Is revalidation worth it? In its present form, probably not. As Shipman Inquiry chair Dame Janet Smith pointed out, the appraisal system may involve little more than a cosy fireside chat over tea and biscuits, where doctors define their own areas of weakness and promise to address them in future. As such, it offers no guarantee of protection from those of us who’ve gone dangerously off the boil.
So what might? The great Dame is in favour of a form of summative testing, and although the thought of more exams fills most GPs with dread, is it any worse than spending your life assembling “a portfolio of evidence of professional standards”? I think not.
I’ve just downloaded the November 2004 version of the revalidation portfolio from the RCGP website, and it makes pretty grim reading. While you can’t doubt its intention (to demonstrate your competence), it’s painstakingly divided into eleven sections, all with various criteria, standards and evidence.
True, it’s only a “once every five years” hurdle (although that may change), but the annual appraisal already has a plethora of criteria, standards and evidence which, from Dame Janet’s legal perspective, cut very little ice. Doctors are in danger of drowning under the weight of accountability without actually proving anything.
If we worked in the private sector, doubtless time would be ring fenced for training and retraining and we’d all have time to pass whatever formative assessments were thrown at us. But the NHS has always needed its staff for service delivery, with training often seen as a luxury, so the considerable time needed to assemble a portfolio properly must be done out of hours.
And when you’re tired, and not entirely convinced of the point of what you’re doing, it’s hard to resist cutting and pasting your previous assessment and simply altering a few words.
Will your appraiser spot it? I doubt it. I’ve known senior GPs refuse to fill in any of the appraisal forms (“I’m not going along with this rubbish!”), and still pass.
So what’s the solution? We need to convince politicians and the public that we’re up to date and up to the job. So why not start with a multiplechoice exam paper which has to be completed every 5 years? No trick questions, just basic testing of important medical facts that might harm a patient if we got them wrong. We would also send in a video of our consultations just as the trainees do, so we can benchmark ourselves against the current crop entering practice.
This is what I’m expected to do as a GP returner, and I don’t resent it at all. Indeed, it’s been very useful having an experienced trainer observe my consultations.
Both these methods of appraisal are relatively straightforward and it’s easy for politicians, the public and the press to see the relevance of them.
GPs have hundreds of ways of staying up to date, and getting them to spend half their lives articulating how they do the job they’ve done for twenty years is a recipe for morale meltdown.
It would be far simpler to get back into the exam groove every five years, then concentrate our efforts on helping those who fail get back up to scratch.