The Evolving Purposes of Medical Revalidation in the United Kingdom: A Qualitative Study of Professional and Regulatory Narratives

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Suggested way forward 1. Regard each individual interview as contributing some complementary pieces of an overall jigsaw, rather than trying to cover all of the ground in every interview. This would mean Covering a few areas in depth/detail in each interview: a. Areas not well-covered by previous interviews conducted during WP1. This can be coordinated through: i. Weekly team discussion of priorities and emerging learning ii. 24 hour turnaround on transcription for the first few interviews b. Areas that the interviewee is knowledgeable about and/or interested in -so that the interview is useful to both sides 2. Focus on new theory elicitation rather than on theory confirmation, at least in initial interviews.
a. This will give the research team more time to consider how theory confirmation/development and triangulation will be integrated into the project, and we may gain useful learning from the first few interviews that will help with this. In view of the difficulty/complexity, better to keep it simple for the time being. b. If we can set up a means of evaluating/prioritising theories for further investigation/testing through the survey, case studies and further literature evidence review (E.g. the steering group plus interviewees who are interested to participate), then this can provide a theory confirmation/validation/development function. We would need to schedule this in the light of interview dates arranged and the survey etc. dates. 3. Provide some structure for the interview, but at a fairly high level.
a. Corresponding to 3 perspectives/dimensions -key areas of: medical performance; organisational systems and processes for managing medical performance; RO revalidation components. This will facilitate monitoring of what ground the interviews cover (see above), will help to stimulate new thinking by the interviewee by bringing in these 3 perspectives, but will not overly lead/prompt them. b. Depth can be obtained through follow-up questioning within each area that is addressed, based on consideration of generic concepts from realist evaluation: context, mechanism, outcome, resources and reasoning. This will be elaborated further if agreed as a way forward. It would have the additional benefit of helping to clarify what we mean by "mechanism," etc., so that research team members gain a common understanding.
Supplemental digital content for Tazzyman A, Ferguson J, Walshe K, Boyd A, Tredinnick-Rowe J, Hillier C, Regan De Bere S, Archer J. The evolving purposes of medical revalidation in the United Kingdom: A qualitative study of professional and regulatory narratives. Acad Med.
4. Priority for theory construction -identify/construct generic/common theories that relate to appraisal and the sources of information relating to organisational processes and systems that are to be considered within appraisals (e.g., CPD, audit, complaints etc.). If there are various common theories that could apply to all of these (as would appear to be the case from the way these aspects are incorporated into appraisal guidance as just a list of items), then we can streamline the investigation of these areas in the interviews by referring to/building on these common theories -whether an interviewee is considering CPD or audit, their theories can be compared with these common theories.

Evaluating the development of medical revalidation in England INTERVIEW GUIDE -STAKEHOLDER INTERVIEWS, WORK PACKAGE 1 Introduction [2 mins]
• Purpose of interview -to consider the impacts revalidation might have on other activities related to medical performance (job planning, CPD, clinical audit, etc.), and why, including facilitators and barriers. The focus is more on rationales underlying the policy design than on evidence of impact -we will be collecting evidence systematically later in the project. We are interviewing about 20 people who have been involved in the development or implementation of the revalidation model.

Informed consent [5 mins]
• Have you received and understood our project information sheet? Any questions?
• Run through consent form, checking/recording consent. Any questions?
• Switch on tape, if appropriate.

What is your role at [Organisation name]?
2. Please describe your involvement in the development and implementation of revalidation.

Impact [40 mins]
For each of the following 3 perspectives on revalidation (Dr outcomes; Dr performance systems; RO responsibilities): a. Identify key areas to focus on (prior to the interview, reorder the focusing prompts as appropriate, so that gaps are addressed first; some areas may be omitted).