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“No One Has Yet Properly Articulated What We Are Trying to Achieve”: A Discourse Analysis of Interviews With Revalidation Policy Leaders in the United Kingdom

Archer, Julian MD, PhD; Regan de Bere, Sam PhD; Nunn, Suzanne PhD; Clark, Jonathan MA; Corrigan, Oonagh PhD

doi: 10.1097/ACM.0000000000000464
Research Reports

Purpose To analyze prevailing definitions of revalidation (i.e., a recently instituted system of ongoing review for all physicians in the United Kingdom), the circumstances of their origin, and proposed applications, after a protracted and sometimes difficult decade in development. This was to support a more consensual approach to revalidation policy before its launch in 2012.

Method In 2010 and 2011, the authors carried out a critical discourse analysis of interviews with 31 medical and legal revalidation policy makers. These individuals represented the main stakeholder bodies, including the General Medical Council, Academy of Medical Royal Colleges, British Medical Association, National Health Service Employers, and the departments of health from across the United Kingdom.

Results The authors identified two overarching discourses: regulation and professionalism, held together by patients as “discursive glue.” Regulation frames revalidation as a way to identify “bad apples,” requiring a summative approach and minimum standards. Professionalism looks to revalidation as a process by which all doctors improve, requiring evolving standards and a developmental model.

Conclusions These two discourses were not mutually exclusive; indeed, most interviewees used them interchangeably. However, they are in some regards at odds. Their coexistence has been supported by a shared discursive formation around patients. Yet the authors found little patient-centered policy in revalidation in its current form. The authors concluded that patients need to be recognized, making them present with an active voice. They also stressed the importance of established and ongoing evaluation of medical regulation as a policy and process.

Dr. Archer is National Institute for Health Research Career Development Fellow, senior clinical lecturer, and director, Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom.

Dr. Regan de Bere is lead for medical humanities and deputy director, Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom.

Dr. Nunn is research fellow, Collaboration for the Advancement of Medical Education Research and Assessment, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom.

Mr. Clark is lecturer in sociology, Plymouth University, Plymouth, Devon, United Kingdom.

Dr. Corrigan is honorary fellow, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, Devon, United Kingdom.

Funding/Support: This report is the result of independent research funded by the Health Foundation, an independent charity working to continuously improve the quality of health care in the United Kingdom.

Other disclosures: None reported.

Ethical approval: Ethical approval was awarded by the Peninsula College of Medicine & Dentistry research ethics committee. Participants gave informed consent before taking part.

Disclaimer: The views expressed in this report are those of the participants and the authors and do not reflect those of the Health Foundation.

Previous presentations: An overview of this report was presented by Dr. Archer on October 4, 2012 at the International Association for Medical Regulators and Authorities Conference 2012, Ottawa, Ontario, Canada.

Correspondence should be addressed to Dr. Archer, Plymouth University Peninsula Schools of Medicine and Dentistry, C521 Portland Square, Plymouth University, Drake Circus, Plymouth, United Kingdom PL4 8AA; telephone: +44 (0) 1752-586750; e-mail: julian.archer@plymouth.ac.uk.

© 2015 by the Association of American Medical Colleges