UK General Medical Council Research Articles

GMC closes inquiry into troubled Aberdeen hospital

A lengthy investigation by the UK General Medical Council into the conduct of senior doctors at Aberdeen Royal Infirmary has concluded without any action being taken. The inquiry was prompted by two critical reports issued in late 2014 by Healthcare Improvement Scotland and the Royal College of Surgeons of England into problems at the hospital, the largest in the NHS Grampian area. The reports found serious …

Interpreting multisource feedback: online study of consensus and variation among GP appraisers.

GPs collect multisource feedback (MSF) about their professional practice and discuss it at appraisal. Appraisers use such information to identify concerns about a doctor's performance, and to guide the doctor's professional development plan (PDP). To investigate whether GP appraisers detect variation in doctors' MSF results, and the degree of consensus in appraisers' interpretations of this information. Online study of GP appraisers in north-east England. GP appraisers were invited to review eight anonymised doctors' MSF reports, which represented different patterns of scores on the UK General Medical Council's Patient and Colleague Questionnaires. Participants provided a structured assessment of each doctor's report, and recommended actions for their PDP. Appraiser ratings of each report were summarised descriptively. An 'agreement score' was calculated for each appraiser to determine whether their assessments were more lenient than those of other participants. At least one report was assessed by 101/146 appraisers (69%). The pattern of appraisers' ratings suggested that they could detect variation in GPs' MSF results, and recommend reasonable actions for the doctors' PDP. Increasing appraiser age was associated with more favourable interpretations of MSF results. Although preliminary, the finding of broad consensus among GP appraisers in their assessment of MSF reports should be reassuring for GPs, appraisers, and employing organisations. However, if older appraisers are more lenient than younger appraisers in their interpretation of MSF and in the actions they suggest to their appraisees as a result, organisations need to consider what steps could be taken to address such differences.

Lessons from a Balint group scheme led by psychiatry trainees for year 3 bristol medical students on their medicine/surgery placements

BackgroundThe UK General Medical Council highlights the centrality of effective communication, reflective practice and the doctor-patient relationship in medical practice. A decline in empathy has been documented as occurring within clinical and early postgraduate years, potentially affecting diagnostic processes and patient engagement. Access to Balint groups can enhance awareness of the patient beyond the medical model, but remains limited at many UK medical schools. This scheme offered Balint groups to Bristol medical students in their first clinical year, demonstrating that this method is relevant beyond psychiatry.MethodsInitial focus groups with medical students indicated that many felt unable to discuss distressing aspects of clinical encounters. During 2013-2014, a Balint scheme run by psychiatry trainees was started for 150 students in their psychiatry placements. During 2014-15, the scheme was introduced to all third-year medical students on their medicine/surgery placement. Balint leaders have group supervision with a psychoanalytic psychotherapist. Evaluation of the scheme was based on pre-and post-group questionnaires and leaders’ process notes.ResultsSixteen groups led by 12 trainees were run twice over the year to serve 246 medical students. Two example cases are discussed here. Students appreciated the chance to discuss complex encounters with patients in a supportive peer environment, and work through a range of emotionally challenging issues.ConclusionsNovel aspects of this work include the implementation of Balint groups within medicine and surgery placements; the enrolment of psychiatry trainees as leaders with group supervision and leadership training workshops from the UK Balint Society; and the scale of the scheme.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Survey of medical students' use of social media.

Medical students are not sufficiently knowledgeable about the dangers of online social media, and education about how to use it responsibly may be beneficial. We conducted an online questionnaire to assess whether or not medical students in years 2-6 of study at the University of Oxford would intuitively know what doctors should and should not do on social media. We also assessed whether the study intervention of sending out guidance about appropriate use of social media published by the UK General Medical Council (GMC) would improve students' knowledge of how to use social media correctly. We found that, although social media use was widespread among medical students, the majority were unaware of GMC guidance on this issue. Administration of GMC guidance significantly improved the proportion of GMC-correct responses in four of 16 questionnaire items. Medical students are not sufficiently knowledgeable about the dangers of online social media It is possible that educating medical students about the dangers of online social media, and how to use it appropriately, could be worthwhile.

An audit of consenting practices in a district general hospital. Can we improve?

Informed consent, as the declaration of patients' will, forms the basis of legality of medical procedures. A standard form based on the Department of Health model is widely used in the National Health Service (NHS). The aim of this audit process was to assess the current consent practice in comparison to the UK's General Medical Council guidance and local policy and make any appropriate improvements. 254 adult consent forms were reviewed during the patients' admission. Data collected included legible documentation, grade of health professional completing the consent form, providing additional written information, use of abbreviations, securing the consent form in the medical records and, providing a copy to the patient. After initial assessment, interventions in an attempt to improve adherence to guidelines were introduced. A repeat audit of a further set of 110 notes was completed to assess the effectiveness of our interventions. Our baseline assessment of 254 consent forms comprised of 198 (78%) elective and 56 (22%) emergency procedures. 87 (34%) consent forms were secure in the medical records. Grade of health professional was recorded in 211 (83%). 191 (75%) forms were legible. 48 (19%) patients were given copy of the consent. Only 24 (9%) patients were given additional written information. Abbreviations were used in 68 (27%) forms. Only 12 (5%) of consent forms met all criteria simultaneously. Re-audit after intervention assessed 110 consent forms; 30 (27%) for elective and 80 (72%) for emergency procedures. 52 (47%) of consent forms were secure in medical records, grade of health professional was recorded in 94 (85%), 101 (75%) forms were legible, 42 (38%) patients received copy of consent and 41 (37%) of patients received additional written information. Initially only 5% of consent forms completely met GMC guidelines. This demonstrates an alarmingly poor adherence to such guidance that plays a vital role in patient safety, patient ethics autonomy, not to mention potential medico-legal and clinical governance implications for surgical practice. Our intervention has improved the quality of consenting within our hospital according to these guidelines. With these interventions set to continue and further develop, we expect that the quality of the consenting process will continue to provide patients with all that it is designed to.

The CanMEDS scholar: the neglected competency in tomorrow's doctors.

Dear editor In 1996, the Royal College of Physicians and Surgeons of Canada proposed a competency-based framework describing the core competencies of specialist physicians, one of which was a scholar.1 The UK General Medical Council has since provided advice on developing teachers and trainers in undergraduate medical education.2 However, guidance about how to most effectively incorporate this advice into the medical curriculum remains unclear. Everyone within medical education and academia has a role and responsibility to play in promoting a healthy and positive research culture that is conducive to the training of young scientists and doctors.3 It is imperative for students to learn how irresponsible research practice may hinder scientific progress4 or cause undue harm to society at large such as the well-publicized, and now disproved and discredited, case of a purported link between autism and the measles, mumps and rubella vaccine.5 Unfortunately, many universities do not sufficiently teach students how to become a good researcher, how to publish successfully, or how to conduct responsible research. A recent survey of a cohort of 515 UK medical students found that only 22% of students had been taught how to write a paper and only 30% had been taught how to write an abstract.6 This study also identified that only 12% of students surveyed had any experience of applying for ethics committee approval for a research project,6 thus raising concerns about whether students are aware of the different types of research necessitating ethics approval and the types of research that do not require ethics approval. The lack of training related to research methodologies and publications led the International Federation of Medical Students’ Associations to organize its first pre-General Assembly workshop during their meeting in Tunisia in March 2014, with the aim of providing insight into good research practice and dissemination of results. Moreover, in the last 20 years, with the advent of the Internet and the diffusion of accessible computing among the masses, we have witnessed a total revolution in the dissemination of information. The advantages of new technologies from social networking to artificial intelligence and from big data exchange to mobile processing are now everyday concepts that define the scientific landscape within which current medical students work. As such, it is vital that medical students continue to have the opportunity to develop scholarly principles early on in their careers, as this will promote a lifelong commitment to reflective learning and dissemination and application of evidence-based medicine.1

Surgeon length of service and risk-adjusted outcomes: linked observational analysis of the UK National Adult Cardiac Surgery Audit Registry and General Medical Council Register.

To explore the relationship between in-hospital mortality following adult cardiac surgery and the time since primary clinical qualification for the responsible consultant cardiac surgeon (a proxy for experience). Retrospective analysis of prospectively collected national registry data over a 10-year period using mixed-effects multiple logistic regression modelling. Surgeon experience was defined as the time between the date of surgery and award of primary clinical qualification. UK National Health Service hospitals performing cardiac surgery between January 2003 and December 2012. All patients undergoing coronary artery bypass grafts and/or valve surgery under the care of a consultant cardiac surgeon. All-cause in-hospital mortality. A total of 292,973 operations performed by 273 consultant surgeons (with lengths of service from 11.2 to 42.0 years) were included. Crude mortality increased approximately linearly until 33 years service, before decreasing. After adjusting for case-mix and year of surgery, there remained a statistically significant (p=0.002) association between length of service and in-hospital mortality (odds ratio 1.013; 95% CI 1.005-1.021 for each year of 'experience'). Consultant cardiac surgeons take on increasingly complex surgery as they gain experience. With this progression, the incidence of adverse outcomes is expected to increase, as is demonstrated in this study. After adjusting for case-mix using the EuroSCORE, we observed an increased risk of mortality in patients operated on by longer serving surgeons. This finding may reflect under-adjustment for risk, unmeasured confounding or a real association. Further research into outcomes over the time course of surgeon's careers is required.

Effective foundation trainee local inductions: room for improvement?

We aimed to evaluate whether UK foundation trainees receive local unit inductions, and their timing, content and value. We used published literature and guidelines from the UK's General Medical Council (GMC) and National Health Service Litigation Authority (NHSLA) to identify key topics to be covered at the induction. We surveyed all foundation doctors in the North Western Foundation School and used questionnaires to assess inductions for the posts starting in December 2011. The total response rate was 45 per cent, but this covered 100 per cent of the programmes and departments in the school: 22 per cent received an induction before their post; 10 per cent received no induction whatsoever. There was a large difference between how useful trainees find most topics and how often they were provided. Some departments use more interactive formats in induction, such as e-learning and practical workshops. Overall, trainees expressed very positive views about the potential value of inductions, and 88 per cent felt that inductions should be standardised. Trust monitoring of inductions often appears to be unreliable. Timely, good-quality inductions can potentially reduce service delays and improve patient safety. Inductions currently appear not to be prioritised in the trusts studied, and they are not focused on the needs of trainees. Local inductions are currently suffering from a lack of guidelines into their implementation. From this study we have drawn up a set of guidelines for local induction and a template for an induction booklet. We recommend inductions should contain a minimum set of essential topics, be multidisciplinary, include more trainee input and be monitored more effectively.

Core competencies in teaching and training for doctors in Scotland: a review of the literature and stakeholder survey

Background: The UK General Medical Council requires all registered doctors to be competent in all areas of their work, including teaching and training.Aims: The current research sought consensus on core competencies for all consultants and GPs involved in teaching and training in Scotland.Method: A draft list of 80 competencies was developed from the literature and made available as a survey to all consultants and GPs with teaching roles and all final year speciality trainees working in Scotland. Respondents rated the importance of each competency and provided free text comments.Results: There were 1026 responses. Eighteen competencies were rated as “high priority”, and are recommended as a baseline for all doctors involved in teaching and training; 55 were rated as “medium priority”, and are recommended in relation to specific teaching and training roles; and 7 were rated as “low priority”. Free text responses suggested the topic was controversial and emotive, and emphasised the importance of further work to engage trainers.Conclusions: The findings appeared to have face validity, and it was felt these could be used as the basis for developing a “Scottish Trainer Framework” for doctors and others involved in teaching and training in Scotland.

Systematic review of new medics' clinical task experience by country.

ObjectivesThere is a need for research which informs on the overall size and significance of clinical skills deficits among new medics, globally. There is also the need for a meta-review of the similarities and differences between countries in the clinical skills deficits of new medics.DesignA systematic review of published literature produced 68 articles from Google/Google Scholar, of which nine met the inclusion criteria (quantitative clinical skills data about new medical doctors).ParticipantsOne thousand three hundred twenty-nine new medical doctors (e.g. foundation year-1s, interns, postgraduate year-1 doctors).SettingTen countries/regions.Main outcome measuresOne hundred twenty-three data points and representation of a broad range of clinical procedures.ResultsThe average rate of inexperience with a wide range of clinical procedures was 35.92% (lower confidence interval [CI] 30.84, upper CI 40.99). The preliminary meta-analysis showed that the overall deficit in experience is significantly different from 0 in all countries. Focusing on a smaller selection of clinical skills such as catheterisation, IV cannulation, nasogastric tubing and venepuncture, the average rate of inexperience was 26.75% (lower CI 18.55, upper CI 35.54) and also significant. England presented the lowest average deficit (9.15%), followed by New Zealand (18.33%), then South Africa (19.53%), Egypt, Kuwait, Gulf Cooperation Council countries and Ireland (21.07%), after which was Nigeria (37.99%), then USA (38.5%) and Iran (44.75%).ConclusionA meta-analysis is needed to include data not yet in the public domain from more countries. These results provide some support for the UK General Medical Council’s clear, detailed curriculum, which has been heralded by other countries as good practice.

Annual Review of Competence Progression (ARCP) performance of doctors who passed Professional and Linguistic Assessments Board (PLAB) tests compared with UK medical graduates: national data linkage study

Objective To determine whether use of the Professional and Linguistic Assessments Board (PLAB) examination system used to grant registration for international medical graduates results in equivalent postgraduate medical performance, as...

Using simulation for prescribing: an evaluation

Drug errors are a major cause of patient morbidity. The UK General Medical Council has highlighted that prescribing teaching should be prioritised. How should medical teachers best teach the practical aspects of prescribing? We piloted a set of eight prescribing simulation tutorials for 35 final-year undergraduate medical students in Great Western Hospital, Swindon, UK. Students completed baseline questionnaires addressing confidence levels in prescribing. They then prescribed independently for simulated cases of common medical emergencies within tutor-led tutorials (n=17) or self-directed prescribing tutorials (n=18). Confidence scores and numbers of drug errors were documented at baseline and following four tutorials. Drug errors were categorised according to potential harm. Students then swapped to receive the alternative tutorial type. Both tutorial types resulted in a statistically significant decrease in the number of unsafe drug errors: from 57 to three in the tutor-led group (p=0.003) and from 60 to 14 in the self-directed learning group (p=0.001). Both tutorial types led to statistically significant increases in confidence scores for global prescribing, prescribing in medical emergencies and managing medical emergencies (with a median increase of one point on a modified Likert scale). Confidence using the British National Formulary improved, but reached statistical significance for the self-directed group only. Simulating cases and using real drug charts is an effective method for improving students' prescribing ability and confidence in common medical emergencies. Tutorials like these, whether tutor-led or self-directed, could be incorporated into medical curricula. This could help prevent drug errors in practice, thereby improving patient care and safety.

Evaluating PLATO: postgraduate teaching and learning online

The use of the Internet as a teaching medium has increased rapidly over the last decade. PLATO (postgraduate learning and teaching online) was launched in 2008 by the e-learning unit (ELU) of Wales Deanery. Located within Learning@NHSWales, a Moodle virtual learning environment (VLE), it hosts a wide range of freely available courses and resources tailored to support the education, training and continuing professional development (CPD) needs of health care professionals working across the National Health Service (NHS) Wales. The evaluation aimed to identify the costs and benefits of PLATO, report its value as attributed by users, identify potential cost savings and make recommendations. Five courses (case studies) were selected, representing the range of available e-learning resources: e-induction; fetal heart monitoring; cervical screening; GP prospective trainers; and tools for trainers. Mixed methods were used: one-to-one qualitative interviews, focus group discussions and surveys explored user views, and identified individual and organisational value. Qualitative findings identified six key areas of value for users: ELU support and guidance; avoidance of duplication and standardisation; central reference; local control; flexibility for learners; and specific features. Survey results (n=72) indicated 72 per cent of consultants reported that PLATO was easy to access and user friendly. E-learning was rated as 'very/important' for CPD by 79 per cent of respondents. Key challenges were: access, navigation, user concerns, awareness and support. PLATO supports education and helps deliver UK General Medical Council standards. Future plans should address the suggested recommendations to realise cost savings for NHS Wales and the Wales Deanery. The findings have wider applicability to others developing or using VLEs.

Revalidation: Patients or process? Analysis using visual data

Revalidation is a significant recent regulatory policy reform from the UK General Medical Council and being considered elsewhere around the world. The policy aims to regulate licensed doctors to ensure that they are ‘up-to-date and fit-to practise’. Fundamental to the policy is that the revalidation of doctors should benefit patients and improve doctor–patient relationships. As part of an evaluation of the development of revalidation, 31 policy makers involved in its development were interviewed in 2010–2011 and were asked to draw what revalidation meant to them. From this, 29 drawings were produced and this article focuses on their analysis. The drawings emphasised abstract systems and processes, with a distinct lack of interpersonal interactions or representation of individual patients and doctors. Only 3 of the 29 images included individual patients and doctors. This depersonalisation of policy is examined with respect to the purported key objective of revalidation to benefit patients. Using a distinctively different modality, the drawings serve to confirm the two key discourses of regulation and professionalism prevalent in the interview data, while highlighting the notable absence of the patient. The benefits and limitations of using drawings as a research method are discussed for a health policy context.

GPAQ-R: development and psychometric properties of a version of the General Practice Assessment Questionnaire for use for revalidation by general practitioners in the UK

BackgroundThe General Practice Assessment Questionnaire (GPAQ) has been widely used to assess patient experience in general practice in the UK since 2004. In 2013, new regulations were introduced by the General Medical Council (GMC) requiring UK doctors to undertake periodic revalidation, which includes assessment of patient experience for individual doctors. We describe the development of a new version of GPAQ – GPAQ-R which addresses the GMC’s requirements for revalidation as well as additional NHS requirements for surveys that GPs may need to carry out in their own practices.MethodsQuestionnaires were given out by doctors or practice staff after routine consultations in line with the guidance given by the General Medical Council for surveys to be used for revalidation. Data analysis and practice reports were provided independently.ResultsData were analysed for questionnaires from 7258 patients relating to 164 GPs in 29 general practices. Levels of missing data were generally low (typically 4.5-6%). The number of returned questionnaires required to achieve reliability of 0.7 were around 35 for individual doctor communication items and 29 for a composite score based on doctor communication items. This suggests that the responses to GPAQ-R had similar reliability to the GMC’s own questionnaire and we recommend 30 completed GPAQ-R questionnaires are sufficient for revalidation purposes. However, where an initial screen raises concern, the survey might be repeated with 50 completed questionnaires in order to increase reliability.ConclusionsGPAQ-R is a development of a well-established patient experience questionnaire used in general practice in the UK since 2004. This new version can be recommended for use in order to meet the UK General Medical Council’s requirements for surveys to be used in revalidation of doctors. It also meets the needs of GPs to ask about patient experience relating to aspects of practice care that are not specific to individual general practitioners (e.g. receptionists, telephone access) which meet other survey requirements of the National Health Service in England. Use of GPAQ-R has the potential to reduce the number of surveys that GPs need to carry out in their practices to meet the various regulatory requirements which they face.

Initial agreement is reached on EU rules on professional mobility

EU institutions have hammered out an initial agreement on a directive that would make it easier for EU doctors to practise in other European countries. Full details of the directive on the mutual recognition of professional qualifications are not yet available, but the deal is understood to cover all the substantive proposals set out in the draft directive in December 2011.12 The draft directive agreed by the European parliament, the Council of Ministers (representing the member states), and the European Commission will allow the UK General Medical Council to …

Teaching skills training for medical students

The UK General Medical Council has recommended that medical students be taught how to teach; however, the current state of teaching skills training in England has not yet been investigated. To explore the current state of undergraduate teaching skills training at medical schools in England. A questionnaire survey was sent to all 24 medical schools in England, enquiring about the basic structure, content areas, staffing, delivery and assessment methods of compulsory courses. A response rate of 22/24 (92%) was achieved, and 18/22 (82%) of the responding institutions offered some form of teaching skills training. The most frequently covered content areas were small group facilitation skills, large group teaching skills and use of effective feedback. Teaching was delivered by a combination of hospital doctors, non-physician educators or general practitioner educators in the majority of courses. Six of the nine (67%) compulsory courses featured student assessments. The main barriers to implementing these courses were staffing limitations, insufficient time and lack of student engagement. Our study demonstrates both the similarities and variation between undergraduate teaching skills courses across England. However, further research will be necessary to determine whether the long-term impact of such training will result in better educators, and ultimately in improved patient care.

Undergraduate teaching on biological weapons and bioterrorism at medical schools in the UK and the Republic of Ireland: results of a cross-sectional study

ObjectiveTo determine if individual undergraduate schools of medicine in the UK and the Republic of Ireland provide any teaching to medical students about biological weapons, bioterrorism, chemical weapons and weaponised...

Cases relating to anaesthetists handled by the UK General Medical Council in 2009: methodological approach and patterns of referral

The General Medical Council is the regulatory body charged with maintaining standards in the medical profession in the UK. We analysed cases relating to anaesthetists handled in 2009 using fitness-to-practise data, comparing them with the profession as a whole and examining patterns of referral. Complaints were made about 105 doctors practising in anaesthesia. The 81 anaesthetists who were investigated further were subject to a total of 225 separate allegations, median (IQR [range]) of 2 (1-3 ) allegations per anaesthetist. Anaesthetists had a lower rate of referral compared with doctors in general (0.095% vs 0.20%, respectively, p = 0.0001). They were less likely than doctors in general to be referred by an individual member of the public (27% vs 64%, respectively, p = 0.0001). As with other specialties, allegations were most commonly made about clinical care, probity and relationships with patients. On the basis of 2009 data, we calculated that a mean (95% CI) of 1 in 120 (1 in 100-145) doctors practising in anaesthesia in the UK will be referred to the General Medical Council every year. We have provided examples of allegations and made recommendations for maintaining good practice in anaesthesia.

Self-Other Agreement in Multisource Feedback: The Influence of Doctor and Rater Group Characteristics

Multisource feedback (MSF) ratings provided by patients and colleagues are often poorly correlated with doctors' self-assessments. Doctors' reactions to feedback depend on its agreement with their own perceptions, but factors influencing self-other agreement in doctors' MSF ratings have received little attention. We aimed to identify the characteristics of doctors and their rater groups that affect self-other agreement in MSF ratings. We invited 2454 doctors to obtain patient and colleague feedback using the UK General Medical Council's MSF questionnaires and to self-assess on core items from both patient (PQ) and colleague (CQ) questionnaires. Correlations and differences between doctor, patient and colleague mean feedback scores were examined. Regression analyses identified the characteristics of doctors and their rater groups that influenced self-other score agreement. 1065 (43%) doctors returned at least one questionnaire, of whom 773 (73%) provided self and patient PQ scores and 1026 (96%) provided self and colleague CQ scores. Most doctors rated themselves less favourably than they were rated by either their patients or their colleagues. This tendency to underrate performance in comparison to external feedback was influenced by the doctor's place of training, clinical specialty, ethnicity and the profile of his/her patient and colleague rater samples but, in contrast to studies undertaken in nonmedical settings, was unaffected by age or gender. Self-other agreement in MSF ratings is influenced by characteristics of both raters and ratees. Managers, appraisers, and others responsible for interpreting and reviewing feedback results with the doctor need to be aware of these influences.