For the purposes of revalidation, you will have to demonstrate that you regularly participate in activities that review and evaluate the quality of your work. Quality improvement activities should be robust, systematic and relevant to your work. They should include an element of evaluation and action, and where possible, demonstrate an outcome or change.

Quality improvement activities could take many forms depending on the role you undertake and the work that you do. If you work in a non-clinical environment, you should participate in quality improvement activities relevant to your work. Examples of quality improvement activities include:
(i) Clinical audit – evidence of effective participation in clinical audit or an equivalent quality
improvement exercise that measures the care with which an individual doctor has been
directly involved
(ii) Review of clinical outcomes – where robust, attributable and validated data are available.
This could include morbidity and mortality statistics or complication rates where these are
routinely recorded for local or national reports
(iii) Case review or discussion – a documented account of interesting or challenging cases that a
doctor has discussed with a peer, another specialist or within a multi-disciplinary team
(iv) Audit and monitor the effectiveness of a teaching programme
(v) Evaluate the impact and effectiveness of a piece of health policy or management practice

If you work in a non-clinical role you might find it helpful to discuss options for a quality improvement activity with your appraiser, or a relevant professional association. 

Medical Royal College and Faculty guidance: The Medical Royal Colleges and Faculties will provide guidance on the type of activity that would be most appropriate for doctors working in particular specialties or general practice. Many specialties have in place robust and validated quality measures, such as national specialty databases.

Healthcare Quality Improvement Partnership Resources: The Healthcare Quality Improvement Partnership (HQIP) has a wide range of resources for quality improvement activites and audit on its website, this useful for both primary and secondary care doctors. The HQIP website can be found here.

Of particular relevance is the HQIP Guide to Using Quality Improvement Tools to Drive Clinical Audits.

The Wales Deanery has produced an educational module called 'All about audit'. 

A document has been created to provide guidance for Sessional Doctors on both Significant Events & Quality Improvement Activities, this can be found here. 

Frequency: Involvement in quality improvement activities is expected at least once every revalidation cycle; however the extent and frequency will depend on the nature of the activity. For example, participation in a full national clinical audit might be appropriate once per revalidation cycle, whereas a case review might be expected to take place more regularly. You should discuss and agree the frequency of the quality improvement activity with your appraiser.


  • Active participation relevant to your work – You will need to demonstrate that you have actively participated in a quality improvement activity or a clinical audit relevant to your work.
  • Evaluate and reflect on the results – You need to demonstrate that you have evaluated and reflected on the results of the activity or audit. This might be through reflective notes about the implications of the results on your work, discussion of the results at peer-supervision, professional development or team meetings and contribution to your professional development.
  • Take action – You will need to demonstrate that you have taken appropriate action in response to the results. This might include the development of an action plan based on the results of the activity or audit, any change in practice following participation, and informing colleagues of the findings and any action required.
  • Closing the loop: demonstration of outcome or maintenance of quality – You should consider whether an improvement has occurred or if the activity demonstrated that good practice has been maintained. This should be through the results of a repeat of the activity or reaudit after a period of time where possible.