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Revalidation assessment ‘should be done anonymously’

GPs could be forced to submit a portfolio of work online to three anonymous assessors in order to prove they are fit to practise, under a new model of appraisal developed by researchers.

The research – part-funded by the RCGP - raises questions over the reliability of a face-to-face appraisal as the basis for judgements on revalidating doctors.

The team from Dundee University developed the model as they said there was a ‘sparse evidence base' for the use of face-to-face appraisals and that using anonymous appraisers offered a more ‘robust' alternative.

The GMC, currently preparing to roll out revalidation from the end of this year, called the research offered ‘useful insights' and could be used to improve appraisal methods in revalidation.

The researchers applied a new online method of gathering a portfolio of evidence called ‘insightful practice' to a cohort of 60 GPs.

The method involves GPs reflecting and setting goals based on a portfolio of colleague and patient opinions, clinical governance information, self-tested knowledge and practice complaints.

The study – published in BMJ Quality and Safety last month - found an anonymous evaluation of the portfolios by three appraisers scored GPs significantly lower than the usual assessments by a single face-to-face appraiser.

Face-to-face assessments found none of the portfolios was unsatisfactory, whereas repeat anonymous marking highlighted 23% (42 of 180 evaluations) that did not meet required standards.

The team also found that when a seven-point assessment scale was used, rather than a yes/no question, three anonymous assessors were enough to produce highly reliable results.

They concluded: ‘Face-to-face appraisal did not discriminate between GPs and therefore could not be classed as reliable. In contrast, high reliability was demonstrated by anonymous global assessment by three assessors.'

Study leader Dr Douglas Murphy, senior clinical research fellow at the University of Dundee, Scotland, said: ‘Our findings show that face-to-face judgement of one appraiser may be a bit too much to ask and the research may be of interest to those developing systems for revalidation in the future to make them more robust and resistant to challenge.'

He added it was common sense that multiple opinions were always going to be more reliable than one.

Niall Dickson, chief executive of the GMC, said: 'This is interesting and thoughtful research.

‘It offers useful insights as we implement revalidation and could help those responsible for delivering appraisal across the healthcare system.'

A Department of Health spokesperson said: ‘Elements of the revalidation process, such as patient feedback questionnaires that measure their experience with a doctor, may be anonymised.'