Murie Jill, McCrae Janette, Bowie Paul
NHS Education for Scotland, Glasgow, UK.
Educ Prim Care. 2009 Jan;20(1):34-40. doi: 10.1080/14739879.2009.11493759.
GP appraisal may, in future, have to include objective and verifiable elements. This condition could be achieved by developing peer review of core areas of clinical practice. The setting for the study was two regions of NHS Education for Scotland (NES) without existing peer review systems (Figure 1). The South East region was further divided into South and East areas. A triangulation methodology was adopted to reflect the perspectives of peer reviewers, GPs submitting materials and the GPs appraising them (Figure 2). Outcomes measures included peer reviewers' feedback, learning needs identified by peer review, feedback from contributors and appraisers' perception of making judgements within GP appraisal. 1 Peer reviewers were recruited, trained and allocated to provide feedback on significant event analysis (SEA), criterion audit or video consultation submitted by professional colleagues. 2 GP appraisers voluntarily submitted materials for peer review then commented on feedback provided by peer reviewers. 3 A focus group of appraisers examined issues relating to professional judgement and national standards within appraisal. 4 All 15 peer reviewers recruited considered the project successful. Peer reviewers thought the model piloted could be delivered nationally if adequately resourced and supported by GPs. 5 Twenty six items (14 SEAs, nine audits and three videos) were submitted for peer review, which demonstrated moderate or high levels of learning need among GP participants. 6 In the focus group, most appraisers expressed difficulty making 'professional judgements' within appraisal but demonstrated a clear willingness to accept peer-reviewed material as evidence for discussion and development. Appraisers identified a range of educational material with the potential to conform to a national standard. There is potential for peer review to contribute to the development of objective and verifiable elements in GP appraisal, encouraging GPs to achieve agreed educational standards independent of the appraisal process. This small study suggests that a national system of peer review to support GP appraisal may be desirable among relevant stakeholders and should be explored further. Additional resources would clearly be required. A comparative review of different systems in other countries suggests further research is necessary to provide greater evidence of feasibility, acceptability and educational benefit of such a system in the UK.
未来，全科医生评估可能必须纳入客观且可核实的要素。这一条件可通过开展临床实践核心领域的同行评审来实现。该研究的背景是苏格兰国民医疗服务体系教育（NES）的两个地区，这两个地区此前没有同行评审系统（图1）。东南部地区又进一步划分为南部和东部区域。采用了三角测量法来反映同行评审人员、提交材料的全科医生以及对他们进行评估的全科医生的观点（图2）。结果指标包括同行评审人员的反馈、同行评审确定的学习需求、材料提供者的反馈以及评估人员对在全科医生评估中做出判断的看法。1. 招募、培训并分配同行评审人员，以便对专业同事提交的重大事件分析（SEA）、标准审核或视频会诊提供反馈。2. 全科医生评估人员自愿提交材料以供同行评审，然后对同行评审人员提供的反馈发表意见。3. 一个由评估人员组成的焦点小组研究了评估中与专业判断和国家标准相关的问题。4. 招募的所有15名同行评审人员都认为该项目很成功。同行评审人员认为，如果有足够的资源并得到全科医生的支持，试点的模式可以在全国推行。5. 提交了26个项目（14个重大事件分析、9次审核和3个视频）以供同行评审，这表明全科医生参与者中存在中等或较高水平的学习需求。6. 在焦点小组中，大多数评估人员表示在评估中做出“专业判断”存在困难，但表现出明显愿意接受经过同行评审的材料作为讨论和发展的证据。评估人员确定了一系列有可能符合国家标准的教育材料。同行评审有潜力为全科医生评估中客观且可核实的要素的发展做出贡献，鼓励全科医生独立于评估过程达到商定的教育标准。这项小型研究表明，相关利益攸关方可能希望建立一个支持全科医生评估的全国同行评审系统，应进一步探索。显然需要额外的资源。对其他国家不同系统的比较性审查表明，有必要进行进一步研究，以提供更多关于这种系统在英国的可行性、可接受性和教育效益的证据。
