Friday, 02 April 2004
I am in favour of Appraisal and Continuous Professional Development for health care professionals but I also strongly believe that any intervention in Health Services needs to be evaluated. The efficacy of Revalidation and Appraisal needs to be evaluated moreover when this is going to be an expensive intervention. I was surprised to find very vague references about evaluation on the Department of Health web side mainly regarding at the number of doctors appraised and the quality of the process.
In a discussion group during one session of the Masters of Public Health at the UWCM in Cardiff I asked how we could possible evaluate Revalidation and Appraisal. We though that it is difficult to evaluate an intervention when the objectives of the intervention are not clear. According to the objectives of the intervention we can design a correct evaluation.
Looking at the numbers of doctors appraised and revalidated is a measure of activity but not a measure of outcome of the intervention. If the objective of appraisal and revalidation is to avoid another Shipman them we should be looking at mortality as outcome and we should be comparing mortality rates amongst doctors. If we want to assess doctor’s performance and improve patient’s care maybe we should be looking at markers of good quality of care. For example we could be looking at the use of Aspirin and B-Blockers after myocardial Infarction or the use of statins. We may find like Dr Manesh Patel, a cardiology fellow at Duke Clinical Research Institute, that educating health care professionals does not improve the care of their patients.
I believe that no evidence for a potential positive intervention should not preclude implementing it. However we should expect a clear evaluation of the intervention in order to justify the use of health care resources .
Dr Josep Vidal-Alaball
Competing interests: None declared