Revalidation: the survey results

It’s one of the most controversial topics in medicine. Would revalidation serve a useful purpose or be a waste of time and money? And would you pass?

The introduction of competence checks for doctors is now up for debate. This year the Medical Board of Australia will publish a discussion paper on revalidation — a process of regular assessment that is supposed to help ensure doctors are fit to practise.

Last month Australian Doctor ran an in-depth survey to find out what you think. See the key results below:

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Which revalidation system would be most appropriate?
Annual tests for practising doctors are common in the US, but critics say the process captures only clinical knowledge and fails to measure whether a doctor is practising competently.

Peer-review assessment by senior colleagues is the system now in place in the UK. It means a "responsible officer", such as a practice principal or hospital medical director, assesses the doctor.

Watch our video interivew with Professor Clare Gerada, president of the UK's RCGPs.

They take feedback from colleagues and patients, find out whether the doctor works co-operatively and even look at the accuracy of the doctor's records. From that they recommend to the UK medical board whether a doctor is fit to practise.

This is the most complex version of revalidation. The concern is the administrative burden, which takes doctors away from frontline work to carry out the reviews.

In the UK, the cost was estimated at £128 million a year — almost a quarter of a billion Australian dollars. For that amount of money, it has been claimed revalidation would identify only 20-30 GPs in need of support.

Clearly the costs and benefits, as well as the question of who pays for it all, will be a key part of the Medical Board of Australia's discussion. Don't expect either government or the profession to say they will happily foot the bill.

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Would you be concerned about passing a revalidation test?
The survey didn't ask why those who expressed concerns felt that way. Some may feel such assessments generate the false positives — label competent doctors as unfit to practise. Perhaps this will depend on the bluntness of the revalidation instrument.

Annual clinical tests used in the US offer the simpler prospect of pass or failure. Peer review is more complex, with personal dynamics that are harder to predict.

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Do you support targeted revalidation for high-risk groups such as doctors who have faced multiple complaints?
There is support for targeted revalidation. But there are issues.

First among them — who to target? The international literature suggests it may be those practising in isolation from the rest of profession — solo GPs for example.

There has also been discussion about the risk profiles of older doctors and whether doctors are good at identifying when cognitive impairment is affecting their abilities. But the evidence is far from clear.

The second issue is that the Medical Board of Australia has already ruled out targeted revalidation on the basis of age as they've been told it would breach anti-discrimination laws. In fact, board chair Dr Joanna Flynn went further, saying that any revalidation system must be across the entire profession. Targeted revalidation, despite the support for it, is not on the agenda.

It is also worth stressing that the board already has the powers to impose competence tests on doctors sanctioned for poor practice. So would it be fair to target doctors who may have faced multiple complaints, even when there were no formal findings against them?

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Would you be concerned about passing a revalidation test?
The survey didn't ask why those who expressed concerns felt that way. Some may feel such assessments generate the false positives — label competent doctors as unfit to practise. Perhaps this will depend on the bluntness of the revalidation instrument.

Annual clinical tests used in the US offer the simpler prospect of pass or failure. Peer review is more complex, with personal dynamics that are harder to predict.