Greenhalgh and Wong's editorial1 on revalidation is timely and important. I have just completed a so-called ‘Strengthened Medical Appraisal’ or SMA, and found the experience not only infuriatingly clumsy in terms of its online functionality, but pathetically irrelevant to my own sense of what it is to be, I hope, an adequate GP. And, just as Greenhalgh and Wong foresee, the requirement for this annual exercise is very likely to dissuade me from continuing in practice part-time following my retirement in May.
At the heart of the appraisal process is the matching of ‘supporting information’ to 12 ‘attributes’ clustered into four ‘domains’, the idea being that by filling in all the gaps over the 5-year revalidation cycle one thereby demonstrates oneself to be a fully-rounded and competent practitioner. Each year the ‘personal development plan’ is designed to fill in the missing gaps, while conscientious ‘reflection’ serves to consolidate the learning process. The problem, for me at least, is that this approach bears absolutely no relation to how I have spent my past quarter-century.
I believe myself to have internalised professional standards, imbued through training and subsequent experience, that I would find difficult to put into words (although I did try a few years ago2), but whose maintenance is a matter of personal pride. I expect to be judged by colleagues and patients, and like to think that I am aware of my shortcomings. As for my professional development, I have pursued various interests down the years, including a spell as a trainer, but rarely have I had a clear plan; chance and opportunity have played a greater part.
By all means let us build audit, significant event monitoring, and some form of feedback into our practice organisation; and let us admit that a regular objective test of our knowledge-base should be a requirement to continue in practice. But let's not allow ourselves to be cowed into the bureaucratic, prescriptive, painting-by-number exercise that is currently being foisted on us.
I cannot resist ending by pointing out that SMA is also the name of an infant formula. Coincidence or rich irony?
- © British Journal of General Practice, May 2011