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Evaluating the impact of assessing doctors’
performanceDr Julian Archer
NIHR Career Development Fellow& Clinical Senior Lecturer in Medical Education,Director of CAMERA, Consultant Paediatrician
Evaluating the impact of assessing doctors’ performance
Outline Why evaluate impact of assessment? Programmatic research into medical
revalidationSome earlier work
GMC revalidation evaluation framework
Why evaluate impact?
APA Validity framework – Five headings
Content Response process Internal structure Relationship to other
variables Consequences
Medical education Predominately all
validity areas except consequences
Why? Consequences are
Complex
Socio-political
Not positivistic
EVALUATING IMPACT OR ‘CONSEQUENCES’
Programmatic approach to evaluation
What is Revalidation?
What is the meaning of Revalidation?
The Literature
Policy makers
What are the intended and unintended consequences of Revalidation in practice?
Ward/Theatre/Lab
GP
Appraisees &Appraisers
Focus groups
•To provide an understanding of Revalidation translational to policy, education and practice
•To shape and propose positive consequences while minimising negative consequences of Revalidation•To disseminate positive responses about Revalidation in order to shape future national policy
Stage 1 - Policy Stage 2 - Practice Stage 3 - Public
Private Practice
Research Questions
Setting
MethodSystematic
ReviewInterviewee
drawings
Methodology
What is the impact of Revalidation on the relationship between the profession and society?
Patients
Journalist InterviewsAnalysis of
Media
Outputs
Visual anthropology
Mental Health
Patient Focus
Groups
Video appraisals
Appraisee Interviews
Media
Activity TheoryConversation
Analysis
•Ascertain the messages that the public are getting from the media•Develop communication about Revalidation more cost effectively
Discourse analysis
STAGE 1
What is Revalidation in policy? - To explore the origins, definitions, and potential purpose of Revalidation
Methods
Policy review starting from the Merrison report (1975)
31 unique elite interviews leading members of Revalidation policy
development ranged from the leaders past and present of main stakeholder bodies such as the GMC, AoMRC, BMA, NHS Employers, 4 DHs
Discourse
PROFESSIONALISMDriven by a professional
movement for reformInternally motivated
Evolutionary DevelopmentThe Quality Agenda: for patientsRestore/maintain confidence by continuing to elevate standards
AppraisalFormative Development
Ongoing evaluation (process)Up-to-date
REGULATION Driven by medical scandal
Externally motivatedRevolutionary change requiredThe Safety Agenda: for patients
Reassurance by measuring against a fixed standard
Clinical GovernanceSummative Judgment
Point-in-time Decision (product)Fit-to-practise
PATIENTS
DEVELOPING EVALUATION FRAMEWORKS
Working with the GMC
Methods – evaluative cycle
Literature
Interviewed major stakeholders
Worked with GMC (Main stakeholder)
Develop evaluative questions
Develop possible methods for an initial pilot
Step 1: Engage stakeholders
Step 2: Describe the programme
Step 3: Focus the evaluation question
Step 4: Gather credible evidence
Hansen HF. Choosing Evaluation Models: A Discussion on Evaluation Design. Evaluation. 2005;11:447-462.
Stakeholder interview themesImportance of evaluation
“people who go through the process…without any thought of what it actually represents and how it might actually add value to the system”
What is revalidation for? Drive-up standards (performance improvement) vs.
picking out ‘bad apples’
Appraisal “to get inside the closed door of appraisal”
RO judgements “I’m not sure exactly how the RO’s decision is made”
SummaryImpact or consequences of assessment is an important part of validity evidence
Complex
Programmatic research required (drawing on theoretical perspectives)
Acknowledgements and thanks
Colleagues Sam Regan de Bere CAMERA team
Funders NIHR The Health Foundation General Medical
Council
Evaluating the impact of assessing doctors’ performance
[email protected]@plymouth.ac.uk
www.plymouth.ac.uk/peninsula/research/camera
Twitter: @CAMERAPUPSMD