GMC's proposals for revalidation. Effective revalidation system looks at how doctors practise and quality of patients' experience.
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Accreditation↗
Biomedical subjects
P McAvoy
Publications and source records attributed to P McAvoy.
Setting performance standards for medical practice: a theoretical framework.
BACKGROUND: The assessment of performance in the real world of medical practice is now widely accepted as the goal of assessment at the postgraduate level. This is largely a validity issue, as it is recognised that tests of knowledge and in clinical simulations cannot on their own really measure how medical practitioners function in the broader health care system. However, the development of standards for performance-based assessment is not as well understood as in competency assessment, where simulations can more readily reflect narrower issues of knowledge and skills. This paper proposes a theoretical framework for the development of standards that reflect the more complex world in which experienced medical practitioners work. METHODS: The paper reflects the combined experiences of a group of education researchers and the results of literature searches that included identifying current health system data sources that might contribute information to the measurement of standards. CONCLUSION: Standards that reflect the complexity of medical practice may best be developed through an "expert systems" analysis of clinical conditions for which desired health care outcomes reflect the contribution of several health professionals within a complex, three-dimensional, contextual model. Examples of the model are provided, but further work is needed to test validity and measurability.
Clinical Competence↗
The General Medical Council's Performance Procedures: peer review of performance in the workplace.
The General Medical Council procedures to assess the performance of doctors who may be seriously deficient include peer review of the doctor's practice at the workplace and tests of competence and skills. Peer reviews are conducted by three trained assessors, two from the same speciality as the doctor being assessed, with one lay assessor. The doctor completes a portfolio to describe his/her training, experience, the circumstances of practice and self rate his/her competence and familiarity in dealing with the common problems of his/her own discipline. The assessment includes a review of the doctor's medical records; discussion of cases selected from these records; observation of consultations for clinicians, or of relevant activities in non-clinicians; a tour of the doctor's workplace; interviews with at least 12 third parties (five nominated by the doctor); and structured interviews with the doctor. The content and structure of the peer review are designed to assess the doctor against the standards defined in Good Medical Practice, as applied to the doctor's speciality. The assessment methods are based on validated instruments and gather 700-1000 judgements on each doctor. Early experience of the peer review visits has confirmed their feasibility and effectiveness.
Clinical Competence↗
The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures.
BACKGROUND: Modernization of medical regulation has included the introduction of the Professional Performance Procedures by the UK General Medical Council in 1995. The Council now has the power to assess any registered practitioner whose performance may be seriously deficient, thus calling registration (licensure) into question. Problems arising from ill health or conduct are dealt with under separate programmes. METHODS: This paper describes the development of the assessment programmes within the overall policy framework determined by the Council. Peer review of performance in the workplace (Phase 1) is followed by tests of competence (Phase 2) to reflect the relationship between clinical competence and performance. The theoretical and research basis for the approach are presented, and the relationship between the qualitative methods in Phase 1 and the quantitative methods in Phase 2 explored. CONCLUSIONS: The approach is feasible, has been implemented and has stood legal challenge. The assessors judge and report all the evidence they collect and may not select from it. All their judgements are included and the voice of the lay assessor is preserved. Taken together, the output from both phases forms an important basis for remediation and training should it be required.
Clinical Competence↗
Health reforms: a New Zealand perspective.
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Health Care Reform↗
An empirical typology of dyadic formation.
The background of and justification for empirical typologies are outlined. Various family typologies are discussed. Data from a random sample of 291 couples are subjected to a cluster analysis on the dyadic interaction, dyadic preference, dyadic stability, and identification as a pair by others of the couple. Seven types of dyadic formation were found: Uncommitted; Structurally Isolated, Wife-Supported; Self-Selected Committed; Structurally Committed; Vital; Unformed; and Wife-Removed. The types are shown to differ on value consensus and couple happiness, as well as on some background factors. The contribution of the work to theories of dyadic formation and family typologies is discussed.
Adolescent↗
Improving substance abuse service delivery to Hispanic women through increased cultural competencies: a qualitative study.
In 1985, one woman in seventeen in the US was Hispanic-an estimated 8.5 million-and it is predicted that by the end of this century, Hispanics will comprise the largest ethnic group in this country (Amaro & Russo, 1987). Although the term "Hispanic" suggests a homogeneous group, united by similarities, this is not the case. The term refers to an ethnic group, not a racial one, whose chief commonalities are the Spanish language and some broad cultural values. Making substance abuse treatment services accessible to Hispanic women and their families requires that agencies become culturally competent to deal with this population. The authors of this qualitative study interviewed female Hispanic substance-abuse treatment clients and therapists to find what agencies might do to create a receptive atmosphere for Hispanic women.
Acculturation↗