Medical Appraisal and Revalidation 2021-2022
To retain your license to practice you usually need to have an appraisal every year and to revalidate every five years. The GMC says, “Revalidation assures patients and the public that doctors remain up to date and fit to practise, in line with the standards of practice required in the UK. It is founded on the principle that you have met the professional expectations placed on you as a doctor practising in the UK. You have a professional obligation to give an honest and comprehensive picture of your whole practice for revalidation.”
How to revalidate
Regulations require you to engage with the following revalidation processes:
Guidance on the appraisal of clinical informaticians
The following guidance is intended for all doctors working in clinical informatics, whether or not informatics is their primary role, their appraisers and responsible officers.
Since the introduction of revalidation, the Medical Royal Colleges and Faculties have worked with the Academy of Medical Royal Colleges and the General Medical Council (GMC) to provide guidance for doctors on appraisal and revalidation. Updated guidance was published in 2018 by the GMC and the Academy and form the basis of the FCI’s expectations for revalidation.
The GMC has outlined that medical appraisals for revalidation must be based on Good Medical Practice (GMP). There are six types of supporting information that you are expected to provide across your whole scope of practice for your annual appraisal for revalidation.
Keeping up to date:
Continuing professional development
Review of your practice:
Quality improvement activities
Feedback on your practice:
Feedback from patients or those to whom you provide medical services
Compliments and complaints
The AoMRC framework document, Supporting information for appraisal and revalidation (2019), provides detail on how you can fulfil GMC requirements whilst protecting time for your core professional activities. The FCI aims to develop supplementary faculty-specific advice to be read alongside the Academy framework.
By providing a range of good quality supporting information over the revalidation cycle and through reflection and discussion at your appraisals you should have evidenced your whole scope of practice against all the domains and attributes of GMP. A key output of your appraisal is the summary of your appraisal discussion, which is agreed between you and your appraiser and structured around the four GMP domains.
Across the revalidation cycle, appraisals should consider the whole scope of practice. Clinical informatics is a diverse discipline operating across the whole cycle of information processes, programmes, products and projects, bringing benefit to people and users at service, system and population levels. Clinical informatics is a specialist skill set that colleagues and patients may not easily understand, indeed phase 1 of the Faculty’s Core Competencies Project (CCP) found that there remains confusion about the ‘what’ and ‘who’ of clinical informatics (2020). This applies to doctors as much as other professionals and may mean that the clinical informatics aspects of a doctor’s practice may not be adequately considered within the appraisal.
The CCP Phase 1 Summary Report included the following statements which, in the context of revalidation, may help appraisees and appraisers to clarify whether a doctor’s role may be considered to fall within the description of clinical informatics.
Clinical Informatics is the interdisciplinary study of data, information and computing technology (ICT) and communication with respect to human health and wellbeing; including understanding, developing, integrating, applying, evaluating and closing ICT innovations to advance comprehension of human health and wellbeing, and the delivery of health and social care.
The FCI definition of clinical informatician is: Uses unique knowledge and experience of person-centred care and informatics concepts, methods and tools to promote care that is safe, effective, efficient, timely, person centred and equitable.
A doctor’s role in clinical informatics is often interdisciplinary and the CCP noted that the role may include the following areas, amongst others:
How people interface with ICT in health and social care, including electronic record systems, apps and remote devices
Collect, manage, analyse and provide security for data
Clinical decision support, safety alerts, and data visualisation to facilitate health care delivery
Innovative communications with patients to facilitate health care provision
Ethical and information governance frameworks, and data usage policies
Leadership, strategy and policy formation, and change management
Research, design, implementation, evaluation and regulatory compliance of emerging technologies
Education and training
The nature of clinical informatics means it is particularly important for doctors to ensure that they are working within an effective and safe governance framework because of the potential to have a great impact on patient services or health protection. GMC’s handbook, Effective clinical governance for the medical profession (2018), makes it clear that organisations have a responsibility to ensure their clinical governance arrangements support the medical workforce to practice safely and meet their professional obligations. Further, safeguards should be in place to ensure clinical governance arrangements for doctors are fair and free from bias and discrimination. The GMC handbook includes a template that doctors can use to self-assess whether their organisation is meeting the outcomes of effective clinical governance. Clinical informaticians who work as contractors rather than employees may be working outside a formal clinical governance structure and FCI suggests that doctors should reflect on such circumstances in their appraisal. Clinical informaticians working independently from their medical peers should consider what steps they can take to reduce professional isolation. The Faculty runs an informal mentoring scheme which can provide support and more information is available at https://facultyofclinicalinformatics.org.uk/professional-mentoring-scheme .
In order to support appraisal and revalidation of clinical informaticians, the FCI has developed a framework to provide guidance for doctors and their appraisers and responsible officers on the core professional attributes described by the CCP.
The behaviours laid out in the FCI Medical Appraisal and Revalidation Framework below would be appropriate to reflect on in preparation for appraisal, discuss in the appraisal meeting, and reference in the appraisal summary. Within each of the Good Medical Practice domains, the FCI framework is in four parts. First, the GMC requirements for all appraisals are listed and then the professional attributes of clinical informaticians as described by the CCP are noted. These are followed by indicative activities that are likely to be relevant to doctors practising clinical informatics and which link to the FCI’s mission, values and objectives and GMC guidance. Lastly, good leadership behaviours in clinical informatics are included that may be relevant for the doctor to reflect on and discuss with their appraiser. Leadership attributes are included primarily because effective clinical leadership is key to ensuring the protection of patient safety and also because doctors of all grades may be seen as leaders in multidisciplinary settings. Appraisers and responsible officers can find comprehensive information about competencies in clinical informatics in the Core Competency Framework developed by the University of Manchester and the FCI.
Whilst appraisal is a GMC requirement, a key purpose is to promote good practice and professional development. FCI believes that appraisal should be supportive and encourage continued improvement in the appraisee’s practice. The framework is intended to add value to the appraisal discussion by supporting appraisal preparation and written reflection with the aim of professional development and should not be used as a checklist.
The framework and this document will be reviewed in September 2021. The FCI would like to acknowledge that the style of the framework draws from Faculty of Medical Leadership and Management guidance (2015).
Your revalidation recommendation
Multi-source feedback for revalidation
Formal Multi-Source Feedback (MSF) is a requirement of medical revalidation and must be undertaken once in each revalidation cycle. The General Medical Council (GMC) says that for your revalidation you must collect, reflect on, and discuss at your appraisal feedback from patients and colleagues across the whole scope of your practice.
Where a doctor does not provide medical services to patients there is no requirement to undertake a patient feedback survey but all doctors must undertake colleague feedback and the GMC says that the questionnaires should be validated and independently administered whenever possible to maintain objectivity and confidentiality.
Many colleague feedback tools that are currently used for revalidation may not be optimally suited to clinical informaticians for various reasons including a focus on clinical contact with patients.
FCI has developed a colleague feedback tool for medical revalidation which meets GMC criteria and reflects the values and principles of GMC’s Good Medical Practice. The tool may be suitable for all doctors whose scope of practice includes clinical informatics, whether or not they provide medical services to patients.
Some designated bodies may mandate a particular MSF tool and doctors can discuss with their appraiser whether the FCI-approved MSF is appropriate for them. If there is any doubt doctors should confirm that the responsible officer is content. John Woodhouse, suitable person, accepts a range of MSF tools and has supported the development of the FCI-approved MSF indicators.
In seeking colleague feedback for revalidation purposes, you should try to ensure that you ask a range of colleagues that is representative of the people you work with and across the scope of your practice.
GMC requires that the MSF process includes a supported discussion either through appraisal or a separate feedback session. FCI advises that you include in your appraisal portfolio some written reflections on the feedback you have received, ready to discuss at your appraisal.
The FCI-approved indicators were developed iteratively from the core GMC indicators, with particular thanks to the Faculty of Occupational Medicine and members of the FCI education and standards committee. The aims included keeping the number of indicators low and the rating scale simple and that the tool should be equally suitable for those that do and don’t have direct contact with patients. GMC guidance on the development of questionnaires was reviewed for compliance.
The MSF is available at and can be viewed after registering with them. Registration is simple and free and there is a nominal charge for the survey which is payable once the survey is complete and you want to view the results report .
FourteenFish Ltd is a small UK company that specialises in providing appraisal toolkits and did not charge a set-up cost to FCI. A 10% discount is offered to FCI Members and Fellows.
The MSF tool will be kept under review, if you would like to provide constructive comments on it, please contact FCI.