Lesley Southgate

Patient-oriented learning: a review of the role of the patient in the education of medical students

To explore the contribution patients can make to medical education from both theoretical and empirical perspectives, to describe a framework for reviewing and monitoring patient involvement in specific educational situations and to generate suggestions for further research.

When enough is enough: a conceptual basis for fair and defensible practice performance assessment

Introduction An essential element of practice performance assessment involves combining the results of various procedures in order to see the whole picture. This must be derived from both objective and subjective assessment, as well as a combination of quantitative and qualitative assessment procedures. Because of the severe consequences an assessment of practice performance may have, it is essential that the procedure is both defensible to the stakeholders and fair in that it distinguishes well between good performers and underperformers.

The assessment of poorly performing doctors: the development of the assessment programmes for the General Medical Council's Performance Procedures

Modernization of medical regulation has included the introduction of the Professional Performance Procedures by the UK General Medical Council in 1995. The Council now has the power to assess any registered practitioner whose performance may be seriously deficient, thus calling registration (licensure) into question. Problems arising from ill health or conduct are dealt with under separate programmes.

Evaluating assessment: the missing link?

Methods chosen for assessment and the manner in which they are applied are so intimately associated with how individuals learn that developing appropriate assessment strategies is a key part of effective curriculum development.

The General Medical Council's Performance Procedures: peer review of performance in the workplace.

The General Medical Council procedures to assess the performance of doctors who may be seriously deficient include peer review of the doctor’s practice at the workplace and tests of competence and skills. Peer reviews are conducted by three trained assessors, two from the same speciality as the doctor being assessed, with one lay assessor. The doctor completes a portfolio to describe his/her training, experience, the circumstances of practice and self rate his/her competence and familiarity in dealing with the common problems of his/her own discipline. The assessment includes a review of the doctor’s medical records; discussion of cases selected from these records; observation of consultations for clinicians, or of relevant activities in non‐clinicians; a tour of the doctor’s workplace; interviews with at least 12 third parties (five nominated by the doctor); and structured interviews with the doctor. The content and structure of the peer review are designed to assess the doctor against the standards defined in Good Medical Practice, as applied to the doctor’s speciality. The assessment methods are based on validated instruments and gather 700–1000 judgements on each doctor. Early experience of the peer review visits has confirmed their feasibility and effectiveness.

Learning together in medical and nursing training: aspirations and activity

Policy documents about service innovation, education priorities and professional development exhort professions to learn together and work collaboratively. However, the literature suggests that the existence of shared learning in medical and nursing pre‐qualifying education is patchy.

The General Medical Council's Performance Procedures: the development and implementation of tests of competence with examples from general practice.

This paper describes the development of the tests of competence used as part of the General Medical Council’s assessment of potentially seriously deficient doctors. It is illustrated by reference to tests of knowledge and clinical and practical skills created for general practice.

CeMENT: evaluation of a regional development programme integrating hospital and general practice clinical teaching for medical undergraduates

To determine the feasibility and effectiveness of shared hospital and general practice clinical teaching for medical undergraduates.

Training the assessors for the General Medical Council's Performance Procedures.

From July 1997, the General Medical Council (GMC) has had the power to investigate doctors whose performance is considered to be seriously deficient. Assessment procedures have been developed for all medical specialties to include peer review of performance in practice and tests of competence. Peer review is conducted by teams of at least two medical assessors and one lay assessor. A comprehensive training programme for assessors has been developed that simulates the context of a typical practice‐based assessment and has been tailored for 12 medical specialties. The training includes the principles of assessment, familiarization with the assessment instruments and supervised practice in assessment methods used during the peer review visit. High fidelity is achieved through the use of actors who simulate third party interviewees and trained doctors who role play the assessee. A subgroup of assessors, selected to lead the assessment teams, undergo training in handling group dynamics, report writing and in defending the assessment report against legal challenge. Debriefing of assessors following real assessments has been strongly positive with regard to their preparedness and confidence in undertaking the assessment.

In the steps of Peter the Great-building links between London and St Petersburg

Czar Peter founded his new capital to be a ‘window on the West’, following a European tour including boatbuilding in London. It is therefore fitting that having resumed its original name, St Petersburg should again look to Western Europe, and London in particular in a period of change.