Medical revalidation: a route to excellence?

All doctors who hold a licence to practise will need to revalidate every 5 years. The process includes the consideration of defined items of supporting information at five annual appraisals. These essentials must support professional development and the achievement of excellence in patient care.

'Effectiveness of Continuing Professional Development' project: a summary of findings.

This article reports on a study examining continuing professional development (CPD) for consultant doctors. The aim of the study was to identify what promotes or inhibits the effectiveness of CPD and met the following objectives: comparing and contrasting the experiences of CPD across the range of specialties; identifying and describing the range of different models of CPD employed across the different specialties and clinical contexts; considering the educational potential of reflective practice in CPD and its impact on professional practice and exploring how different professionals judge the effectiveness of current CPD practices. Using a mixture of qualitative (interviews, letters, observation) and quantitative (online questionnaire) methods, the views of CPD providers and users were surveyed. Findings suggested that the effectiveness of CPD, as inferred from the comments made by interviewees and questionnaire respondents, relates to the impact on knowledge, skills, values, attitudes, behaviours and changes in practice in the work place. The quality of CPD was seen as inextricably linked to any improvements in the quality of the professional practices required for service delivery. There was widespread consensus as to the value of learning in professional settings. There was recognition that there needs to be a move away from tick boxes to the in-depth identification of learning needs and how these can be met both within and external to the work place, with learning being adequately enabled and assessed in all locations. In conclusion, it can be said that CPD is valued and is seen as effective when it addresses the needs of individual clinicians, the populations they serve and the organisations within which they work. However, the challenge for CPD may lie in the dynamic interaction between educational opportunities and service delivery requirements, as there may be occasions where they vie with each other for resources.

Specialist recertification: a survey of Members and Fellows.

The Royal College of Physicians has completed a survey of Members and Fellows to ascertain opinions about the development of specialist standards and the applicability of potential methods/evidence for specialist recertification. Of 985 respondents, 68.6% felt that 11 of the suggested methods would be appropriate for specialist practice and most of these would also be applicable to sub-specialist practice. More than two thirds agreed that it was appropriate to include evidence related to the performance of the clinical team for individual recertification. Respondents expressed concern about the current appraisal process but many felt that it could be effective if it was strengthened and consistently applied.

Vertebral artery dissection: not a rare cause of stroke in the young.

We hereby describe a 42-year-old lady who developed vertebral artery dissection following a head injury. The clinical features and management of the condition are discussed.

III Sesión: Retos del desarrollo profesional continuado y de la regulación de la profesión / III Sesion: Challenges in continuing professional development and the regulation of the profession

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Improving care for patients with dysphagia.

BACKGROUND: Early diagnosis and effective management of dysphagia reduce the incidence of pneumonia and improve quality of care and outcome. Dysphagic stroke patients rarely perceive that they have a swallowing problem, and thus carers have to take responsibility for following the safe swallow recommendations made by the Speech and Language Therapist (SLT). Published work and observations in our own Trust indicated that patients with dysphagia may be fed in a manner which places them at significant risk of aspiration, despite SLT advice for safe swallowing. OBJECTIVE: To determine compliance with swallowing recommendations in patients with dysphagia and to investigate the effectiveness of changes in practice in improving compliance. DESIGN: Sequential observational study before and after targeted intervention. SETTING: An acute general and teaching hospital in an inner city area. SUBJECTS: All patients with dysphagia on the caseload of the speech and language therapy department at the time of the study. METHODS: Observations were made on compliance with the recommendations of SLTs regarding consistency of fluids, dietary modifications, amount to be given at a single meal/drink, swallowing strategies, general safe swallow recommendations and whether supervision was required. A dysphagia link nurse programme was established, together with modification of an in-house training scheme, use of pre-thickened drinks and modification of swallowing advice sheets. The same observations were repeated after this intervention. RESULTS: Thirty-one patients were observed before and 54 after the intervention. There was improvement in compliance with the recommendations on consistency of fluids (48-64%, P<0.05), amount given (35-69%, P<0.05), adherence to safe swallow guidelines (51-90%, P<0.01) and use of supervision (35-67%, P<0.01). There were no significant differences in compliance with dietary modifications or swallowing strategies. Improvement in compliance was demonstrated in medical and geriatric wards and the stroke unit, but not in the surgical wards. Compliance with 'nil by mouth' instructions was 100% throughout. CONCLUSIONS: Relatively simple and low-cost measures, including an educational programme tailored to the needs of individual disciplines, proved effective in improving the compliance with advice on swallowing in patients with dysphagia. It is suggested that this approach may produce widespread benefit to patients across the NHS.

Stroke medicine: a new subspecialty.

The specialist management of patients with stroke has assumed increasing importance over the last 10 years. In recognition of this the Specialist Training Authority has accepted stroke medicine as a subspecialty. The scope of the training programme and the route into it are described.