Revalidation for Stroke Physicians
BASP Clinical Standards Committee
The aim of this document from the British Association of Stroke Physicians (BASP)1 is to provide
a framework of supporting information and resources where applicable to enable stroke
physicians to meet the requirement for revalidation. It provides guidance in collaboration with
the individual’s appraiser to highlight evidence of discussion of supporting information at their
appraisal at least once in every five year cycle. Ideally it is envisaged that the appraiser will have
a background of stroke medicine but where this is not feasible, it is hoped that this guidance
provides the appropriate template to facilitate discussion. Whilst providing supporting evidence
of information required for revalidation for stroke, it should be acknowledging that there is
variation in the specific roles of a stroke physician with regards to the breadth of expertise
practiced such as involvement in hyper-acute/acute/rehabilitation and neurovascular clinic care
as well as stroke academia (See BASP definition of Stroke Specialist).2 Therefore the guidance,
whilst taking this into account aims not to be prescriptive in its content. In order to revalidate
there is a number of supporting information set out by the GMC (General Medical Council) that
requires discussion at appraisal. These include the following:
1) Continuing Professional Development (CPD)
2) Quality Improvement activity including review of practice and significant events
4) Feedback from colleagues
5) Feedback from patients and carers
6) Complaints and compliments
Continuing Professional Development:
All physicians need to demonstrate 50 hours of CPD per year (250 hours over the
revalidation cycle). 125 hours should be external credits. As stroke medicine is a subspecialty of Medicine, in some instances stroke physicians will also be practicing in other
specialties such as Geriatrics, Neurology and General Internal Medicine and therefore the
breadth of CPD activity needs to be appropriately spread. Within the specialty of stroke
medicine, evidence of CPD activity will need to be tailored according to the clinical areas of
involvement including:
1)
2)
3)
4)
Hyper-acute Stroke Care
Acute Stroke Care
Stroke Rehabilitation
Neurovascular Clinic and Secondary Prevention
Evidence for CPD activity for stroke medicine can be demonstrated in the following ways:
1) Attendance at annual National or International stroke specific meetings
Stroke Physicians should be encouraged to attend BASP endorsed national annual
conferences 3 or other relevant stroke specific conferences nationally or internationally.
2) Attendance at regional clinical and scientific meetings
These include educational courses spanning the breadth of the specialty but also focusing on
specific elements of stroke practice
3) Participation in stroke subspecialist meetings
These include departmental clinical and educational meetings where stroke specific topics or
case based reviews are undertaken as part of a multidisciplinary team
4) Use of web based programmes for educational resource
Examples include training in brain imaging, NIHSS neurological score assessments, access to
National and International Stroke Guidelines and other educational platforms and modules
for stroke training
5) Teaching and Research
Provision of undergraduate, postgraduate, multidisciplinary education and training including
lecture preparation, scientific manuscript reviews and preparation. Supervision of students
for audit and research purposes should be reflected upon. Participation in stroke research
network studies should be recorded where applicable. Evidence of Good Clinical Practice
(GCP) should also be explored.
Quality Improvement Activity
This will provide evidence of delivering, sustaining and developing a high quality stroke
service. Reference to the BASP Stroke Service Standards document (2014)4 will provide
specific examples of clinical practice, which should be documented and reflected upon.
Participation in national audits (SSNAPP, SSCA)5,6 are strongly encouraged and reflection on
the key process and outcome measures should be sought. It should be acknowledged that
specific components of the individual’s contribution to clinical practice should be explored
through local audit, reflection and patient feedback where possible. The following section
provides guidance and examples of the content of supporting information that BASP believe
are acceptable to meet the requirements for revalidation.
Hyper-acute care:
a) Reflection of experience and activity within a thrombolysis service
b) Clinical governance measures to ensure competence and safety in hyperacute care (e.g. participation in regular case based discussions with
multidisciplinary partners (neuro-radiology, neurosurgery) mortality and
morbidity meetings and comparison against national benchmarks)
c) Aspects of care that the stroke physician is singly or collectively responsible
for (e.g. development of specific protocols across the hyper-acute pathway)
Acute Stroke Care:
a) Reflection of stroke in-patient activity against national benchmarks.
(Participation in national audit may reflect the performance of the team but
certain elements of individual contribution to the service should be focused
upon)
b) Demonstration of regular multidisciplinary team meetings and participation
with colleagues from other disciplines (e.g. neuroradiology , cardiology,
allied health professionals)
c) Development of stroke care pathways to enhance quality improvement (e.g.
enhance acute stroke unit admission)
Stroke Rehabilitation:
a) Maintenance of clinical competence in specific areas through reflection of
activity and regular performance (e.g. spasticity management)
b) Reflection of in-patient activity and length of stay
c) Development on protocols or pathways leading to improved processes and
outcome for stroke rehabilitation (e.g. reduction in post stroke
complications or enhanced discharge planning, provision of six month
reviews)
d) Evidence of collaboration with early supported discharge and community
stroke services
Neurovascular Clinic and Secondary Prevention:
a) Evidence of personal involvement within a multidisciplinary vascular service
b) Involvement in developing protocols and pathways for secondary
prevention and reflection of outcome
c) Reflection of activity in neurovascular clinic (e.g. timing of assessment)
d) Evidence of case based discussions
Feedback from colleagues
Individuals should use the Royal College of Physicians validated feedback questionnaires and
accompanying guidance where appropriate7.
Feedback from patient and carers
Physicians should use the appropriate feedback tools approved by their own Trusts.
Employment of stroke specific feedback questionnaires should also be used where available.
Complaints and Compliments
Discussion and reflection of complaints and compliments should be highlighted and
reviewed with active participation in clinical governance
References:
1) British Association of Stroke Physicians. http://www.basp.ac.uk
2) Definitions of a stroke specialist physician.
http://www.basp.ac.uk/Portals/2/Definition%20of%20a%20Stroke%20Specialist%20FINAL%
20Aug%202011.pdf
3) UK Stroke Forum. http://www.ukstrokeforum.org
4) BASP. Stroke Service Standards. http://www.basp.ac.uk/Portals/2/BASPStrokeStandards%20Latest%20June%202014.pdf
5) Sentinel Stroke National Audit Programme (SSNAP).
http://www.rcplondon.ac.uk.uk/projects/sentinel-stroke-national-audit-programme
6) The Scottish Stroke Care Audit. www.strokeaudit.scot.nhs.uk
7) http://www.rcplondon.ac.uk/cpd/revalidation/supporting-information-tools-andtemplates/feedback-and-revalidation.