TY - JOUR T1 - Regulation: appraisal alone is not enough JF - British Journal of General Practice JO - Br J Gen Pract SP - 80 LP - 81 DO - 10.3399/bjgp08X264027 VL - 58 IS - 547 AU - Maurice Conlon Y1 - 2008/02/01 UR - http://bjgp.org/content/58/547/80.abstract N2 - Until now, the ultimate goal of medical training has been to achieve the right to independent medical practice. The prime benefit of this has been the professional ability of a doctor to think, speak, and act objectively, purely in the interest of clinical benefit, and free from corporate constraint. The noxious side effect has been a litany of medical scandals, well documented elsewhere, where doctors, both misguided and malicious, have become the agents of harm. The challenge for a new regulatory process is to eliminate the latter while preserving the former.The introduction of appraisal for all NHS doctors was an excellent first step in addressing this challenge for several reasons. Firstly, it is a universal process following a standard format. Secondly, it has broadened the remit of professional development to include all aspects of good medical practice, not just maintenance of knowledge. And thirdly, it has begun with the premise that most doctors are diligent and honest, and will voluntarily bring the important issues to their appraisal.This is not to say that appraisal has solved the problem. Although universal, there is inconsistent implementation. The dawning of realisation that professional development goes beyond knowledge has been slow, so that there remain too few learning resources around subjects such as teamwork and probity. And, partly because we choose what we present in appraisal by way of evidence, and partly because at its heart appraisal is a developmental activity, there remains the question of how we assure that individual doctors meet acceptable standards of practice.These contradictions are part of the reason why researchers such as Colthart et al end up with the results … ER -