Standards, Evidence and Tools

The Academy Revalidation Group has identified three work-streams covering the main practical developments needed to build a framework for delivering revalidation. Details of the Academy’s initiatives within the workstreams and across specialties can be found on their website but the key developments, including for the medical specialties in particular, are summarised below. This section will be kept updated as the different projects progress.

Work-stream 1: Setting standards

Generic standards:The GMC have used the measurable standards in Good Medical Practice to devise a draft framework to support generic assessment and which they believe could be used within appraisal. As well as defining standards, the framework suggests possible sources of evidence that doctors could use to demonstrate they meet the standards. The GMC is currently consulting with the Colleges and others on the draft framework.Further information, including the current draft, is available on the GMC website. Initial comments on the framework submitted by RCPE are available here

Specialty standards: the Colleges and Faculties have been asked to consider and adapt the criteria outlined in the GMC framework to their medical specialty and to identify the appropriate types of evidence that clinicians of different grades could use to demonstrate their performance against these criteria. The Colleges, working with the Specialiist Societies, also need to define additional specialty-specific standards for recertification. This aspect will be an early priority for the RCPE Revalidation Working Group, feeding into collaborative work with RCPL and RCPSG.

Funding has been allocated to each of the Colleges to facilitate consultation with their members on the developments of standards and evidence. RCPE will contact Fellows, Collegiate Members and Associates with further information.

Work-stream 2: Defining standards and criteria for methods and evidence used to demonstrate specialist practice

The Academy aims to develop a portfolio approach to re-certification with the identification of a selection of appropriate and acceptable methods for the doctors to demonstrate that they meet these defined standards. It is anticipated that there will be several common, generic types of evidence that will be applicable to doctors in different specialties such as CPD, MSF and Patient Surveys. In that context, the Academy Revalidation Group has established a number of sub-groups to look at key sources of evidence and associated mechanisms for recording evidence. The groups established so far cover:

CPD: This group will evaluate the range of CPD models in use throughout the UK and overseas and establish common standards and requirements that should be implemented in all CPD systems used in medical colleges and faculties.

For physicians, principles and standards for CPD, supported by an online diary, are long established through the Federation CPD system and it is anticipated that this will adapt well to support recertification.

e-Portfolio: An e-portfolio is seen as an essential requirement for the efficient and effective delivery of revalidation. Based on initial discussions with the Colleges, the Academy has suggested that an electronic system must, at a minimum, have the ability to record activity, offer space for reflection on learning and self assessment, give ‘amber’ and ‘red’ warnings and proffer options for advice on remediation. The group will establish common standards and minimum specifications for all E-portfolios systems developed for medical colleges and faculties.

The physician Colleges have established an e-portfolio for Core Medical Training and are rolling this out for specialty training. Although the components required for an e-portfolio for recertification will be different, the experience of developing, piloting and implementing a UK wide system will be invaluable in feeding into the generic discussions at Academy level and in tailoring to meet the requirements of the medical specialties.

MSF:Multi-source or 360◦ feedback has already been identified in the White Paper as a key component of relicensure. The Academy group will establish common standards and requirements for MSF, and also patient surveys, for use in specialist recertification, recognising that there will be different needs and degrees of patient input between specialties.

Non-clinical work:This group will work on identifying and considering issues associated with the demonstration of the non-clinical work of doctors for specialist recertification.

Remediation:This group will consider how the Colleges and Faculties could best support those doctors who are struggling, for whatever reason, to provide sufficient evidence to demonstrate their practice. It will aim to produce a register of suggested pathways by which a doctor may seek assistance at an early stage in the revalidation cycle, both generic and specialty related.

Work-stream 3 – Developing and validating tools for the assessment of standards

In addition to the generic methods and evidence outlined above, different medical specialties have already developed, or are seeking to develop, speciality-specific tools that are appropriate for the recertification of their members. The Academy will work with the Colleges and Faculties to identify and fund work on specialty tools that could be developed and validated, with priority given to those tools that would be applicable across more than one medical specialty.

The physician Colleges, through JRCPTB, are developing new workplace-based assessments in addition to those already introduced in recent years. Although developed primarily for assessment of trainees, some of these tools may prove adaptable to support revalidation.

Beyond the current development phase, the Academy plans to conduct a large scale, multi-centre pilot of revalidation incorporating those tools developed and validated by the Colleges and Faculties for specialist recertification, but also trialling the more generic processes associated with relicensure, including appraisal and MSF.