Insightful practice: a reliable measure for medical revalidation.
BACKGROUND
Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback.


METHODS
60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK.


METHODS
A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a 'good doctor' were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice, defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory.


METHODS
Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation.


RESULTS
Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83).


CONCLUSIONS
Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed.
Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK. d.y.murphy@dundee.ac.uk
Douglas J
DJ
Murphy
Bruce
B
Guthrie
Frank M
FM
Sullivan
Stewart W
SW
Mercer
Andrew
A
Russell
David A
DA
Bruce
D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D005246:Feedback; D058005:General Practitioners / Q000592:standards*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010465:Perception; D010817:Physician-Patient Relations; D058996:Quality Improvement; D011787:Quality of Health Care / Q000458:organization & administration*; D015203:Reproducibility of Results; D017751:Safety Management / Q000458:organization & administration; D035502:Trust