Intended for healthcare professionals


Revalidating and rethinking

BMJ 1999; 319 doi: (Published 30 October 1999) Cite this as: BMJ 1999;319:0

The theme of this week's issue is revalidation: how doctors can maintain their performance throughout their working lives and—perhaps harder—demonstrate this convincingly to their patients and employers. As Graham Buckley points out in his editorial (p 1145), Britain has come late to this game. Only now is the General Medical Council starting to build a system of periodic revalidation for all British doctors.

What this system might look like is explained by Lesley Southgate and Mike Pringle on p 1180. They envisage regional revalidation groups in each specialty that will assess the evidence each doctor will provide. In coming late to revalidation Britain can learn from work that has been going on for years in countries such as the United States (p 1183), Australiaand New Zealand (p 1185), Canada (p 1188), and the Netherlands (p 1191). One common feature is an increased interest in peer assessment as part of the revalidation mechanism.

Being a peer assessor implies a heavy, and responsible, workload, but might there also be benefits for the assessor in terms of improved learning and performance? This certainly seemed to happen to general practitioners when they started to teach clinical medicine to undergraduates in primary care. On p 1168 Sarah Hartley and colleagues describe their qualitative study among general practitioners who were given paid protected time to teach medical students core clinical skills such as history taking, examination, and problem management. “The unifying theme that emerged from respondents' experience … was a boost to their morale.” Through the teacher training they were given the GPs received feedback and developed their own clinical skills and from the teaching itself they broadened their horizons, and renewed their enthusiasm for clinical work.

If using general practitioners to teach clinical medicine to undergraduates is still an innovation, then Robin Dowie and Michael Langman argue in their article on the staffing of hospitals that we will need much more such innovatory thinking (p 1193). With its current shortage of doctors, nurses, and other professionals, they say, the UK “is ill placed to support its traditional methods of practice.” Matthew Cooke has perhaps already started: his editorial argues that ambulance services should rethink what they do at the scene of an accident and train paramedics to do more assessment and rely less on protocols (p 1150).

Finally, John Middleton suggests that public health practitioners might like to rethink their heroes: John Snow is widely celebrated, but he was a prominent physician and Queen Victoria's anaesthetist. Middleton's hero is Joseph Goldberger, “a career public health specialist working with poor black people.”


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