Revalidation: the purpose needs to be clear
BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.328.7441.684 (Published 18 March 2004) Cite this as: BMJ 2004;328:684
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Editor
In recent years there has been mounting concern about the incidence
and prevalence of doctors whose performance is unacceptably poor or, worse
still, deliberately harm their patients(1). This has increased following
the high profile Bristol paediatric cardiac surgery scandal and the
conviction of Harold Shipman for murdering some of his patients. The GMC
has responded to criticism of the council’s role by proposing a number of
major reforms, the cornerstone of which is revalidation(2). This will
require all practising doctors to collect a portfolio of documentary
evidence that may be used to demonstrate that their practice has been in
line with the principles set out in Good Medical Practice (3).
Although the GMC claim that revalidation will not be a means of screening
for poorly performing doctors, it will inevitably be seen as such by
politicians, the media and the public. It will be viewed as a measurement
tool that should enable the GMC to screen the population of practising
doctors for incompetence, the prevalence of which is likely to be very low
given the continuous stream of assessments that already have to be
negotiated by all doctors during their careers.
However the sensitivity, specificity, positive and negative predictive
values of revalidation have not been quantified. Without this information
we cannot judge whether the introduction of revalidation will be of
benefit to the public, or if its implementation has been successful. The
introduction of revalidation will not be without harm and the net benefit
should be demonstrated, as with any other medical intervention, prior to
implementation. Inevitably there will be false positives and false
negatives, which will damage the individual doctors, the profession and
the GMC. This may well result in a worsening of the relationship between
the public, the medical profession and the GMC.
An better approach is to take positive steps to improve the performance of
all doctors by whole heartedly supporting their practice, training and
study and actively managing the risks involved in medical activity. In
spite of good intentions this has yet to be implemented in practice.
references
1. van Zwanenberg T. Revalidation:the purpose needs to be clear BMJ
2004;328:684-6
2. General Medical Council. A licence to practice and revalidation.
London:GMC, 2003
3. General Medical Council. Good Medical Practice. London:GMC,2001
Competing interests:
None declared
Competing interests: No competing interests
Re: Revalidation
Robert Price writes, "However the sensitivity, specificity, positive
and negative predictive values of revalidation have not been quantified.
Without this information we cannot judge whether the introduction of
revalidation will be of benefit to the public, or if its implementation
has been successful."
Indeed. But what is certain is that there will still be "bad doctors"
in the future, and that the media will print news stories about them.
These stories will be taken as evidence that whatever revalidation is in
force is not forceful enough. We are on a treadmill that we will not be
able to get off, and the most important sentence of van Zwanenberg's
article is the final one: accountability comes with a price - patients'
trust and doctors' professionalism.
Competing interests:
None declared
Competing interests: No competing interests