revalidation and anaesthesia

1. Andy Tomlinson RCoA Revalidation Lead

2. Front page of the BMJ in 1998 Front page of the BMJ in 1998

3. What is Revalidation? It is about providing assurance that all doctors with a licence are up to date and fit to practice It is not a �point on time� assessment of knowledge and skills It will be based on continuing evaluation of practice in the context of everyday working environment Both generic and specialty aspects It will be based on local systems of annual appraisal

4. Reality Is everyone signed up for a Licence to Practise? Then you have already signed up for revalidation Why? Because to keep your License to Practice you will need to revalidate regularly.Why? Because to keep your License to Practice you will need to revalidate regularly.

5. Reality Therefore the profession needs to ensure that the process developed is: Straightforward Robust Consistent Equitable across all disciplines in medicine Deliverable UK wide Remember the profession includes us as anaesthetists!Remember the profession includes us as anaesthetists!

6. and��. It must not be: bureaucratic costly diverting attention and resources from front line care It should be: based on what is happening now in every doctor�s practice a continuing process supported by the organisations in which we work

7. Revalidation is�. A single process Based on what a doctor actually does in practice A process that must be capable of delivering a single recommendation on revalidation to the GMC It is a five year process NOT a fifth year event

8. The final decision on whether or not to revalidate any doctor remains with the GMC

9. It is important to remember that �.. The vast majority of doctors practice medicine to a high standard Revalidation is a positive affirmation that a doctor is up to date and fit to practise The purpose of revalidation and medical regulation is not solely to identify doctors whose performance is not of a sufficiently high standard Revalidation should be a process that will support continuous quality improvement in standards and practice for both doctors and patients alike

10. GMC: Revalidation Model GMC have worked with the Colleges to define a model of the revalidation process Important to find a balance between the local and specialty elements of the process Period of 12 months and much consultation has led to a model �

11. GMC revalidation cycle

12. Work streams: 2009 CPD MSF Remediation E-Portfolio Non-clinical work Clinical audit Specialty standards documentation Specialty led projects to develop and test methods for collecting supporting information Policy development � (GMC) revalidation model; registers; (DH) ROs; impact analysis Only include this to show that much preparatory work has been undertaken alreadyOnly include this to show that much preparatory work has been undertaken already

13. Work streams: 2010 Legal and indemnity E-portfolio Piloting Within the NHS and outside Across all 4 UK countries Specialist Appraisal Guidance and Training Impact Study Quality Assurance Consultation

14. What�s new about revalidation? Current Process Appraisal Clinical and non-clinical Review of CPD Core topics and against job plan Matching of job plan to Trust needs Personal development plan Increasingly MSF is being used Revalidation Strengthened appraisal Clinical and non-clinical Review of CPD Core topics, higher and advanced Recorded Supporting evidence Personal development plan Matching of job plan to Trust needs Audit essential MSF essential MSF, and separately patient feedback where appropriate [at present not considered appropriate for anaesthetists] That in red is trying to differentiate between now and the futureMSF, and separately patient feedback where appropriate [at present not considered appropriate for anaesthetists] That in red is trying to differentiate between now and the future

15. CPD

16. CPD: Four categories

17. CPD: Matrix Autumn 2008 Specialist societies consulted on range and levels of CPD March 2009 CPD working party refined and agreed draft matrix July 2009 Draft matrix returned to Specialist Societies for verification and final comments October 2009 Final �codified� matrix locked and on web for comment April 2010 Further review and refinement of matrix

18. CPD Matrix Three levels: Core Knowledge based and essential Higher Directly related to on-call activity Advanced Directly related to job-planned activity Not quite sure what we mean by �Evidence form clinical practice accepted�!Not quite sure what we mean by �Evidence form clinical practice accepted�!

19. CPD Matrix Core Knowledge based and essential Incorporates Core Topics from <>1998 onwards Provided as e-learning Evidence from clinical practice

20. CPD Matrix Higher Directly related to on-call activity Unit specific Directly related to on-call commitments not in job-planned service delivery Able to rescue a colleague in difficulty Able to provide anaesthesia for patients too complex for more inexperienced colleagues Therefore knowledge and skills

21. CPD Matrix Advanced Directly related to job-planned clinical activity Expertise State-of-the-art skills and knowledge Able to support consultant colleagues with their most complex cases Usually accessible from specialist society meetings

22. CPD: Final stages Archive data for all approved events from 2005 Most Fellows have certificates but no identifiable content Specialist societies to confirm data and codify if possible Electronic system For all Fellows as part of subscription (launch autumn 2010) Available to non-Fellows at for a fee New approval process Only electronic Approved providers Audit an intrinsic element

23. Appraisal

24. Appraisal Must be robust, challenging and uniform across UK Assuring the Quality of medical Appraisal for revalidation (AQMAR) (RST England) �Gold standard� is an appraisal by someone from your own speciality Has to map to the �new� framework covering GMC Good Medical Practice domains

25. Specialty standards Four domains adapted from Good Medical Practice Domain 1: Knowledge, skills and performance Domain 2: Safety and quality Domain 3: Communication, partnership and teamwork Domain 4: Maintaining trust

26. Must recognise the ability of being a �specialist� Support all doctors Including those not on Specialist/GP register and not in training Be a positive affirmation by appropriate College/Faculty through the RO to the GMC Colleges have a key role Setting standards for the specialist elements Developing methods by which doctors will be evaluated for those elements Must be agreed by the GMC

27. Domains and attributes

28. Specialty Standards All specialties developed standards, methods and supporting information using the GMC framework For all doctors working in the specialty Standards and supporting information for non-clinical work developed including: Medical Education and Training Clinical Leadership and Medical Management Medical Research Specialist Expertise (e.g. expert witness) Colleges have a key role Setting standards for the specialist elements Developing methods by which doctors will be evaluated for those elements All doctors includes those not on the Specialist/GP register and not in trainingAll doctors includes those not on the Specialist/GP register and not in training

29. Specialty Standards Progress Frameworks completed for all specialties (including non-clinical work) Signed off by GMC December 2009 Further 3/12 consultation with the GMC March � June 2010 www.gmc-uk.org/thewayahead or email: thewayahead@gmc-uk.org Piloting begins Spring 2010

30. Specialty Standards GMC approved December 2009 Incorporates the GMC generic standards applicable to all doctors Defines the current specialty specific standards for anaesthesia Will be used by the RO when assessing an anaesthetist�s revalidation Supplemental documentation being prepared for Pain Medicine and Intensive Care Medicine

31. �Generic� Standards Domain 1 - Knowledge, Skills and Performance Attribute: maintain your professional performance Possible sources of evidence Maintain knowledge of the law & other regulation relevant to practice (13) � Keep knowledge and skills up to date (13) � � Participate in professional development & educational activities (12) � � Take part in regular and systematic audit (14) � � Peer Feedback Multisource Feedback References and Letters Practice Complaints and Compliments Incidents � including contribution to NPSA and confidential enquiries Outcomes � Audit National and Clinical Audit Education, Training and Development CPD E-Learning Specialty Certificates & Courses Internal Training �

32. Specialty specific appraisal Expert group met September 2009 Experienced clinical directors with current appraisal practice Consensus against �good anaesthetist� standards and GMC GMP generic standards Generation of appropriate topics/questions to address the generic and anaesthetic specific standards Road-testing commenced October 2009

33. Specialty specific appraisal Programme for 2010 January: Process reviewed following approximately 70 appraisals using the suggested models Integration into the �generic� model from the RST planned Development of training / information materials Video clips developed using consensus from the appraisal group �Pathfinder pilots� commencing March 2010 Both generic and specialty specific RCoA to work closely with anaesthetists

34. Appraisal Working Party AoMRC/GMC view: appraisal process should be uniform across the UK Both Hospital Medicine and General Practice Time scale Training material developed - June 2010 Training delivered to pilot sites - Oct 2010 Roll out - Feb 2011

35. Multi-Source Feedback

36. MSF / PF for anaesthesia Principles and criteria for MSF developed by the AoMRC for GMC sign off Must cover generic and specialty specific aspects Aim to develop anaesthesia specific MSF for each attribute within GMC GMP framework to support remediation Professional Standards Committee Patient feedback (PF) CARE questionnaire project Currently �where appropriate�

37. What should I do now? For 2010: Plan, collect and organise Appraisal documents Evidence mapped to Attributes CPD certificates & content Summarise CPD against Matrix Copy it! Use on-line CPD when arrives Identify annual time slot for your appraisal process Read the RCoA Getting Ready for Revalidation booklet

38. What should I do now? For years 2007-09: Collate, review and organise paperwork All previous appraisal documents CPD certificates & content Summarise CPD against Matrix Map to attributes MSF / any other form of peer review If none consider when Box files / ring binder for each year Identify what needs to be reviewed / revisited

39. Contact details Andy Tomlinson � Revalidation Lead andy.tomlinson@doctors.org.uk Don Liu � revalidation manager dliu@rcoa.ac.uk Sharon Drake - education director sdrake@rcoa.ac.uk Charlie McLaughlan � professional standards director cmclaughlan@rcoa.ac.uk