Revalidation: do we need it?

AUSTRALIA’S ongoing efforts to improve professional development and information sharing in clinical practice negate the need to adopt a UK-style revalidation system for doctors, says AMA president Dr Steve Hambleton.

“We need to make sure we maintain our currency and continue to improve health outcomes, but in terms of value for money, making everybody go through a 5-yearly process of 360-degree evaluation is not needed in the Australian health system”, Dr Hambleton said.

He said the “world had moved on” since the UK’s General Medical Council first proposed revalidation in 1998. The UK system was launched in 2012, with a similar system being considered by the Medical Board of Australia.

Dr Hambleton was commenting on an MJA “For debate” article by Professor Kerry Breen, adjunct professor at Monash University’s Department of Forensic Medicine, who has called for broader debate about the proposed revalidation system. (1)

“The medical regulator and the medical profession might be wiser to first more clearly identify what the problem is that revalidation is trying to fix and then examine what methods might best suit that aim”, Professor Breen wrote

“It seems illogical and unnecessarily costly to introduce an additional layer of assessment of all doctors when there is general agreement that most doctors strive to maintain and enhance their knowledge and skills and are rarely the subject of complaint. This is even more problematic without an evidence base to indicate that revalidation will achieve its stated aim.”

Dr Hambleton agreed that it was important to consider what problems a proposed revalidation system was trying to fix.

“We do have some of the best outcomes in the world with the current system and to impose on that unique system a solution developed in another area, particularly when the world has moved on ... we certainly do have the right to question it”, he said.

Dr Hambleton said Australia did not lack confidence in the profession, as was the case in the UK when its revalidation scheme was first mooted, but the AMA recognised the need to “close the gap between what we know and what we do”.

This was being achieved with mandatory continuing professional development (CPD) and clinical audits, and by all professional colleges encouraging self-analysis and comparison, he said.

The adoption of the SNOMED CT-AU system to standardise the terminology in clinical medicine would also provide a “rail gauge” for communication between clinicians that would enable them to measure and compare outcomes, Dr Hambleton told MJA InSight. (2)

“Australia is at the threshold of an enormous increase in the ability to share and analyse information that we can utilise to improve CPD, minimise unwarranted clinical variation and you will get better outcomes for the profession and better outcomes for the public”, he said.

“Measure and compare is a really powerful way of minimising clinical variation and maximising outcome and it’s something that clinicians are already demonstrating that they want to embrace.”

Dr Joanna Flynn, Medical Board of Australia chair, said the MJA article offered interesting perspectives on the issue of revalidation.

“We welcome contributions to this important discussion and are monitoring the debate closely. The Board continues to have an open mind”, she said.

“We are considering the evidence from overseas experience and will work closely with our stakeholders to determine the best course for Australia to help ensure that any registered medical practitioner has up-to-date knowledge and skills to provide safe care.”

In the MJA paper, Professor Breen said the most attractive immediate option for the board might be targeted assessment of the competence of doctors believed to be at highest risk of poor performance. “Research indicates that appropriate targets may be doctors who have been the subject of more than one substantiated complaint, and older doctors”, he wrote.

Dr Hambleton said he didn’t think “age per se” was a problem. “But if there are problems, then it may be worth a closer look.” He said supporting older doctors in career transition might be a solution when older doctors were beginning to struggle with some aspects of their practice.

1. MJA 2014; 200: 153-156
2. NEHTA: SNOMED CT-AU