Case Mix, Personal Audits and Critical Incidents

For the purposes of revalidation, doctors will have to demonstrate that they regularly participate in activities that review and evaluate the quality of their work. Examples of these activities include:

  • Clinical audit
  • Review of clinical outcomes
  • Case review or discussion
  • Review of significant events (untoward or critical incidents)

GMC guidance

RCoA guidance

Review of Practice FAQs

Does the College recommend any specific topics for clinical audit?
The College has developed an Audit Recipe Book which has provided a popular manual of audit topics for anaesthetists since the first edition in 2000. It is a compendium for continuous quality improvement in anaesthesia. The emphasis is on the provision of audits focused mainly on measurement against defined process standards. Since the publication of the last Recipe Book clinical audit nationally, has demonstrated some very impressive achievements.

Is there a minimum amount of anaesthetic sessions I should undertake in order to retain clinical skills and remain competent and therefore allowing me to revalidate?
There are some doctors whose scope of practice is largely away from the anaesthetic environment. It is conceivable that doctors who spend only one day per week or less giving anaesthetics could lose the ability to maintain their clinical skills. However this is a complex multifactorial situation, and will be heavily influenced by such factors as their other clinical activities, the case-mix that they undertake and their overall career progression. It is not possible to generalise, since there is so much individual variation from doctor to doctor.

Appraisers are faced with a difficult decision in these cases, particularly if the appraiser comes from another specialty and is unable to determine whether or not the doctor has maintained the key skills necessary to fulfil his or her clinical commitments.

We therefore recommend that if a doctor spends only one full day per week or less in clinical anaesthesia, and their appraiser is not an anaesthetist, then the views of the Clinical Director in Anaesthesia, or an appropriate Deputy, are sought and that their views are considered at the appraisal.

Should I keep a logbook of my anaesthetic practice for purposes of revalidation?
In accordance with the latest GMC guidance on Supporting Information for Appraisal and Revalidation (2012) you will need to provide a comprehensive description of the scope and nature of your practice – in NHS and/or private independent settings. The description will provide the context for your appraisal and review of practice. We are recommending that your description of practice draw on individual and/or departmental data from hospital information systems (e.g. theatre records) or your personal logbook. Several electronic logbook systems are available and capable of producing a summary of this data. The summary should outline the volume and nature of clinical activity in all relevant settings, e.g. operating theatres. Further information can be found in the RCoA Guidance on Supporting Information for Doctors in Anaesthesia, Intensive Care and Pain Medicine (2012)

Am I required to review and present two significant events at every appraisal meeting?
There are no minimum or maximum numbers of significant events that you should present at appraisal. It may be the case that no significant event has been logged against you or your team during the year, in which case you just need to make a declaration to that effect for your appraisal.

If there have been any significant events, you should summarise the details, together with any resulting reflection, learning and action points, for discussion at your appraisal. Demonstration of your reflection and learning could be through focusing on one or two patient safety related significant events.

It is also worth remembering that significant event management and analysis in healthcare is often a team activity. The outcomes of any team review of significant events can also be brought to appraisal, especially if you have learned about the quality of the care provided and what, if any, changes should be made as a result.