Description
Most UK anaesthetists have now completed a first cycle of professional appraisal. The GMC and specialty view of revalidation is also now becoming clearer and it seems probable that revalidation will be based upon a number of cycles of appraisal being undertaken satisfactorily. Is this system going to be credible to the public and their representatives? The recent A level fiasco has demonstrated yet again how little politicians understand about assessment, and these problems have arisen in the field of knowledge testing that is much better understood than is the complex issue of measuring clinical competence. It is unlikely that appraisal or revalidation will much affect the activities of under-performing or dysfunctional doctors and it is almost inevitable that further bad press will lead to calls for more stringent revalidation; for which read exam based knowledge testing and clinical outcome audit. Apart from the problems of measuring performance one difficulty in detecting potential under-performers is that their problems often lie neither in their knowledge nor their skill but in their professionalism, probity and workplace behaviour. In the jargon, their failure lies in the affective domain. Dysfunctional doctors often work in dysfunctional departments and the deficiencies of the group tend to lead to the problems of individuals being ignored. This is because several of the department members are distorting the individual and group performance in the affective components of good practice.
How then should we conduct revalidation if the group is apt to have impact on individual performance? Perhaps the issue of CPD should be one for the whole department, as well as its individuals. Departments could plan their learning activities together and agree both common threads and individual learning strategies. This is the function of the educational supervisor for postgraduate learners and there is no evidence that consultants are any better at useful, organised, self directed learning than are trainees. It is axiomatic in most fields of education that the assessment drives the learning.
In revalidation we are keen to avoid the stress and pitfalls of inappropriate, difficult, high stakes assessment. If we are to do so we must make organised, transparent efforts to organise and measure our efforts in CPD; at the level of the consultant group.
This journal is now one of a number dedicated to helping anaesthetists to keep their knowledge up to date. Departments could use the reading and assessment tasks in such journals to add a knowledge-learning component to their departmental CPD. Such an approach would improve the credibility of the data they submit to management. It might even help keep us all more up to date.
