Revalidation for anaesthetists
Every licensed doctor who practises medicine must revalidate
We provide a range of guidance and resources to assist with the supporting information requirements for revalidation.|
The GMC has announced that from 17 March 2020, doctors who are due to revalidate before the end of September will have their revalidation date deferred for one year. This will be kept under review and further deferrals will be made as necessary.
The GMC has made this decision to give responsible officers (ROs) and doctors more time to reschedule and complete appraisals, and to avoid the need for ROs to make revalidation recommendations during this time. Further information is available on the GMC website.
You may wish to review a series of FAQs which have been produced by the Academy of Medical Royal Colleges.
The GMC website also includes information on temporary registration for all doctors with a UK address who left the Register after March 2014 or who had registration but didn’t have a licence to practise.|
Introduced in 2012, revalidation is the process where all licensed doctors have to demonstrate to the GMC that they are up-to-date and fit to practise. It is based on a local evaluation of doctors' practice through appraisal, during which the following types of supporting information are reviewed:
- continuing professional development
- quality improvement activities
- significant events
- feedback on your practice from patients or those to whom you provide medical services, and from colleagues
- review of compliments and complaints.
The GMC recommends that doctors in specialist practice should consult the supporting information guidance provided by their College or Faculty. This guidance amplifies the headings provided by the GMC, by providing additional detail about the GMC requirements and what each college or faculty expects relating to this, based on their specialty expertise. These expectations are laid out under ‘Requirements’. Not all of the supporting information described needs to be collected every year, although some elements are required, or should be reviewed, annually. This is also stipulated in the document under ‘Requirements’.|
All of the Medical Royal Colleges and Faculties have worked with the Academy of Medical Royal Colleges to develop specialty-specific guidance on supporting information.
The RCoA version is available below.
Continuing Professional Development (CPD)
Continuing Professional Development (CPD) refers to any learning outside of undergraduate education or postgraduate training which helps doctors to maintain and improve their performance. It covers the development of knowledge, skills, attitudes and behaviours across all areas of the doctor's professional practice. It includes both formal and informal learning activities.
Examples of CPD include external activities: regional, national or international educational meetings organised by national bodies, specialist societies or commercial providers; internal activities: locally-organised teaching programmes and clinical governance meetings within the doctor's employing organisation; and personal study: reading of relevant books and journals, and e-Learning.
One credit or one point equates to one hour of learning activity and the RCoA recommends that doctors should complete a minimum of 50 hours CPD per year of which a minimum of 20 hours per year should be completed in each of external and internal activities. The key message is that over a five-year revalidation cycle there should be a balanced approach to the doctor's CPD across their whole scope of practice.|
Participation in and reflection upon CPD is one of the annual supporting information requirements for revalidation.
You can read the College guidance here.
RCoA resources to support CPD
The College offers a range of resources to support doctors with their CPD.
- CPD functionality within the Lifelong Learning platform for doctors to plan, record, reflect and report upon their CPD. Full information including user guides is available here.
- CPD event accreditation - a free of charge service for NHS Trusts and hospital boards, registered charities, specialist societies and associations. The benefits of CPD accreditation include that accredited events are featured in the Lifelong Learning Platform, on the College website and can use the Revalidation logo.
- BJA and BJA Education Online - the following journals are published by Elsevier and are available free of charge to Members of the College: The British Journal of Anaesthesia (BJA) and BJA Education (BJAEd). BJAEd offers an MCQ test for each article, for which a ‘pass’ generates a PDF certificate of completion, and reading the BJA online also counts as an approved CPD personal activity. Access details for BJA Education online are available here.
- Online learning with e-Learning Anaesthesia (e-LA) - e-LA is an interactive and engaging web-based learning resource developed by the Royal College of Anaesthetists in partnership with e-Learning for Healthcare (e-LfH). Phase 2 features 13 modules to support intermediate and higher specialist training including CPD for consultants.
- Webcasts - free video recordings of lectures (including lecture slides) from selected RCoA events which can be recorded as personal study for CPD credits.
Patient and Colleague Feedback
Feedback from patients and colleagues can provide doctors with information about their work through the eyes of those they treat and work with. It provides the opportunity for patients, non-medical co-workers and medical colleagues to comment on the professional skills and behaviour of a doctor, and in turn allows the doctor to reflect on this information for his or her professional development.This is one of the supporting information requirements for revalidation and at least one colleague and one patient feedback exercise should be undertaken in each five year revalidation cycle. The results from both should be included in a doctor's revalidation portfolio and discussed at appraisal. Full information is available in the College guidance.|
Licensed doctors are required to seek feedback from patients and colleagues using structured questionnaires at least once in every revalidation cycle. Further information is available below.|
Additional patient and colleague feedback resources
In addition to the above guidance, the College has developed, piloted and validated a questionnaire tailored specifically for the interaction between patients and their anaesthetist in the surgical setting. It is available to download in Word format and it has been approved for use by the GMC. A sample letter is also available which has been sent to patients with a reply-paid envelope to get responses. The College has not developed a colleague feedback questionnaire. Instead, the example questionnaire which has been produced by the GMC is recommended. This provides a template for other versions to get based.|
Returning to practice
The revalidation cycle allows for short periods of absence during a five year cycle. Some types of supporting information – such as colleague and patient feedback – don’t need to be collected each year and where doctors have been unable to collect sufficient supporting information, their Responsible Officer may recommend a deferment of their revalidation to the GMC in order to allow them sufficient time to address these gaps.
Where the period of absence will be longer, the GMC advises that doctors should consider giving up their licence to practise but maintaining their registration. This means that the doctor will remain in good standing and won’t need to revalidate, and we understand that the restoration of the licence to practise is a relatively quick process.
For both of the above approaches, it is advisable for doctors to keep their CPD in their clinical areas up to date as far as possible and there may be opportunities to do this via reading, e-Learning and ‘keep in touch days’ – consideration about a return to practice will need to be given to a doctor’s amount of time in practice before taking a break, as well as any CPD participated in during this period, both of which may affect the rate at which they return to their previous levels of confidence, competence and knowledge.
Further information including a framework of recommendations on how to make a successful return is available in guidance produced by the Academy of Medical Royal Colleges (AoMRC).|
Revalidation for anaesthetists in training
The GMC states that anaesthetists in training will revalidate by engaging in their training programme. This means they must engage in and meet the assessment and curriculum requirements of their training programme, and discuss their progress and learning needs with their educational supervisors (including any practice they do outside of their training programme). A revalidation recommendation will be made to the GMC confirming that the trainee is up to date and fit to practise. This recommendation will be made by their Responsible Officer based on their participation in the Annual Review of Competence Progression process, or equivalent. Further information is available on the GMC website.|
Revalidation Helpdesk – Advice for Doctors, Appraisers and Responsible Officers
We have established a telephone and email helpdesk, which can provide generic advice and can get help with specific circumstances. Questions regarding the processes underpinning revalidation, or help with finding the relevant guidelines and regulations, will be answered by non-clinical staff within the department, and can normally be dealt with very rapidly. Questions that require clinician input will be referred to a clinician adviser for a response – this may take a little longer.
Note: the College cannot become directly involved in the decision-making process regarding a revalidation recommendation. However it can provide advice on the standards expected by the College in a given situation or set of circumstances. Advisers will act in good faith although it is inherent in a process like this that there could be differences in opinion or interpretation. All enquiries should be made by email and sent to: email@example.com.|
No, there is no requirement that the appraiser works in the same specialty. An appraiser will be required to verify and validate the specialty supporting information presented by an appraisee during the appraisal discussion. Much of the discussion will be generic but another anaesthetist may have greater insight into the issues and skills expected. Where the appraiser is from a different specialty the College has developed guidance on the supporting information requirements for revalidation.
The College does not view maintenance of competence in terms of the 'number of sessions or days per week'. Rather, competence is based on a mixture of demonstrating ongoing practice at a level proportionate to training, self-audit of practice, quality improvement and reflection.
Whilst 'direct clinical care' can and does include time spent in peri-operative care, clinics, etc. (and not just time spent in the operating room), the range of activities actually performed will determine the individual's 'scope of practice'. Competence is something therefore maintained within this scope of practice and not always transferrable across domains.
All of these factors pertaining to competence and scope of practice, should be assessed within the annual appraisal process, where the necessary attesting evidence can be reviewed. That said, our data suggest that few if any practising anaesthetists undertake less than an average of one day per week in intraoperative care.
No, you do not have to document all your learning activities, but you do need to document enough to give assurance that you are keeping up-to-date in the work that you are doing. We recommend that you focus on the quality not quantity of your supporting information. You should be selective about documenting your reflection on your most valuable and meaningful learning, over the course of the year. If you find it convenient and helpful to record extensively all of your CPD for your own benefit to capture your learning then that is your choice, but your appraiser will focus on the quality of your learning and reflection.
If you work part-time you will be expected to revalidate in the same way as full time doctors, including participating in annual appraisal and collecting supporting information in relation to the practice that you do.
If you work across different specialties you will ideally, where possible, have one annual appraisal, which covers all your roles and scope of your practice. This is known as a ‘whole practice appraisal’. Your annual appraisal must cover the whole scope of your practice; therefore you should collect information to represent all aspects of your professional work across both specialties.
You may need to refer to the specialty specific guidance from different Medical Royal Colleges or Faculties; for example if you are working as a GP and as a specialist physician, you will need to take into account the requirements set out by both the Royal College of General Practitioners and the Royal Colleges of Physicians, and your revalidation portfolio and appraisal will need to cover both areas of work.
If you are on the specialist register but are working only in primary care you will not have to provide supporting information in relation to your specialty practice. You will only need to provide evidence for your primary care work.
Your licence to practise and the process of revalidation do not restrict you to working in a particular specialty or field of practice. Revalidation is not about demonstrating that you are up to date in a specific field, but that you are up to date and fit to practice in your current field(s) across your current scope of work.
It is expected that some doctors may change specialties within the five years, and their revalidation will not be affected by this – the types of information will remain the same, but the detail of the supporting information will differ. You will need to discuss your practice changes at appraisal and start collecting supporting information in relation to your new area of practice.
If you choose to continue to hold your licence while practising abroad, you will have to revalidate in the same way as doctors practising in the UK, and link to a UK designated body. If your employer or contractor is based within the UK it may be that they will be able to provide you with a link to a Responsible Officer, and you should discuss your revalidation with them at the earliest opportunity.
If you have not already done so, you should confirm your current circumstances with the GMC through your GMC online account, so that the GMC can provide you with appropriate advice.
However, doctors who are based exclusively overseas do not need a license to practise in the UK. The licence to practise gives doctors legal rights and privileges in the UK that do not apply in any overseas country. Doctors who are based overseas must abide by whatever regulatory requirements exist in the country in which they practise.
You can relinquish your licence to practise whilst working abroad and reinstate it on return to the UK. Once your licence is restored, you would need to link to a designated body, participate in annual appraisal in the UK and provide supporting information in line with guidance. Any relevant information gathered while working abroad, as well as evidence of ongoing CPD, should be brought to your first appraisal on return to the UK.
There is no requirement to use the GMC questionnaires (for colleague or patient feedback) although there is the expectation that feedback is collected using
standardised questionnaires that comply with GMC guidance in this area, as is the case with the RCoA version.
Most questionnaires have been designed and piloted to demonstrate reliability and validity including the best time to administer the questionnaire, and the subsequent psychometric and statistical analysis has helped to clarify the minimum number of responses required, to provide reliable and valid ratings of a doctor’s interaction with patients. The GMC patient feedback questionnaire, for example, has been designed to be administered as a post-consultation or exit survey, and requires a minimum of 34 completed responses based on their pilot. In the case of the RCoA version, which it is advised should be distributed after the pre-operative consultation with the anaesthetist, the pilot found that feedback from between 15 and 30 patients should be the target.
It is for the Responsible Officer to be satisfied that the doctor has provided sufficient supporting information to assure a recommendation about the doctor and, in the
case of patient feedback, a key theme is reflection on what that feedback means for the doctor’s current and future practice.
Specifically, does the RCoA consider that the CCT in anaesthesia and specialist register status indicate that a consultant anaesthetist has undertaken appropriate Advanced Life Support (ALS) training, or does this have to be supplemented by a commercial (UK Resuscitation Council) ALS course?
Response: The College requirements are deliberately flexible in this area, as anaesthetists may be able to demonstrate their continuing skills in their daily practice, and many are involved in teaching resuscitation skills to others. In our Guidelines for the Provision of Anaesthetic Services document we recommend that all clinicians dealing with patients should be 'appropriately trained' in resuscitation skills. Anaesthetists should be 'appropriately trained and assessed' in advanced life support. The reference level is that of the ALS courses or equivalent. The 'equivalence' aspect is one for local agreement; there are simply too many organisations providing these courses to be prescriptive.
That said, some Trusts simply accept the CCT qualification, ongoing clinical experience and the maintenance of CPD with in-house assessment in this area – others may demand specific certification confirming the doctor attended their requisite course recently.
Remediation may be defined as ranging from informal agreements to carry out some reskilling, to more formal supervised programmes of remediation or rehabilitation. One reference point is the wide range of CPD resources such as courses and events and e-Learning Anaesthesia.
In conjunction with the Association of Anaesthetists, the College has produced guidance on Managing the poorly performing anaesthetist which includes information on procedures to be followed by levels and sources of advice and supporting resources.
In common with other Medical Royal Colleges the opportunity for mentoring of consultants is also referenced and the AoMRC has produced A Framework of Principles for Mentoring which details guidance which is consistent in values yet flexible in adapting to local demand, need and resources.