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How Doctors Keep up to Date - Dr Mark Burgin

28/06/19. Dr. Mark Burgin BM BCh (oxon) MRCGP describes the rather patchy and disorganised systems that attempt to ensure that doctors are safe to practice.

There has been increasing recognition that a doctor who has been in practice for perhaps 20 years may not have had their knowledge gaps assessed since they left medical school.

Due to the length of careers even for those who have passed their speciality examinations it may be decades since their last examination.

I have made FOI requests to determine how many more senior doctors have sat basic knowledge examinations and the results say that about 200 annually and 15 to 30% fail. (1)

In the USA specialty boards require recertification every 7 or 10 years with a 10-20% failure rate suggesting that it is not uncommon for a US doctor to develop knowledge gaps. (2)

Knowledge gaps

The UK has a system of continuous professional development (CPD) supported by annual appraisal and 5 yearly revalidation but these do not involve assessment.

The failure the royal colleges to provide even a voluntary system to assess where the knowledge gaps are has led to doctors being unaware of their weaknesses.

Although almost all doctors will have a gap in at least one of the areas of their specialist curriculum, few doctors are able to tell their appraisers what it is/they are (personal communication).

Whilst it is acceptable that doctors fall behind in their knowledge, it is unacceptable that these doctors are unaware that their gap(s) may be leading to inadequate care.

Informal learning in GP

For GPs the drive to learn comes from contact with their patients, looking for solutions to the patient’s problems and hearing patients tell them ideas from the internet.

This ensures that a GP in current practice often learns about a new idea and is applying it to patients and sharing with colleagues by the end of that week.

GPs in larger practices find it easier just to refer patients in their knowledge gaps to colleagues than put in the about 200 hours it takes to fill a significant knowledge gap.

Although this ensures that patients get the right care and if that individual leaves the practice may need to increase referrals to specialist services to ensure continuity of care.


The GMC has led the way in reforming the assessment of doctors who are impaired through poor performance and those for medical students and foreign doctors but numbers remain low.

To fail the GMC examinations the doctor’s knowledge must either be poor on all areas or very bad in several areas so a pass does not mean that there are no gaps.

The GMC also uses a peer review looking at the doctor’s work and considers if the knowledge gaps have caused harm and they look at the doctor’s educational activities.

There is understandable secrecy surrounding a doctor’s educational activities and appraisal so it not possible to determine if doctors respond to clinical negligence with additional learning.


The UK system of appraisal is time consuming and in general felt to be a tick box exercise rather than being able to improve the quality of care. (3)

Appraisers do not feel confident to recommend that doctors should pay for a commercial knowledge test to diagnose their knowledge gaps in case they will have fail a doctor.

It is important to recognise that skills are important so a knowledge gap does not immediately imply that the doctor will give poor care but there are limits.

There is urgent need for all doctors to plan their CPD based upon an online annual formative knowledge assessment where their scores remain confidential from the regulators.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register.

Dr. Burgin can be contacted on This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website

  1. Burgin 2018 Clinical Negligence experts may have deficient knowledge of their area of expertise in new figures from the GMC and HEE. 2018

  2. Maintenance of Certification Exam Ultimate Pass Rates 2008 – 2018

  3. Cook 7 March 2019 Revalidation has failed to improve patient safety, GPs warn

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