcgp.org.uk/revalidation_eportfolio_home.aspx), which will enable GPs to store their information for revalidation and allow annual appraisals to be carried out using the facility. In time, this will form a comprehensive electronic portfolio to allow complete appraisal management by the commissioning organisation, and it will have full clinical governance and Responsible Officer functionality. This means that the ePortfolio will allow the Responsible Officer to make a revalidation recommendation to the General Medical Council (GMC). It will also allow the appraisal lead to monitor the appraisal process from a quality assurance point of view.2
In December 2010, the RCGP released phase 1 of the Revalidation ePortfolio. The tool has been designed as a holistic lifelong learning portal that will support GPs in collecting and organising their continuing professional development (CPD) documentation in the simplest possible way, and which will meet the anticipated requirements of revalidation. A ‘traffic light’ dashboard (see Figure 1) provides a visual indicator of progress to appraisal and revalidation across the 12 areas of supporting information detailed in the RCGP Guide to the revalidation of general practitioners (see: www.rcgp.org.uk/revalidation.aspx).3
Current phase 1 functionality includes:
- the ability for the appraiser to view shared log entries at any time
- an option to record information confidentially (not for appraisal/primary care organisation [PCO] view)
- a secure environment that will maintain data for years to come.
It is planned that future phases of the tool will include structured ‘at-a-glance’ summaries to facilitate decision-making by the Responsible Officer and the GMC. The next release in Autumn 2011 will include:
- advanced appraiser management tools (aligned to Strengthened training of appraisers for revalidation guidance4)
- support for Assuring the quality of medical appraisal for revalidation5 (AQMAR) readiness
- the option for PCOs to upload clinical governance data.
|Figure 1: The 'traffic light' dashboard from the RCGP ePortfolio|
Continuing professional development log
At the heart of the ePortfolio is a CPD log, which becomes the ‘core’ of the appraisal process. The CPD log uses the credit system, under which 1 hour of learning counts as one credit, but the credits can be doubled if the GP can show that the learning has been implemented in practice.6 This is designed to reflect the way GPs actually keep up to date, by learning either alone or in groups from a wide variety of materials, which may range from new guidelines to complaints, audits, and significant events. Each CPD item can be optionally mapped to Good Medical Practice attributes and also to the RCGP GP curriculum. Figure 2 shows an example of a typical CPD log (see Figure 2).
|Figure 2: A typical CPD log on the RCGP ePortfolio|
Information entered by the GP is synthesised and summarised by the ePortfolio tool for ‘at-a-glance’ overview. Users can sort any column alphabetically or by date, and enter a search term in the top righthand box to extract all entries containing that keyword. The tool can, therefore, be fully interrogated to assist the user (and appraiser) in establishing the mix and coverage of CPD across any defined period. In the planned phase 2 version, the GP will be able to record time and impact credits separately so that both appraisee and appraiser can see how learning has been used in practice, and therefore recognise the outcomes of learning.
The GP whose log is shown in Figure 2 has 25 credits (the annual requirement is 50) across a spread of the learning ‘dimensions’ (defined by the Academy of Medical Royal Colleges) such as:7
- personal (alone)
- local (in their team)
- external (at regional or national meetings).
Learning also spreads across three ‘fields’:
The GP’s CPD credits are automatically summarised by the ePortfolio tool into the nine-point grid shown in Figure 3 (below), which allows appraisers to see at a glance whether the spread of learning is appropriate for that GP’s type of work (be it solely clinical, or also including managerial or academic work). Once the appraiser has reviewed each credit, it shows on this table as ‘Reviewed’.
|Figure 3: An example of the nine-point grid from the Revalidation ePortfolio (appraiser section)|
Medical Appraisal Framework
Table 1 outlines some key differences between appraisal and revalidation. The RCGP ePortfolio is structured to support the Medical Appraisal Framework, which builds on the ‘strengthened appraisal’ process.8 However, the College has kept in mind that there will be a transitional period prior to revalidation, and PCOs and appraisers are not necessarily expecting appraisees to comply with all aspects of strengthened appraisal prior to 2012. This flexibility has been built into the tool, so many areas are optional, which means:
- CPD credit scoring is encouraged but not compulsory
- domains/attributes are kept in the background (optional)
- there is no absolute requirement to complete areas 2 or 7–12 of the dashboard (see Figure 1, above)
- sign-off will simply comprise confirmation from the appraiser that they are satisfied with the Personal Development Plan (PDP) outcome and CPD progress and have agreed PDP targets.
As with the existing appraisal process using forms 1 to 5, the RCGP Revalidation ePortfolio has the PDP as the key summative outcome. The appraiser form 4 is replaced by a comment log, which requires the appraiser to make specific and attributable comments on each item of supporting information.
As the appraiser reviews each of the items, their comments build up a serial log, which is reviewed at the end of the appraisal discussion and is summarised to create a document functionally equivalent to the current form 4.
The NHS Revalidation Support Team has released a statement on the use of transitional ePortfolios in the run-up period prior to revalidation, which can be found at www.revalidationsupport.nhs.uk/faq.asp. The RCGP is including a form 3 and form 4 equivalent so that the appraisee and appraiser can record a narrative matched to the domains of Good Medical Practice, similar to the current appraisal forms. This will be released over the next few weeks. Each PCO must make a local decision as to how much of the ePortfolio functionality they will ask their appraisees to utilise in the transitional period leading up to revalidation; for example, many PCOs expect all complaints to be declared and this is certainly likely to become compulsory for revalidation.
|Table 1: Some key differences between appraisal and revalidation|
|Appraisal is:||Revalidation is:|
|Led by the NHS organisation/employer||Led by the professional regulatory body (GMC)|
|A local process||A national process that is standard for all doctors, whoever employs them|
|Primarily formative (developmental)||An assessment process (summative)|
|Structured according to headings of:
||Structured according to domains:
|A process under which an individual is invited to submit documents in support of form 3 but not expected to 'prove' assertions||A process under which an individual is required to submit supporting information in a standard format geared towards evidence of assertions|
|Mainly confidential, with a few outcomes shared narrowly||A matter of public record|
|GMC=General Medical Council|
Quality assuring appraisals
Table 2 shows some key ways in which the Revalidation ePortfolio assists users to provide a high-quality appraisal output.
|Table 2: How the Revalidation ePortfolio helps to provide high-quality appraisal output|
|Appraisal quality marker/output||RCGP ePortfolio functions||Highlights|
|Incorporates comprehensive information about all professional roles undertaken||Overview of working life of that GP||Portfolio includes:
|Previous appraisal output available prior to appraisal discussion||Form 4 or equivalent must be attached (dashboard area 3)|
|Range of CPD appropriate to working pattern||CPD categorised into nine-point grid||CPD can also be sorted and linked to both attributes and RCGP curriculum to further demonstrate spread of learning|
|Reflection on care provided to patients and outcomes of CPD||
|Omissions tracked and actioned||
||Tool prompts user to complete key fields prior to sign-off|
||New 'proposed' PDP item template for items not on current PDP that have either been identified during appraisal year or are documented for future years|
|Clear evidence of PDP outcomes||Anticipated and actual outcome fields||Appraiser ratification turns dashboard green|
|Thorough appraiser review of whole portfolio||Comment function on each page/template, so appraiser adds their comment while they are reviewing the information—maximises capture of feedback||Screen prompts remind appraisers that comments must be specific and attributable. The comment log therefore forms high-quality 'overview' of progress|
|Structured appraisee feedback on appraiser performance||Appraisee directed to complete Revalidation Support Team questionnaire, which is incorporated into the software||Comparative PCT mean and range of scores will be available in phase 2 for bodies managing appraisers|
|Secure output||Sign-off appraisal is 'locked' into PDF format and enters area 3 of dashboard. Copy sent to PCO||
|RCGP=Royal College of General Practitioners; CPD=continuing professional development; PCO=primary care organisation; PDP=personal development plan; PCT=primary care trust; GMC=General Medical Council|
Future development of the ePortfolio
The RCGP intends to survey early adopters of the Revalidation ePortfolio, to receive feedback on how user-friendly the tool is and any improvements that can be made. The College will continue to monitor requirements for revalidation as they are announced in response to current pilot schemes, and will adjust the tool accordingly. It is planned that functionality of the tool will be widened to create interoperability between other College e-learning tools and the trainee ePortfolio. The RCGP is confident that the Revalidation ePortfolio will fulfil its aim of becoming a holistic portal for lifelong learning that every GP can use from the time they commence training until they retire.
- General Medical Council website. Revalidation: a statement of intent. October 2010. Available at: www.gmc-uk.org/Revalidation_A_Statement_of_Intent_October_2010__Final_version___web_version_.pdf_35982397.pdf
- Royal College of General Practitioners. Quality assuring appraisals conducted using the RCGP Revalidation ePortfolio. December 2010. Available at: www.rcgp.org.uk/pdf/ReP_Revalidation_ePortfolio_QA_of_appraisals.pdf
- Royal College of General Practitioners. RCGP guide to the revalidation of general practitioners, version 5. December 2010. London: RCGP, 2010. Available at: www.rcgp.org.uk/PDF/Guide_to_Revalidation%20for%20GPs_fifth_FINAL.pdf
- NHS Revalidation Support Team. Strengthened training of appraisers for revalidation. December 2009. Available at:
- NHS Revalidation Support Team. Assuring the quality of medical appraisal for revalidation. April 2009. Available at:
- Sparrow N. RCGP CPD credits are based on time spent and impact on practice. Guidelines in Practice 2009; 12 (12): 24–30. Available at: www.eguidelines.co.uk/eguidelinesmain/gip/vol_12/dec_09/sparrow_cpd_dec09.php
- Royal College of General Practitioners. Guide to the RCGP revalidation ePortfolio. December 2010. London: RCGP, 2010. Available at: www.rcgp.org.uk/pdf/ReP_Full_Guide.pdf
- NHS Revalidation Support Team. Strengthening NHS medical appraisal to support revalidation in England. November 2009. Available at: www.revalidationsupport.nhs.uk/files/Strengthening%20Medical%20Appraisal%20to%20Support