Model for directly assessing and improving clinical competence and performance in revalidation of clinicians.

It is now clear that revalidation and clinical governance will drive continuing professional development in medicine in the United Kingdom. 2 Thus patients, society, and the profession are to be assured that individual doctors not only are fit to practise but are providing high quality care for patients. The focus of professional revalidation is rightly moving from the requirement that practitioners merely provide evidence of participation in continuing education towards the requirement that they provide evidence that better reflects their clinical practice. 4 Nevertheless, the primary screening procedures that have been proposed for revalidation are indirect (see box). If used at all, tests of clinical competence come much later in the process, but few tests include direct observation of practice. We present the case for the primacy of obtaining direct evidence of clinical competence of any doctor being revalidated; discuss the essential attributes of any process of obtaining such evidence; describe the ways in which such evidence can be gathered; explore the limitations of review tools currently available; and suggest an appropriate model for performance review.