BMJ Qual Saf 21:649-656 doi:10.1136/bmjqs-2011-000429
  • Original research

Insightful practice: a reliable measure for medical revalidation

Open Access
  1. David A Bruce4
  1. 1Quality, Safety and Informatics Research Group, University of Dundee, Dundee, UK
  2. 2Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
  3. 3Medical Directorate, NHS Tayside, Dundee, UK
  4. 4Postgraduate General Practice Education, NHS Education for Scotland, UK
  1. Correspondence to Dr Douglas Murphy, Senior Clinical Research Fellow, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK; d.y.murphy{at}
  1. Contributors All authors contributed to the design of the study. DJM, AR and DAB recruited the study participants. DJM analysed all data. DJM managed the literature review and wrote the manuscript. All authors contributed to the interpretation of the findings and the critical revision of the manuscript for intellectual content and were involved in the decision to submit the manuscript for publication. DJM acts as guarantor for the study.

  • Accepted 20 April 2012
  • Published Online First 31 May 2012


Background Medical revalidation decisions need to be reliable if they are to reassure on the quality and safety of professional practice. This study tested an innovative method in which general practitioners (GPs) were assessed on their reflection and response to a set of externally specified feedback.

Setting and participants 60 GPs and 12 GP appraisers in the Tayside region of Scotland, UK.

Methods A feedback dataset was specified as (1) GP-specific data collected by GPs themselves (patient and colleague opinion; open book self-evaluated knowledge test; complaints) and (2) Externally collected practice-level data provided to GPs (clinical quality and prescribing safety). GPs' perceptions of whether the feedback covered UK General Medical Council specified attributes of a ‘good doctor’ were examined using a mapping exercise. GPs' professionalism was examined in terms of appraiser assessment of GPs' level of insightful practice, defined as: engagement with, insight into and appropriate action on feedback data. The reliability of assessment of insightful practice and subsequent recommendations on GPs' revalidation by face-to-face and anonymous assessors were investigated using Generalisability G-theory.

Main outcome measures Coverage of General Medical Council attributes by specified feedback and reliability of assessor recommendations on doctors' suitability for revalidation.

Results Face-to-face assessment proved unreliable. Anonymous global assessment by three appraisers of insightful practice was highly reliable (G=0.85), as were revalidation decisions using four anonymous assessors (G=0.83).

Conclusions Unlike face-to-face appraisal, anonymous assessment of insightful practice offers a valid and reliable method to decide GP revalidation. Further validity studies are needed.


  • Funding The study was funded by the Chief Scientist Office (CSO) Scottish Government, Royal College of General Practitioners (RCGP), NHS Education for Scotland (NES) and Scottish Patient Safety Research Network (SPSRN). DM, BG and FS are employed by University of Dundee. SM is employed by the University of Glasgow; AR is employed by NHS Tayside, and DB by NHS Education for Scotland. All authors had full access to all the data and agreed responsibility for the decision to submit for publication independently from any funding source. DM is supported by a Primary Care Research Career Award from the Chief Scientist Office, Scottish Government.

  • Competing interests None.

  • Ethics approval Formal application and submission of the research proposal was made and ethical approval granted for all of the work contained in this paper by the Tayside Committee on Medical Research Ethics A. Participants gave informed consent before taking part.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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