Appraisal & Revalidation
I am sure you will be aware of the recent publicity regarding Dr Bawa-Garba a paediatric trainee.
This case involves the tragic death of a young child and Dr Bawa-Garbas role in his care. The case has attracted significant attention as it raises a number of fundamental issues regarding the supervision of trainee doctors and individual and system failures that were factors in this tragic outcome.
An additional outcome has been that significant concerns have been raised that reflections recorded as part of an individual doctors appraisal could be used in disciplinary or court proceedings against them. Appraisal is designed to support and encourage doctors to engage with reflective practice. Reflection on performance and professional values is an essential part of maintaining and improving patient care, as well as our own development as clinicians.
All appraisers will be aware that effective SEAs and reflection on complaints can improve patient care and promote learning. It would be very disappointing if this case had unintended consequences for learning and reflective practice. The GMC have emphasised that they see reflective practice as core to professionalism and this has been echoed in a statement from the CMO and others in Scotland.
I have reviewed many of the responses to the judgement in this case and I hope it may be useful to highlight some salient issues.
The MPS who represented Dr Bawa-Garba have stated that the junior doctors e-portfolio was not, in fact, part of the evidence used in court at the criminal trial. The court was clear that reflections were irrelevant to the facts to be determined and that no weight should be given to remarks documented after the event
The GMC have stated that Dr Bawa-Garbas reflective notes did not contribute to their decision making process and they do not ask doctors to provide their reflective statements when investigating a concern.
Personal reflections made by Dr Bawa-Garba but not her e-portfolio entry were introduced into the GMC Fitness to Practise hearing on her behalf to demonstrate her remediation efforts.
It is important to emphasise to appraisees that all case studies or SEAs presented at appraisal must be fully anonymised.
I think it very likely that individual colleges, the defence organisations and the GMC will be publishing further advice about the issues raised in this case.
At present I think the following resources offer a useful summary of the key points and some advice that may be helpful in your role as appraisers and for appraisees.
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