Quality improvement activities (QIAs)

You do not need to do all the background work and data collection or analysis for your quality improvement activity yourself. Someone else being delegated to undertake a literature search, or do some of the research, is a reasonable and proportionate use of your time. Many QIAs such as clinical audits are team-based anyway, involving colleagues in the hospital, or are regional or national projects. Personal audits you undertake will also no doubt involve colleagues in the collection and collation of data.

For the purposes of revalidation, you are required to participate in QIA although no single type is mandated.

The GMC provides broad examples of QIAs in their revalidation guidance: audit, review of clinical outcomes, case-based discussions, and impact and effectiveness evaluations.

What is expected is that you participate in QIAs at least once every five years. we recommend that QIAs are selected according to what is relevant and important to you in improving the quality of care and services you or your team provides.

What is also expected for revalidation is reflection on any QIA. Your personal reflective notes should include an explanation about your role and a description of the findings, including any lessons you have learned and the impact they have had on the quality of care or services provided.

Further guidance on case-based discussions for psychiatrists in available in College Report 194.


Clinical audit is not a revalidation requirement. However, participating in quality improvement activities is a requirement, and many doctors choose to participate in local, regional and/or national clinical audit. It is worth considering:

  • The type and level of involvement in clinical audit will vary according to a doctor’s specialty (national clinical audits are being run in some but not all specialties). See the  HQIP guide on the use of national clinical audit data in appraisal.
  • Where a personal or local audit is undertaken, the methodology should be robust and systematic, include an element of evaluation and action, and, where possible, demonstrate an outcome or change.

Providing clinical outcome data based on your work as a clinician is not a revalidation requirement. However, if validated and robust national clinical outcome data is regularly collected in your specialty or subspecialty and is made accessible in a database, any relevant data should be taken to appraisal.

The data should be accompanied by evidence of reflection and, where relevant, improvement in practice. You should reflect on the personal data at least once in the five-year revalidation cycle. Self-awareness of the quality of care provided in relation to the clinical skill is important.

Many doctors choose to participate in clinical audit or review outcome data as activities in meeting the quality improvement requirement for revalidation. Where this is not possible, an alternative activity is case-based discussion with documentation of appropriate reflection and action taken.

Further information is provided in the College’s  guidance on supporting information. Doctors working in a non-clinical area should discuss options for quality improvement activity with their appraiser. Possible options include evaluation of teaching or management practice.

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