Volume 200 - Issue 9
Revalidation - what is the problem and what are the possible solutions?
Author: Matthew J Links
Med J Aust 2014; 200 (9): 521. || doi: 10.5694/mja14.00400
Published online: 15 May 2014
Published online: 15 May 2014
Closing the implementation gap: making sure CPD improves quality of care
Breen raises an important issue and asks some salient questions,1 but the “bad apples” do not provide the main professional or educational impetus for revalidation. The real problem is that the continuing professional development practices of most practitioners have little impact on quality of care:2 there is an “implementation gap”.3 There is good evidence that immediate and substantial improvements in patients' outcomes can be had if what is known to work is implemented in clinical practice.4
High-level evidence shows that the solution to this problem is to link learning to assessment and improvement of performance by audit, 360°ree; assessment or quality-improvement projects.5 It is impossible to defend to our community why we would not do this.
The linkage of revalidation, professional learning and improvement in practice is a political necessity and an appropriate response to our social contract with the community. The key question is how. The experience in the United Kingdom is overly bureaucratic, and the focus on examinations in the United States is inappropriate; however, other models, such as those in Canada and the Netherlands,6 offer more promise. The challenge is to learn from international experience and develop an Australian revalidation system that meets the needs of Australian consumers and professionals. We will still have to deal with the bad apples, but there is a real prospect that by linking the learning of individual physicians with meaningful assessment of their performance, we can improve the quality of the whole crop.
Competing interests
No relevant disclosures.
References
- Breen K. Revalidation — what is the problem and what are the possible solutions? Med J Aust 2014; 200: 153-156. 1
- Forsetlund L, Bjørndal A, Rashidian A, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2009; (2): CD003030. 2
- Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet 1993; 342: 1317-1322. 3
- Seddon ME, Marshall MN, Campbell SM, Roland MO. Systematic review of studies of quality of clinical care in general practice in the UK, Australia and New Zealand. Qual Health Care 2001; 10: 152-158. 4
- Ivers N, Jamtvedt G, Flottorp S, et al. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2012; (6): CD000259. 5
- Lombarts MJMH, Klazinga NS. Supporting Dutch medical specialists with the implementation of visitatie recommendations: a descriptive evaluation of a 2-year project. Int J Qual Health Care 2003; 15: 119-129. 6