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Revalidation in Wales

Significant events

The purpose of collecting and reflecting on significant events is to allow you to review and improve the quality of your professional work; to identify any patterns in the types of significant events recorded about your practice; and to consider what further learning and development actions you have implemented, or plan to implement to prevent such events happening again.

You must declare and reflect on every significant event you were involved in since your last appraisal.

Your discussion at appraisal should focus on those significant events that led to a change in your practice or demonstrate your insight and learning.

You must be able to explain to your appraiser, if asked, why you have chosen these events.

Your reflection and discussion should focus on the insight and learning from the event, rather than the facts or the number you have recorded.

GMC, Guidance on supporting information for appraisal and revalidation

What is a significant event?

The GMC defines a significant event as any unintended or unexpected event, which could or did lead to harm of one or more patients.

This includes incidents which did not cause harm but could have done, or where the event should have been prevented.

You should focus on your learning from any events that have or could have harmed your patients.

The GMC emphasis is on patient safety incidents - events that reach a significant level of actual or potential harm to patients.

Significant events should be collected routinely by your employer where you are directly employed by an organisation. Many organisations (including hospitals and general practices) have formal processes in place for logging and responding to all such events. If you are self-employed you should make note of any such events or incidents and review them.

All healthcare professionals have a duty of candour – a professional responsibility to be honest with patients when things go wrong. As a doctor you must be open and honest with patients, colleagues and your employers. The professional duty of candour guidance makes clear the need for honesty with patients after healthcare harm, and the importance of contributing to a learning culture to improve patient safety and make sure lessons are learned.

As a doctor you have a responsibility under the duty of candour to log incidents and events according to the reporting process within your organisation.

Your appraisal entry should include details of your participation in any formal process. You should reflect on any patterns in the types of incidents or events, and should discuss the action you have taken and any changes made to your practice to prevent such events or incidents happening again.

Areas for further learning and development should be reflected in your personal development plan and CPD.

Remember – ‘Confidentiality’ and ‘reflection is essential’

It is the insight and learning from the significant event, rather than the facts or the number you have recorded, which should be the focus of your reflection and discussion at appraisal.

Significant events should be discussed with colleagues to maximise and share learning.

The use of “team learning” around these events is often very relevant as it is rare that an event occurs in isolation, and the GMC encourage an open and inclusive approach to reviewing these events to see how the whole organisation can learn from the event.

The checklist manifesto approach as espoused by Atul Gawande is one way to think about these events

Another is to think about the human factors in errors and the situational awareness model for reflecting on these issues.

Effective review of significant events should lead to quality improvement in practice.

The numbers of significant events may vary across different specialties.

If you have not been involved in any significant events you must declare this fact.

You should either reflect on your local significant event process or what you have been doing well to mitigate the risk of a significant event occurring.

Events that do not reach the GMC threshold of significant harm or adverse patient safety incidents need not be declared as significant events for revalidation purposes, but may still present valuable learning opportunities.

Learning from events should be considered a normal part of review of practice leading to quality improvement.

You may learn from positive events and good practice, as well as events where things could have been done better.

It would be unusual to not encounter any events with some potential for learning.

The MARS template headings are designed to ensure you cover all the relevant information in your appraisal entry.

If you believe that an event meets the GMC threshold for patient safety incidents (events that reach a significant level of actual or potential harm to patients) then enter it on MARS as a Significant Event. If it is below the threshold, then you may wish to enter it under QIA.