Audit of medical practice
The Council has updated the wording, definition and criteria related to the key activity of audit as a part of continuing professional development (CPD).
This will make it easier, particularly for doctors who do not see patients, to ensure that audit forms a part of their annual CPD programme.
Self regulation is one of the defining elements of a profession. A key outcome from a profession that manages self regulation well is that the public can have confidence that the members of that profession are competent, trustworthy and fit for work.
These three aspects – competence, conduct and health are the areas that the Council needs to be assured about when exercising its legislative powers to issue a practising certificate to a doctor.
Competence – is arguably the most challenging aspect for the Council to assess, and almost certainly the most important from the public’s viewpoint.
The Council, together with many registration authorities internationally, has continued to develop and evolve the approach for the monitoring of ongoing competence beyond initial registration where competence has been formally evaluated through examination.
Active involvement in continuing professional development (CPD) is used by the Council as an indicator that a doctor is maintaining competence. The Council views CPD as being made up of three broad areas – audit, peer review and continuing medical education (CME). Research tells us that of these areas, audit activity is most strongly associated with a positive effect.
Until recently audit was described as ‘clinical audit’, but Council has updated this to ‘audit of medical practice’ recognising that not all doctors are in clinical practice. Our revised definition, and the criteria that should underpin your audit activities, are as follows.
Definition of ‘audit of medical practice’
A systematic, critical analysis of the quality of the doctor’s own practice that is used to improve clinical care and/or health outcomes, or to confirm that current management is consistent with the current available evidence or accepted consensus guidelines.
Criteria for conducting an audit of medical practice
- The topic for the audit relates to an area of your practice that may be improved.
- The process is feasible in that there are sufficient resources to undertake the process without unduly jeopardising other aspects of health service delivery.
- An identified or generated standard is used to measure current performance.
- An appropriate written plan is documented.
- Outcomes of the audit are documented and discussed.
- Where appropriate an action plan is developed that will identify and maximise the benefit of the process to patient outcomes. The plan should outline how the actions will be implemented and a process of monitoring.
- Subsequent audit cycles are planned, where required, so that the audit is part of a process of continuous quality improvement.
Council requires that doctors have audit activity as a part of their CPD every year. It may be that some audit activities span several years.
In essence many audits can be described as continuous quality improvement (CQI) activities. Many doctors will already be involved in CQI activities in their practice or workplace.
An audit of medical practice may take many forms. The specifics will often be determined by the nature of the doctor’s employment. Some examples are:
- Audits of clinical procedures are an obvious choice for clinicians.
- Comparing the processes, or outcomes of health delivery or patient care with recognised benchmarks or standards.
- Patient satisfaction surveys are often used as the basis for a CQI activity. Doctors who do not see patients usually produce outputs for someone – their customers – and satisfaction surveys of customers rather than patients can also be the basis of a CQI activity.
- Audits of written outputs e.g. patient records, policy, board or research papers, are another area where CQI can be applied. There are a many existing standards and guidelines that can be accessed via the web to help.
- Annual performance agreements may be another source for audit of medical practice.
- Personal development plans often include an audit activity.
The Council also recommends that regular practice review (RPR) form a part of CPD4. Multisource feedback is a part of RPR but this activity can also be viewed as an audit activity. A number of colleges have already incorporated this into their CPD programmes.