Assessing your professional performance
An independent study by a team at Peninsula Medical School has shown that patient and colleague questionnaires developed by the GMC have potential as a means of collecting information regarding doctors’ performance.
These questionnaires may offer a mechanism to support doctors to demonstrate their fitness to practise as part of the revalidation process where local systems are weak or non-existent.
The questionnaires could also offer complementary evidence of fitness to practise within local systems that are well-managed and fit for purpose. Professor John Campbell, who led the team, discusses the findings of his research.
The questionnaires used in this research were originally developed by the GMC in 2004 with content which was based on the duties of a doctor as set out in Good Medical Practice. The questionnaires were designed to capture information from patients and colleagues regarding a doctor’s professional behaviour and practice.
The 18 item patient questionnaire comprises questions addressing such areas as the doctor’s inter-personal and consultation skills, and also questions concerning the patient’s confidence in the doctor’s honesty, trustworthiness and confidentiality.
The 25 item colleague questionnaire addresses some similar items, but also covers such issues as the doctor’s contribution to team functioning, and their clinical, diagnostic and teaching abilities. Both questionnaires provide for the possibility that an individual respondent may feel they cannot comment meaningfully on all the questions.
Preliminary agreement to take part in the study was obtained from 541 doctors. Responses were received from 13,754 patients following a consultation with one of 380 volunteer doctors and from 4,269 colleagues of 309 doctor volunteers.
The questionnaires appeared acceptable to participants. Patient and colleague responses were skewed towards favourable impressions of the doctor’s performance. There were high levels of internal consistency in responses to core questionnaire items. A minimum of eight colleague and 22 patient responses were necessary to achieve acceptable reliability in the assessment of professional practice.
Patient and colleague responses provided complementary perspectives on doctors’ professional practice. Older doctors had lower scores on both questionnaires than younger doctors. Doctors from a mental health trust and doctors providing care in a variety of non-NHS settings (including out-of-hours care, prison healthcare, locum doctors, and independent practitioners) had lower summary scores when compared with doctors providing care in mainstream NHS acute or primary care trust settings. The performance of the questionnaires was similar to other questionnaires having broadly similar intent and which are currently in use in the USA and Canada.
The White Paper Trust,
Assurance and Safety - The Regulation of Health Professionals in the
21st Century (
pdf) has
proposed that multi-source feedback of the type described here will
in future comprise an element in the revalidation of doctors.
Given the volunteer nature of the sample, and the challenging clinical environment in which some of the participants worked, the research team has urged caution in identifying any of the participants as displaying deficient performance. The research team believes these preliminary results are measured, and supports the use of these questionnaires as a means by which a doctor can provide reliable supporting evidence regarding their fitness to practise medicine.
The GMC has now commissioned a second phase of research which will consider the utility of the questionnaires across whole organisations and in different settings. The research will seek to inform the understanding of performance for doctors, thus further informing the process of standard setting. In addition, the research will refine and inform the content and presentation of the questionnaires in the light of earlier experience, and will inform the guidance to be given to doctors regarding the sampling of patients and colleagues who might be suitable to comment on their professional practice as part of the revalidation process.
Reference: Campbell JL, Richards SH, Dickens A, Greco M, Narayanan A, Brearley S. Assessing the professional performance of UK doctors: an evaluation of the utility of the GMC patient and colleague questionnaires. Qual Saf Health Care, June 2008;17:187-93.
GMC notes
Revalidation is the process by which doctors will, in future, demonstrate to the GMC on a regular basis that they remain up to date and fit to practise. Revalidation has three elements:
- To confirm that licensed doctors practise in accordance with the GMC’s generic standards (re-licensing).
- To confirm that doctors on the GMC’s specialist register or GP register continue to meet the standards appropriate for their specialty (re-certification).
- As a backstop, to identify for further investigation, and remediation where appropriate, doctors whose practice is impaired or may be impaired.