The United Kingdom's Experience With and Future Plans for Revalidation

Abstract

Assuring fitness to practice for doctors internationally is increasingly complex. In the United Kingdom, the General Medical Council (GMC) has recently launched revalidation, which has been designed to bring all doctors into a governed environment. Since December 2012, all doctors who wish to practice are required to submit and reflect on supporting documentation against a framework of best practice, Good Medical Practice. These documents are brought together in an annual appraisal. Evidence of practice includes clinical governance activities such as significant events, complaints and audits, continuing professional development and feedback from colleagues and patients. Revalidation has been designed to support professionalism and identify early doctors in difficulty to support their remediation and so assure patient safety. The appraiser decides annually if the doctor has met the standard which is shared with the most senior doctor in the area, the responsible officer (RO). The RO's role is to make a recommendation for revalidation every 5 years for each doctor to the GMC. Revalidation is unique in that it is national, compulsory, involves all doctors regardless of position or training, and is linked to the potentially performance moderating process of appraisal. However, it has a long and troubled history that is shaped by high-profile medical scandals and delays from the profession, the GMC, and the government. Revalidation has been complicated further by rhetoric around patient care and driving up standards but at the same time identifying poor performance. The GMC have responded by commissioning a national evaluation which is currently under development.

Maintenance of Certification: Current Status and Future Considerations

“…However, they are also required to take the ABCRS MOC examination to complete ABCRS recertifi cation. The process in the United Kingdom is not a system developed by doctors for doctors, but rather a "centralized system using employer (National Health Service) to employee (physician) relations to ensure accountability" [ 41 ]. The UK system is compulsory for all doctors who wish to practice in the UK, including doctors in training, in public or private practice, and those visiting the UK and practicing medicine.…”

Of the Profession, by the Profession, and for Patients, Families, and Communities

“…1 This privilege depends on trust, and this privilege can be (and has been) lost when the public no longer trusts the professional oversight. 2 Specialty board certification arose at the beginning of the 20th century, when the profession began to set standards for medical training, hospital management, and specialty practice. The public needed ways to distinguish qualified specialists from others.…”

Erratum for “Evolving Health Care Systems and Approaches to Maintenance of Certification” from the Journal of Continuing Education in the Health Professions , Volume 33, Supplement 1, pages S1-S4

“…Campbell and Parboosingh report studies of participant satisfaction and of volunteer participant changes in learning and practice in earlier versions of the MOC program of the RCPSC. Archer and Regan de Bere note that the GMC's revalidation program in the United Kingdom was initiated in December 2012, so no data are yet available. Even the current MOC programs in the United States and in Canada are relatively recent—too recent for the effects of interventions with time frames of 5 to 10 years and longer to be studied easily.…”

“…When we used this sequence of questions to examine the contents of this issue, we found the following: Feasibility: At the level of MOC programs, a few studies have demonstrated their feasibility, including the three described in this issue . At the individual and group levels, a variety of interventions have been demonstrated to be feasible …”