Ah Hello, Like I CARE

My appraiser has sent me an email full of positive suggestions. It's time, he suggests, I stopped fiddling with the QOF data and thought about a personal patient satisfaction survey. I'll need two in my five year revalidation folder - so there's no time like the present.

I decide I'll do this. Some patients must like me, since they keep coming back. The ones that don't like me go elsewhere, so there is already a self congratulatory glow around booked surgeries. This could work well for me. I confer with Sally the locum, who has been trialling the eportfolio and is thus a Revalidation Guru.

Sally points out that if I only question the patients who choose to see me, then when they hate me I will cry. She advises me to strike out into the unknown realms of Patients who Have no Choice. At least then I am free to make excuses for the results. It's easy for her to say. Sally has built up a file of the kind of glowing testimonials and cards with care bears on them that those of us who run the duty clinic on Monday afternoons (forty five patients, one doctor) cannot hope to emulate.

Still, I give it a go, and I print off the CARE questionnaire from the RCGP website. Then I plough on through the Armageddon-style afternoon with a beatific smile, since it seems to me that being nicer than normal because I'm running a survey is not REALLY ethically unsound. I smile even when Mr Fester wants me to feel his armpit, and by the time we reach eight o'clock I have the kind of Botox face we're accustomed to seeing only on TV and in wind tunnels.

I arrive home after two late visits to a row about washing up which is only compounded by my wafting, Zen like, into the eye of the storm and asking them how it makes them all FEEL and what they hoped I might DO ABOUT IT.

So how did it go? It's not a competition, Sally points out when I try to compare notes regarding about the number of patients who I forced, through sickening niceness levels, into ticking the ‘the doctor left me understanding more about my condition' box. There isn't a pass mark, I'm meant to reflect on it, and grow. Man, says my son, reading this over my shoulder. You're going to be enormous.

Knickers to revalidation

Few could remain unmoved by the sight of a grown woman chasing a chihuahua through a village shouting, "give me my knickers.' Fortunately, few were watching at the time, but the chihuahua has not given up, and it's only a matter of time before the whole village has witnessed the eternal canine quest for my smalls.

So what's that got to do with revalidation? Persistence, that's what. If a chihuahua with the strength of a chicken and the cunning of a turnip can make off with my one and only set of La Perla then persistence can surely achieve anything.

All of which makes me ashamed to admit that I haven't been very persistent in filling in my outcomes and my programme director appraisal is approaching like an asteroid in a Bruce Willis film. When my friend Sally arrives I am rooting through my revalidation box file in the hope of discovering the records I made at the last examiners conference. Sadly, a quick perusal of its contents swiftly reveals that it hasn't got any contents and I have to start from scratch.

Sally, a locum with multiple irons in the fire, comments superiorly that I need to be more organised - but a short plying with chocolate reveals the truth. Sally has been trialling the new eportfolio for revalidation. This fabulous piece of IT has allowed her to log on whenever and wherever she does something useful, record it swiftly, and gradually build up a revalidation document unmarred by memory loss and the stresses of dog underwear theft.

For a woman such as I, whose personal learning log now has so many columns that none is more than a centimetre wide, this sounds like nirvana. I ask where I can get this wonder-IT but she mutters coyly about the revalidation people making sure it fits locums and portfolio docs as well as everyone else, which is how she got to trial it. It shows off the whole her, she says smugly, and fits all her appraisals in all her roles.

I email The RCGP at once to ask when this eportfolio will be available to lesser mortals who also want to reveal their whole selves easily and efficiently, but Sally comments that showing off the whole me may not be a good thing when my best knickers will soon be buried in a fox hole and I drop everything to head off in rapid pursuit. Later, perhaps.

Further resources

Revalidation resources for GPs

How online tools saved the day at my appraisal

My printer ran out of paper just before my appraisal, which was a problem, given that all of my latest learning was recorded online. Of course, arguably, the place where my learning is best recorded is in my head, so I decided to attempt to placate my appraiser with the breadth of my knowledge and the height of my enthusiasm, and turned up to the appraisal bearing a small macintosh (computer, not coat) and a hopeful smile.

My appraiser, I thought, took it rather well. This was partly because I had availed myself of the NHS appraisal toolkit, the lazy doctor's answer to the panic of appraisal. You log on and enter all your information and the site remembers you from year to year. No need to spend annual hours laboriously recording who you are and what you do (assuming you remember). Instead you stow it in the ether, and when the mother ship calls you in for appraisal, you go back in there and make sure you're still you.

I love it, and am thrilled that the RCGP are commissioning something bigger and better to serve the same purpose for revalidation. For people like myself, who are entirely capable of losing their cutlery whilst they are actually eating their lunch, the online approach to recording learning is simply fantastic and almost foolproof.

Of course, with the loss of David Tennant as Dr Who and the consequent likelihood of aliens taking over the earth and corrupting all our stored data there is some risk of loss (although frankly the tragedy of failing to be revalidated on the basis of my records having been eaten by the Ood would be nothing compared to the pain of not seeing him step out of the tardis Ever Again).

But back to the point. When my appraiser's warm and expectant grin froze like Wallace's when Wendoline told him she didn't like cheese (not even Wensleydale) I remembered, with a suddenness that I can only liken to the shock of being shot at by a Dalek, that I had in fact uploaded all my learning records from my laptop to my appraisal toolkit as I went on. Oh happy day, all was not lost and I was, for once, not found wanting. IT has genuinely replaced my forgetful, certificate-losing, inefficient self with someone that, frankly, I find quite intimidating.

I am considering simply having the laptop replace me next year.

Further resources

Revalidation resources for GPs

GP Curriculum Centre

Revalidation and apple pies

The approach of the New Year heralds more appraisal angst sufficient to stop me watching the sing-along Sound of Music even though the nun was singing Climb Every Mountain, which is my bit. Just as I had set up the giant coloured document Mary's All-New Own-Learning-Development Tasks-With-Impact Table (or Mary's AN OLD TWIT, for short... Yes, it took me ages to come up with that one, but at least it was REFLECTIVE, which is more than I can say for the collection of timetables, certificates of attendance and receipts that constitute my record of having Been At Things this year).... Sorry.

One of the problems of a rambling mind is sentences becoming so long that if I were Shakespeare I'd be getting this bit attributed to Marlowe... anyway, the point is that once I had set up the first appraisal I remembered that's not all. In this world of personal reflection, my PCT appraisal is not enough. I must have an appraisal as a course organiser, since the deanery employ me for that, and quite possibly another as an examiner, given that there I work for neither. My children point out that an appraisal as a mother is also long overdue, particularly given the disagreement over bedtimes last night which resulted in them declaring "we're going to bed now anyway, not because you told us to but because the atmosphere down here is just intolerable". They also suggest an appraisal as a chef, given the fact that I have made six malt loaves in the last week and no apple pies, and some personal reflection on my failure to find them a Samoyed puppy (all help appreciated!).

I was ready for my appraisal, which is so imminent that its Doppler effect is beginning, when I got sent the forms for my programme director appraisal and had to analyse my strengths and weaknesses all over again with a different hat on. The future loomed ominously. I have a wardrobe full of metaphorical hats. I contemplate devoting my life to my many revalidations. The convent looks an appealing alternative, particularly with Climb Every Mountain.

And then the good news — however many hats I wear, there should be just one revalidation. Revalidation intends to be holistic, gathering all the information to view us as one single, glorious, person-specific revalidation pie. I am delighted and relieved. My children, leaning over me, are pleased too, as it seems now that there's going to be pie. Winners all round, then.

What came first? The chicken or revalidation?

As the words revalidation, recertification, appraisal, and relicensing appeared on our horizon I acquired four new chickens. The friendliest is Revalidation, who greets me whenever I arrive home. If I treat her kindly she follows me adoringly, and if I don't she makes a mess on the floor.

I am holding forth rather wittily, I think, on how I meet Revalidation head on every day when my appraiser, who doesn't realise that I am talking about a chicken, points out that revalidation isn't really something I can meet head on, because I am not actually likely to meet it, as such, at all. 

I won't ‘do' revalidation, but an enhanced appraisal. Actual revalidation may well be done, if all proceeds as suggested, by the three wise beings. I imagine them as like the three bears only wiser. And not bears, obviously. They consist of a responsible officer (which, strangely, is what I was when I was milk monitor) and two advisers, one from the college and one from what we nervously call The Real World

So I must sort out a proper folder of learning credits for my appraisals, throw in glowing feedback from adoring colleagues, add a decent PDP, the kind of audit that separates out the men from the boys, and proper reflection on any patients who've told me what they think, including gifts (even the hankifull of snot from Mrs Cross' eldest, because that showed real trust) then submit it to the Three, who will look at it using the standards college have agreed.

If they're happy they'll recommend that I'm recertified. (My children comment that they've always said I needed certifying, and for a brief minute I think we're at last on the same wavelength). I shall then slide like Titanic at her launch, down the slide of history, to be relicensed by the GMC. Nobody will apply a rubber stamp to my forehead, yet I will have undergone revalidation, not one thing, but a group of activities, not a single chicken, but the sum of two resulting from the actions of several.

Revalidation, the chicken, is rather upset to have been demoted from a uni-entity to a Series of Achievable Events, and even though I tell her she is an Important Process she has to be rechristened Jasmine. It's less easy for my revalidation folder, as replacing ‘revalidation' with ‘enhanced appraisal' spoils the front and I can see I shall have to start again.

Putting it off? Moi? 

Further resources
Healthcare Republic's Revalidation resource for GPs

GP Curriculum Resource Centre

Was it wise to ask my children to provide multi-source feedback?

It doesn't take long for my children to come back with the multisource feedback (MSF) they have devised. This perfectly illustrates the First Law of Feedback, which resembles the First Law of Christmas Presents: be very careful what you ask for, because you just might get it.

The feedback, sourced from six separate children, follows several themes. In this it resembles the MSF planned for revalidation, since this will be a validated assessment of various areas of practice, such as clinical care, teamwork and probity, without acting as a vehicle through which you can be blackmailed into forever buying Liquorice Allsorts for reception.

Alas, the similarity ends there. The children have dwelt in depth on my inability to wear stuff on my feet that mothers wear, choosing instead to wear stuff that only Eskimos wear. It comments - rather miserably, I feel - on my unfortunate habit of crying at their carol services.

It reminds me that proper mothers meet their children at the bus stop in a car with a dry dog, rather than assuming that it's reasonable for a teenager to walk more than fifteen yards in those heels you were so awkward about buying (but you did in the end, so you're responsible for the consequences) only to be met by a wet dog. Finally it makes comments about my cooking that, whilst they have some basis in truth, use the word vomit far too often.

How do you make feedback acceptable to those who give it, those who receive it and those who need it to mean something? My children's answer is clear, as their Christmas wish lists were enclosed with their responses, but for us it is more tricky. Some are more destroyed by criticism than others, and even when feedback is anonymised and filtered it may hurt. Perhaps that's why they're still working on the MSF for revalidation.

In the meantime I am left with a dilemma: MSF may finally reveal that the thought of my loud renditions of Abba greats during the patient free hours when surgeries are over is not after all, the one thing that gets my colleagues through the day. On the other hand it might say just the opposite. So, a dilemma arises. Do I carry on singing, or not? 

Further resources
Healthcare Republic's Revalidation resource for GPs

GP Curriculum Resource Centre

Multi-source feedback and Jedward fears

The thorny subject of multi-source feedback has been raised and I find myself looking at my colleagues, with new, more appreciative eyes. You may remember that the story of the Water Babies featured Mrs Do-As-You-Would-Be-Done-By and Mrs Be-Done-By-As-You-Did, characters who reflected the philosophy my grandmother instilled into me (along with red fizzy pop and the best dumplings in the world).

Unfortunately, though, they're not quite right for MSF. The whole point is that people are supposed to say what they actually think about you, rather than what they hope you think about them. I briefly contemplate a pact in which we all agree to give each other maximum scores for everything, but realise this risks a renegade hitting zero in the probity box and fast tracking me to the nice man with the axe at the GMC.

There is much to be said for multi-source feedback, but it's hard to say it when you have spent your professional life haunted by Unspoken Fears, and you see a new one approaching like a stampeding elephant. In the Beginning came the Unspoken Fear that appraisal would mean someone appreciating exactly what I knew, but now this is to be replaced by the Unspoken Fear that revalidation will mean someone appreciating exactly what I'm like. Perhaps, I think wisely, I should check this out in advance. I ask my children exactly what they think I'm like, and words like weird, odd and nuts fill the air. Admittedly my children consider anyone not as addicted to the X Factor as they are as weird, odd and nuts, but that's my point entirely. Could I end up cast aside by The Profession because I don't know nor even care who John and Edward are?

Of course there's no rush, since revalidation in the first year doesn't require MSF, and since no current MSF tools have passed muster I can't try it out. On the other hand, there is much to be said for wiping the metaphorical condensation off the specs of self contemplation and having a proper look at the worst case scenario. But how? My children suggest that they write an MSF for me. I have heard worse ideas (although not very often) so, in the spirit of offering them positive feedback, I agree and they rush off in a huddle, cackling. I'll let you know.

Further resources
Healthcare Republic's Revalidation resource for GPs

A colourful way to record my learning

My daughter took over the design of my learning log when I asked her how to get nine columns across one page without them being only one letter wide (it was physically a very long document. About three feet long.).

She started with eight columns. The first one said date, for the date of the activity. We coloured that red.

The orange column says TITLE. Mine say short things like 'periods' since menorrhagia didn't fit in the box. She says she'll illustrate that column but forty three entries say swine flu. She says she's not drawing forty three different pigs, and why didn't Maureen Baker just send one enormous flu email instead of all those, but I say that kind of misses the point...

The third column is yellow. It says WHY? Forty three times it says BECAUSE OF FLU and she says she's not drawing anything for that because it would just be more pigs.

Column four says ‘WHAT I DID'. She wants to draw me reading, writing, running round the practice taking pictures of people for the website, organising the carpenter into designing the pigeonholes which have reorganised our waiting room, cleaning my room with wet wipes after a patients sneezed (to show the practice hygiene policy we co-wrote). I think she'll be illustrating column four long after revalidation finishes because we've been rendered obsolete with students manning a medical helpline.

Column five says OUTCOME. This looks rather threatening, even though it's green - but it is crucial. If learning has no outcome, I say, what would be the point? I must not write 'makes me a better doctor' on every row so instead I plot to make the first letters of each learning outcome read LEONARDO DA VINCI.

Column six says HOURS and is blue, and seven says IMPACT and is indigo, which is my favourite colour and distracts me slightly (I am a woman, after all). Column eight, a gorgeous purple, says TOTAL, in a cheerful, nearly there sort of way.

I have completed the first row. The columns read 1. today, 2. eportfolio, 3. because I've got to, 4. designed table for recording learning, 5. Started route to revalidation, 6. 2 hours, 7. impact 1 because it doesn't really impact all that much on anything other than my daughter's art GCSE. So that's two.

I have two credits. Okay two out of fifty. But it's really pretty...

Further resources
Healthcare Republic's Revalidation resource for GPs

GP Curriculum Resource Centre

What is impact?

Do you look at the RCGP's website? I bet you don't if you're not a member - why would you? After all it's well known that the acquisition of the letters MRCGP leads to floating around in a haze of self righteousness without any continuing contact with the real world of Mrs Workshy and her Eternal Quest for Another Sick Note.

And of course I'm one of Them. That's what Dr Serious said when I said I thought IMPACT was a good idea. Actually that's not true, he didn't say it, he just shook his head and whistled through his teeth, which is exactly what my father used to do when I poured lemonade on the tablecloth.

I am one of Them, it's true. But I'm one of us too. And one of us and one of them is all the same thing. One day, if the Force is with us, every single GP in the country will join the College, and this may at last expose the fact that its apparent haze of self-righteousness is actually a fog of self doubt, and that Mrs Workshy's illness beliefs pursues all of us with the same persistence...

Where was I? Impact, that was it. It appeared on the college website a couple of months ago, the idea that a unit of learning time could be earned in less than an hour if it was WORTH more.

You must have done maths. I loved maths, especially when they taught us about momentum. They illustrated it with pictures of cars denting one another and of space stations docking. And it was so clear then why the enormous can sometimes make no impact at all. You had to MULTIPLY its mass by some representation of the energy it was expressing. If it's got no momentum it has all the impact of one box of tamiflu in a pandemic.

An hour on BMJ learning clicking your mouse might get you a certificate that says you've done an hour's learning - but if you rush to your practice manager looking transformed, crying Ann, Ann, let's do an audit on the use of PPIs with clopidogrel then two things happen. One is that your hour of learning time gets multiplied up because it has more IMPACT.

The other is that your practice manager tips her tea in your lap but we won't mention that.

Further resources
Healthcare Republic's Revalidation resource for GPs

GP Curriculum Resource Centre

Where is the ePortfolio?

Have you seen an ePortfolio? If you're a trainer you will now need a little lie down, but for those who aren't, as an electronic formative developmental tool they're fab, honestly.

I accept that relatively few of you have searched the corners of your hippocampal gyrus for Ideas For My Christmas Present and come up with electronic formative developmental tool, but run with me on this. If I can be converted there's hope for everyone, and despite having messed up the ePortfolios I've used, duplicating entries, submitting the wrong stuff and generally making a codge of the whole thing, I am an enthusiast. Besides, there's always a patient soul at the other end undoing the mess and actually, it's such a great way of NOT LOSING THINGS.

Sadly I haven't got an ePortfolio because the revalidation ones aren't ready yet. They're probably coming at the beginning of next year, and so till then I've got....

My computer.

My computer, Portal to the Underworld (don't you always get Sucked In? You may not share my need to look at second hand harps and pink umbrellas - but sitting in front of a home computer and working? Please. There are too many things out there that nobody has bought yet.)

Got to try though, so I thought I'd start in the surgery. I went in on my day off, armed with a list of things I vaguely remembered learning about, a printout of BMJ learning because I did that thing on otitis media.  I turned on my computer and tried to remember how to build a table with four columns and fifty rows, but my phone rang, and then I saw 38 patients, two cross nurses and a man promoting emollients with a spare cheese sandwich.

So I decide to record my learning AT HOME.

2am, and I have 30 columns and five rows. I am so looking forward to having an ePortfolio. I tell my husband, I'll be able to get at it from home, from work, from my dongle on the train. Every day in every way I will learn things and log them....

He is unimpressed - he knows mania when he sees it. Actually he seems to be asleep. But several hours later I have five columns and 36 rows and I am ready to start. We're rolling!

Further resources
Healthcare Republic's Revalidation resource for GPs

GP Curriculum Resource Centre

The first step on the road to revalidation

It is a truth universally acknowledged that revalidation will be a series of trap doors through which the committed, non-devious GP is destined to fall, screaming, into a dragon-filled den. It was no surprise then, when I started defending the whole idea with a passion, that someone commented that since I was so keen why didn't I JBDI (just b***y do it). Do a dummy run.

The letter agreeing that this was a Good Idea arrived only eight hours later, suggesting that our appraisal lead had actually held up the mail coach as it trundled out of Ipswich in the early hours of the following morning....

So now here I sit, contemplating the folly of my recklessness, trying to decide which chunks of the nine thousand unrecorded hours of on-the-job reflective learning I've surely done since swine flu hit us are worthy of including in my new, enhanced, revalidation portfolio (thank you, Maureen Baker, you have educated a generation). And what is going to constitute enough?

Sadly, recording my own learning has always been a bit of a challenge particularly when ebay is available with only two clicks. Despite what I preach self-righteously to the trainee it's always been simplest to come up with a list of Things to Please The Teacher the night before my appraisal, trying not to use the word ‘PUNs' more than four times in any one sentence. My appraiser had accepted this, sailing with me in the same slightly leaky boat towards a distant but poorly lit shore, the metaphorical Jack Sparrows of the Reflective Learning world.

Now, alas, the shore of that world is ablaze with light, the original boat now hijacked by Seriously Clever Pirates wearing the RCGP logo on the front and a photo of Mike Pringle on the back, and the flag we're flying says Revalidation. It's very important that we don't arrive in port looking like ageing hippies so it's time to bin my lever-arch file of Vague Intentions and Do It Properly. 

Even now I'm writing about what I ought to be doing instead of doing it. Yet I can put it off no longer, it begins right now. Perhaps it will end in a blaze of glory, my revalidated portfolio framed in the college building a thousand years from now as the very first...

Who knows? The blog is father, as they say, to the man. 

Further resources
Healthcare Republic's Revalidation resource for GPs

GP Curriculum Resource Centre