Revalidation

Revalidation is a mechanism used to "affirm or establish the continuing competence"[1] of health practitioners, whilst strengthening and facilitating ethical and professional "commitment to reducing errors, adhering to best practice and improving quality of care."[2] Medical practitioners, nurses and midwives practicing in the UK are subject to revalidation to prove their skills are up-to-date and they remain fit to practise medicine. It is intended to reassure patients, employers and other professionals, and to contribute to improving patient care and safety.[3][4] The Medical Board of Australia is currently engaged in a review and trial of revalidation of medical registration in Australia.[5][6]

Revalidation in the United Kingdom

In the UK, nurses and midwives will need to revalidate every three years. A doctor will undergo revalidation every five years. A recommendation to revalidate a doctor will go to the UK medical regulator, the General Medical Council, from a local 'Responsible Officer'. The Responsible Officer will usually be a senior doctor in the healthcare organisation which employs the doctor, such as the medical director. The Responsible Officer's recommendation will usually be based on the doctor's history of annual appraisals. Doctors and nurses will need to keep a portfolio of evidence showing how they are meeting relevant standards, which will form the basis for discussion at their annual appraisals.[7] It is not an examination process.

In the UK, Revalidation for Doctors started on 3 December 2012. Revalidation for nurses was approved and finalised on 8 October 2015, the first nurses and midwives to revalidate began to do so in April 2016.

Process of Revalidation

The Process of revalidation will be planned by the UK Revalidation Programme Board[8]

Appraisal Portfolio

The portfolio for the appraisal should include the following six types of supporting information that a doctor is expected to discuss with their appraiser at least once within the five year cycle:

1. Continuing Professional Development
2. Quality Improvement Activity
3. Significant events
4. Feedback from Colleagues
5. Feedback From Patients
6. Review of Complaints and Compliments

More information regarding these may be found from the GMC's publication "Ready for Revalidation" (March 2012).[9]

Responsible Officers

The Health and Social Care Act 2008 created the role of the Responsible Officer.[10]

Proposed Revalidation in Australia

A range of potential revalidation models have been considered, with the Medical Board of Australia recently proposing its preferred approach for further consultation and trial. Most notably, the Medical Board of Australia proposes that revalidation integrate a formal method for proactive identification of potential practitioner competency risk.[11]

The Medical Board of Australia proposes to achieve this by bifurcating revalidation into two separate, but related, stages:[12]

  1. The first stage will consist of universally compulsory continuing professional development activities;
  2. These would be ‘nested’ within a second stage, that consists of more vigorous activities that would only apply to select medical practitioners. These more active measures involve external or independent input or oversight and will take on a more summative character testing that the practitioner is not only ‘up to date’ but assessing if they are ‘fit to practise’. Those subject to the more active appraisal and review activities will be selected based on a risk profile in which age, specialty and patient complaints are considered as potential markers of risk, or in response to an identified issue of competence.

References
  1. Tanya Horsley et al, ‘National Programmes for Validating Physician Competence and Fitness for Practice: A Scoping Review’ (2016) 6(4) BMJ Open e010368.
  2. Stephen N Bolsin, Elizabeth Cawson and Mark E Colson, ‘Revalidation Is Not to Be Feared and Can Be Achieved by Continuous Objective Assessment’ (2015) 203(3) The Medical Journal of Australia 142.
  3. "Revalidation".
  4. "The Nursing & Midwifery Council".
  5. The Medical Board of Australia, Expert Advisory Group on Revalidation, ‘Expert Advisory Group on Revalidation Interim Report’ (August 2016) 43.
  6. Julian Archer et al, ‘The Evidence and Options for Medical Revalidation in the Australian Context: Final Report’ (Collaboration for the Advancement of Medical Education REsearch and Assessment (CAMERA), Peninsula Schools of Medicine and Dentistry, Plymouth University, 7 October 2015).
  7. "Revalidation".
  8. http://www.gmc-uk.org/doctors/revalidation/revalidation_board.asp
  9. "Revalidation resources".
  10. Participation, Expert. "Health and Social Care Act 2008". www.legislation.gov.uk. Retrieved 2019-07-09.
  11. Carter, David J; Street, Deborah J; Bush, Stephen (February 9, 2018). "Building Public Confidence in Medical Registration Revalidation". Osf PrePrints. doi:10.17605/OSF.IO/BDAP6.
  12. "Medical Board of Australia Expert Advisory Group on Revalidation Final Report". Medical Board of Australia. August 2017.
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