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Surgical data should prompt revalidation rethink

Publication of the cardiac surgical mortality figures, those for other surgical specialties and those to be published shortly make the comments of the Alment Committee in the mid seventies: ‘a system of licensing for all could not be based upon measurements satisfactory enough to justify it’, untenable and very short sighted.

It is time for those who pressurised this outcome to say mea maxima culpa and for the organisations, as expressed by Sir Donald Irvine, to stop continuing with appraisals to be based on the flimsiest of evidence of performance at the work place.

Following the Shipman Report, Sir Liam Donaldson, given the task of recommending a system to declare doctors ‘up-to-date and fit-to-Practice, launched a call for ideas in 2005.

Requirement of Fitness to Practice was made law, but there did not seem to be a clear view of how this might be achieved. Continuing medical education was considered a prime component. Testing of knowledge was another, but this was rejected outright by the BMA.

The comparison was made with certification of airline pilots by Sir Liam but this bore little relevance to the medical profession. In addition to the transparency that this introduces into the NHS and the confidence it bestows on the NHS, it is my belief that the value of this exercise in auditing the performance of doctors can be taken much further in establishing that the doctor is up-to-date and fit to practise and is entitled to be revalidated.

There is no denying the pitfalls in the collection and interpretation of data as highlighted in: ‘Surgeon blames crude data for causing debacle’ Zosia Mmietowicz and Krishna Cinthapalli. This should however not deter the adoption of a scheme eminently fit for purpose following essential refinements.

I wish we could re-open the debate around revalidation.

In everyday life we adopt a simple means of assessing competence of an individual through their performance. Pardon me if I sound too elementary for the intellectuals.

When a plumber is contracted to fix the central heating, often on a personal recommendation we would like to ensure that he is a registered plumber. It is unlikely that he brings proof of his qualification, hardly any different from how the public relate to doctors. If the plumber completes the job to the customer’s satisfaction, would it not be reasonable to go down the following train of thought. The plumber’s performance would reflect his ability, competence and skill. To take it a step further back he must have had the knowledge to apply to the task. QED.

During the consultation on revalidation by the GMC I expressed my views as follows: Revalidation is best based on objectively evaluated measurable performance and outcomes: the measure of outcomes reflecting the ability of the individual. The feasibility of this is there now for all to see.

What is essential is for the government to contribute to the establishment of a robust scheme for data collection analysis and interpretation.

Could the public see even a remote resemblance of fitness to practice for doctors to what it means to declare a boxer, a marathon runner fit or an airline pilot to fly? It is my submission that revalidation based on appraisals and the flimsiest of evidence of performance amounts to deception of the public. There could now be a robust way to establish fitness to practice.

Will the GMC entrusted with this sacred duty respond now? Experience tells us that the public and the politicians must make the demand. That the GMC will await condemnation by another Dame Janet Smith will be my confident prediction with more millions of taxpayers’ money down the drain.

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One Response to “Surgical data should prompt revalidation rethink”

  1. John says:

    I agree. Even the GMC’s own commissioned study on multisource feedback (which is vital for appraisal and revalidation) has raised concerns on its validity as you may see as follows,

    Prof. Campbell and Dr Wright February 2012
    Interpreting and handling multisource feedback results: Guidance for appraisers,

    ‘’4.7.1 Primary medical degree
    Doctors who obtained their primary medical degree from any non-European country, tend to receive less favourable feedback from patients than those qualifying in Europe. Doctors who obtained their primary medical degree outside of the UK or South Asia, tend to receive less favourable feedback from colleagues than doctors qualifying in those two regions.

    4.7.2 Clinical specialty
    Doctors who practise as a psychiatrist tend to receive less favourable feedback from patients than doctors working in other clinical specialties. Doctors practising as a general practitioner or a psychiatrist tended to receive less favourable feedback from colleagues than doctors working in other clinical specialties.

    4.7.3 Contractual role (grade)
    Doctors who are employed in a contractual role (grade) as associate specialists or staff grade doctors tend to receive less favourable feedback from their colleagues.

    4.7.4 Locum status
    Doctors who are working in a locum capacity tend to receive less favourable feedback from colleagues than doctors in permanent positions.’’

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