Dr Cardiff and Dr Monmouth work as consultants at the same NHS hospital, in different departments.
They have each collected their six types of supporting information, which are generally of a high standard. You are content that their appraisals have been conducted satisfactorily in line with the relevant policies.
However, you have carried out a spot check on these two doctors’ records and you have found that Dr Cardiff, who works in a small department with a heavy research focus, collected colleague feedback from six colleagues, while Dr Monmouth’s feedback involved 32 colleagues across his busy A&E department and several other teams.
You are concerned about the large difference in sample size, and are unsure whether this casts doubt on your ability to recommend Dr Cardiff for revalidation.
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The question is whether you can agree with the positive revalidation statements about Dr Cardiff and Dr Monmouth individually. Patient feedback is one source of supporting information. It should not be considered in isolation and cannot of itself provide a definitive view on a doctor’s fitness to practise. Supporting information should be considered and discussed in the round.
Dr Cardiff’s sample of colleague feedback may be smaller for a number of legitimate reasons – the obvious one being that she has fewer colleague relationships. You should be confident that these reasons have been understood and taken account of within the appraisal system, and that Dr Cardiff has done enough to secure a sample size appropriate to her practice.
For instance, are you confident that the way the feedback activity is held encourages the doctor to think creatively about who their colleagues are beyond immediate colleagues and managers, and that this could include clients, suppliers or non-medical colleagues1?
The feedback activity should also take some account of the sample size, for example by alerting the doctor to the implications of this2 so that it can inform the reflective discussion at appraisal. However, the quality of the doctor’s insight and reflection is the most important consideration rather than technical issues such as sample sizes.
As long as Dr Cardiff’s feedback was governed by the same requirements as Dr Monmouth’s, and you are assured of its quality, then you can consider Dr Cardiff’s revalidation in the same way as Dr Monmouth’s.
Footnotes
1 For instance, our guidance Supporting information for appraisal and revalidation (GMC, 2012) says “One of the principles of revalidation is that patient feedback should be at the heart of doctors’ professional development. You should assume that you do have to collect patient feedback, and consider how you can do so. We recommend that you think broadly about who can give you this sort of feedback. For instance, you might want to collect views from people who are not conventional patients but have a similar role, like families and carers, students, or even suppliers or customers.” We give a more detailed list of suggested colleague roles in our Instructions for administering patient and colleague questionnaires (GMC, 2012).
2 That is to say that a small sample size can produce valid learning points, but that conclusions about the doctor’s practice overall do not have the same level of statistical reliability that a larger sample size would have given. It is also worth recording the reasons for the smaller sample size, and considering whether alternative sources of this kind of feedback could be available for future exercises.
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