Avant believes that:
- The vast majority of doctors practising in
Australia are competent, perform well and
provide safe and effective health care.
- Lifelong learning, the maintenance of
high standards of practice and continuous
improvement are key aspects of medical
- Programs which seek to encourage the
continuous improvement of the performance
of the medical profession as a whole should
generally be supported.
- The revalidation model proposed by
the Medical Board of Australia does not
demonstrate that it will improve performance
of doctors or assist in identifying and
remediating doctors at risk of poor
- Any model which seeks to encourage a culture
of continuous improvement will only succeed
if it is supported by the medical profession,
and operates within an open and just culture
where doctors feel supported.
Avant recommends that:
- The term “revalidation” not be used for
any model which seeks to encourage the
continuous improvement of the performance
of the medical profession.
- Before rolling out any continuous quality
improvement program to the whole
profession, the Medical Board of Australia
undertakes one or more pilot programs.
- Significant further research be undertaken to
narrow the criteria used in identifying doctors
at risk of poor performance within the medical
Avant Mutual Group Limited ("Avant") is Australia’s
leading medical defence organisation and medical
indemnity insurance provider. It is a mutual
organisation, owned by its members, and offers a
range of insurance products and expert legal advice
Internationally there is an increasing focus on the
importance of medical practitioners demonstrating
their competence to practise throughout their
working lives. Developing mechanisms to enable
medical practitioners to achieve this has occupied
medical regulators for some time. The United
Kingdom introduced a process of revalidation in
December 2012 amid much concern from the
profession. Canada and New Zealand have also
developed mechanisms aimed at ongoing review
and improvement of medical practitioners.
The Medical Board of Australia (MBA) has now
proposed an Australian model for revalidation. It
has two components: (1) strengthened continuing
professional development (CPD) and (2) the
identification and assessment of at-risk or poorly
Avant supports the intentions of the MBA to
encourage continuous improvement of doctors and
proactively identify and remediate doctors at-risk of
poor performance. However, Avant does not believe
that the proposed model will achieve these aims.
This position paper sets out the principles which
Avant believes should underpin any model for
continuous improvement and the identification
of doctors at risk of poor performance, as well as
outlining Avant’s concerns about the revalidation
model that has been proposed by the MBA.
Avant supports continuous quality improvement
among the medical profession. Continuous
quality improvement should be:
- focused on quality improvement and
improving the competence and skills of the
- about improving and enhancing the
professional practice of all doctors
- educative and not disciplinary or punitive
- supportive and collegial
- effective in achieving better health outcomes
- applied across the profession with sufficient
flexibility to take into account different scopes
of practice within the profession and different
specialties in the profession
- simple, not over-engineered, and easily
implemented within existing healthcare
- relevant to the field of practice and context
- procedurally fair, clear and transparent.
Mechanisms for continuous quality improvement
should encourage doctors to assess their skills
against applicable standards and expectations for
quality health care, and assist doctors to identify
skills which require development or improvement.
Avant's comments on component 1 - Strengthened CPD
There is a lack of evidence to show that revalidation/strengthened CPD will lead to better patient care and
safer medical practice. CPD is used as a proxy for competence without clear evidence that participation
in CPD achieves competence or leads to better patient outcomes. In any model, the outcomes of
strengthened CPD need to be identified and evaluated.
- Any CPD system must be easy to implement and not take doctors away from their core business of treating
patients. The model proposes that multisource feedback (“MSF”) will be a key component of strengthened
CPD. However, it is not clear how MSF would be implemented in the context of private practice or out-of hospital
practice where doctors work in consulting rooms alone with the patient. In these contexts there will
be limited opportunities for peers to judge a colleague’s competence.
- There is a lack of clarity around governance. Will governance rest with the colleges or the MBA or both?
- There is an emphasis on peer review and practice visits as part of strengthened CPD but no suggestion
about training programs for reviewers. To provide meaningful engagement, those undertaking peer
review and practice visits, must be appropriately trained in assessing against agreed standards and
providing effective feedback to doctors.
- It is not clear how strengthened CPD will be funded. Doctors would be concerned if the proposal would
lead to an increase in registration fees, which would contribute to pressure on healthcare costs.
Responsibility for CPD
The operation and implementation of CPD programs
rests primarily with the colleges.
Considerable work has been undertaken to date
by many colleges to enhance their existing CPD
programs with a view to improving the performance
of their members. Avant believes that the colleges
should continue to be actively involved in setting the
standards and content for quality CPD programs.
CPD programs need to be flexible enough to be
applied in different practice settings and scenarios,
but there is currently an absence of consistent
profession-wide minimum standards/content for all
Avant’s experience suggests that the profession
would benefit from CPD which extends beyond
clinical skills and includes non-technical skills such as
areas of risk, quality, safety and professionalism. Nontechnical
skills could be the subject of a common
curriculum across all colleges and we recommend
that the colleges work collaboratively to enhance
their CPD programs in this regard.
Download copy of the Continuous quality improvement for the medical profession position paper
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