You couldn't make it up. Or could you?

Revalidation is the new method by which doctors in the UK will stay on the medical register. Most doctors will take the appraisal route to revalidation--that is, they will undergo annual appraisals and five successful appraisals will result in revalidation. So there is a lot riding on appraisal. But it relies almost completely on trust. And in a situation that is based on absolute trust there are endless opportunities for that trust to be broken. Doctors will be encouraged to look at how they are doing as a doctor in terms of the General Medical Council's characteristics of a good doctor-such as providing good clinical care and maintaining good relationships with patients. But doctors can fabricate evidence to show that they work to these standards. There is anecdotal evidence that this happens and also published evidence that medical students cheat and that such cheating may predict dishonesty later on. One study from outside medicine showed that some learners doing a postgraduate diploma in education admitted to cheating. The current system of appraisal and revalidation is currently under review in light of the Shipman inquiry and many doctors are scared that appraisal may be a stepping stone towards assessment. A guaranteed way of speeding up the drive towards introducing assessment is not taking appraisal seriously.