Other consultants pointed to the rapid and significant changes in the terminology used in the field of cervical histopathology, particularly in CIN grading. 16 CHI also considers that re-training in the subject should have been recommended to Dr Elwood, particularly in view of the recent developments in cervical pathology and the fact that so much of the department's work was in this field. 5.10 CHI was impressed by the promptness with which doubts about Dr Elwood's reports, when finally identified, were reported to senior management and investigated in 1999. As well as the absence of a clear system for monitoring their performance, there did not appear to have been a mechanism for dealing with cases of identified errors or poor practice by locum consultants. CHI noted that clinical audit and performance management were somewhat neglected areas until the current management took over from 1998.
Procedures vary from region to region and between cytology and histology schemes.
The fundamental process usually involves pathologists reporting a set of slides chosen by the scheme organisers to reflect the average diagnostic problems of every day work. Individual performance is measured against the consensus diagnostic opinion of all the participants in the scheme. While such schemes have value in measuring performance and identifying areas of weakness over a period of time for permanent staff, they are not an appropriate method for short term locums. CHI is not aware that Dr Elwood was a participant in any such scheme. Now that EQA schemes are operating in nearly all regions it is important that locums as well as permanent staff keep a record of such participation.