Medical Appraisal in
Scotland
Part 1
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Introductions …..
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Name
Specialty
Reasons for attending/wanting to be an appraiser
Expectations of the course
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Aims
• To equip appraisers with the skills necessary to
conduct an appraisal with a colleague with confidence
• To self-evaluate appraisal skills in the light of feedback
and observation following participation in ‘focussed’
appraisal sessions.
• To equip appraisers with the skills necessary to deliver
the appraisal process, to the required standards in
terms of quality and consistency.
• To support, share and reinforce good practice on the
part of appraisers.
• To enable the course participants to feed back on the
training model and approach.
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Methods of the Course – Part 1
Experiential approach
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Plenary and small group discussions
Observe & analyse a tutor role play
Small group work – pairs & trios
Individual exercises
Role plays
Feedback & homework – Video Clips & Summary
Form
• Video and ‘mini’ Appraisals on Day 2
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Course Pre-work
• Observe and analyse simulated appraisal Video Clips
• Preparing for the appraisal exercise
• The job you do
• Supporting Information (Quality Improvement
Activities)
• Personal Development Plan for the year ahead
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Ground Rules
Participate positively
Time keeping
Mobile phones
Avoid jargon
Respect confidentiality
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Appraiser Assessment process
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We need your feedback!
• End of day verbal evaluation
• Post course evaluation questionnaires/interviews
(research)
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Delivering a High Quality
Appraisal
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Characteristics of a high quality
appraisal
• Structured
• Safe/Supportive
• Space for appraisee to talk & reflect
• Emotional issues can be addressed
• Challenges thinking
• Encourages meaningful PDP
• Probity and Health explored meaningfully
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The Appraisal Interview
Is well structured
Appraiser Behaviours
Agenda agreed near the beginning of the interview.
Areas for discussion are flagged up.
The appraiser manages the interview effectively, summarising regularly
and signposts the beginning and end of sections of the interview.
Is a safe/supportive experience Clarity about the boundaries of confidentiality near the beginning of the
interview.
The appraiser develops rapport with the appraiser through the use of
reflective and empathic interventions.
The appraiser works co-operatively with the appraisee and checks that
they are happy to proceed with his/her suggestions.
Allows space for the appraisee Focuses the discussion without inappropriate interruption and without
to talk about and reflect on their blocking the appraisee.
work as a doctor
Interventions are meaningful and designed to encourage further
reflection, deeper understanding and learning.
Is able to tolerate and constructively use silence within the interview.
Where appropriate, offers the
The appraiser is attuned to the emotional content of the material the
opportunity for appraisees to
appraisee is talking about, both explicitly and implicitly.
address emotional issues
Is able to make non-collusive, empathic interventions which encourage
arising from their work
the appraisee to express their feelings.
Is able to accept the expression of emotion (eg anger, sadness, grief)
and responds appropriately.
Challenges the appraisee to
Asks appropriately probing open questions.
think more deeply about their
Asks the appraisee to think about what they could do to develop and
work and in particular to think
improve their work.
about anything they could do
Helps the appraisee to formulate an action plan to address or implement
which might have a positive
any developments or improvements identified.
impact on patient care
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Encourages the appraisee to
develop a meaningful PDP for
the year ahead which is
SMART
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Specific
Measurable
Achievable
Realistic
Time boundaried
Helps the appraisee to identify their learning needs.
Challenges the appraisee to look at their learning in a balanced manner
in terms of their personal interests, their needs as a professional
practitioner and the needs of the wider department or service within
which they work.
Encourages the appraisee to think about how to evidence changes in
their practise that result from their participation in personal development
and quality improvement activities.
Offers the opportunity for the
appraisee to meaningfully
explore issues around their
status with regard to probity
Is alert for issues of probity (ethical issues) which are implicit or explicit
in the material the appraisee both brings to the interview and expresses
or infers during the interview.
Asks exploratory open questions about any probity issues.
Encourages the appraisee to reflect and to challenge themselves to
identify any potential probity issues.
Is alert for issues regarding the appraisee’s health which are implicit or
explicit in the material the appraisee both brings to the interview and
expresses or infers during the interview.
Asks exploratory open questions about any health issues.
Encourages the appraisee to reflect and to challenge themselves to
identify potential health issues.
Refrains from taking on a clinical role in relation to any health issues
identified.
Offers the opportunity for the
appraisee to meaningfully
explore issues around their
ongoing health status
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Learning and Challenge / Support
Support
Low challenge/
high support =
warm/safe but
unsatisfying
High challenge/ high
support =
optimal learning
Challenge
Low challenge/
low support = safe
but unsatisfying
and boring
High challenge/
low support =
Anxiety provoking/
defence response
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Comfort / Stretch / Panic Zones
Comfort Zone
Stretch Zone
Panic Zone
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Communication Skills for Appraisal
• Listening Skills
• Open and closed questions
• Looking for cues – verbal/non-verbal
• Reflecting
• Summarising
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Communication Skills for Appraisal
• Acknowledge feelings and be accepting of the
person
• Allow silence
• Be prepared to challenge
• Facilitate reflection
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Beware of blocking behaviour
• Closed questions too soon
• Leading questions
• Rescuing
• Switching topics
• Overly task orientated
• Jollying along
• Ignoring cues
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Supporting Information
• During annual appraisals, doctors will use supporting
information to demonstrate that they continue to meet
the principles and values set out in Good Medical
Practice.
• The supporting information will reflect the scope of
your particular specialist practice and other
professional roles.
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Supporting Information
• What do you do?
• How do you keep up to date?
• How do you review your practice?
• How do you respond to feedback on your practice
from colleagues and patients?
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Information for Appraisal
Four Domains of Good Medical Practice
1. Knowledge, Skills and performance
2. Safety and Quality
3. Communication, Partnership and Teamwork
4. Maintaining Trust
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Annually
• CPD and PDP
• Quality Improvement Activity
• Significant Events
• Review of complaints and compliments
• Health
• Probity
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Every 5 years
• Feedback from colleagues – MSF
• Feedback from patients – PSQ (CARE/GMC)
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Discussing Supporting Information
at appraisal
• Relevant to your work?
• Active participation?
• Evaluation and reflection on the results?
• Action taken– if appropriate?
• Demonstration of outcome or maintenance of quality
- Closing the loop
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Quality Improvement Activity
(i) clinical audit – evidence of effective participation in clinical audit or
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
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Preparing for the interview
• Identify positives from the supporting information
• Identify areas which could have been done differently
and/or areas for development
• Prepare loose structure and the opening words to
initiate the discussion
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Information and analysis
• How complete is the information?
• Is there anything missing?
• What are the key issues?
• Has the appraisee identified these?
• Has the appraisee reflected on the material?
• Has the appraisee considered/or implemented change
as a result of undertaking this activity?
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Role of Appraiser
• Refrain from telling the appraisee what to do
• Encourage the appraisee’s reflections and solutions
before offering your own
• Be evaluative but avoid an overtly judgmental
approach where appraisee feels criticised/labelled
• Use descriptive language
• Consider carefully before offering specific advice
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Role of Appraiser
• You can share information, make suggestions and act
as a resource and identify areas which could be used
for further development
• Be specific when commenting and offering own view
• Focus on aspects of appraisee’s behaviour which can
be changed
• Structure discussion so that specific outcomes/goals
to be achieved are addressed in each section
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Judgement?
• Appraisal supporting information reflects the doctor’s
scope of work and has been presented in accordance
with GMC Guidance
• Information has been reviewed and summary agreed
• Appraiser has no reason to believe that the doctor is
not practising in line with the principles of Good
Medical Practice
• ‘On track’ for Revalidation
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Communication Skills Exercise
• Practice in interview management
• Questioning
• Giving Feedback
• Practice for ‘mini’ appraisals to come on day 2
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Material to talk about as an
‘appraisee’
• Real issue from your work
• Current or historical
• Carries a degree of emotional charge
• Is suitable for a 10 minute practice session
• A ‘hot topic’ but not too ‘hot’!
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Pendleton rules for feedback
• Clarify any matters of fact
• The learner describes what they did well.
• The observer(s) describes what was done well.
• The learner describes what could be improved.
• The observer(s) describes what could be improved
and offers suggestions on how it could be improved.
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Appraisal Summary Forms
(Form 4)
• A core tangible outcome of the appraisal process.
• A record of the interview.
• Appraisers need to put as much effort into drafting the
summary form as other components of appraisal.
• Can and may be viewed by other legitimate
stakeholders eg: Responsible Officer
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• Appraisals are professional interviews
• Must be robust, based on attributable supporting
information
• Record of appraisal interview to be accurate,
comprehensive, clear and effective
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Current Summary Forms
Independent review of GP summary forms conducted
in 2006 suggested:
• Were too short
• Omitted relevant information discussed at the
interview
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An effective summary
• Meaningful
• Specific
• Objective
• Avoids assumptions
• Avoids collusion
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What does this mean?
• Objective – relevant with clear reference to supporting
information reviewed
• Highlights omissions & material needed for next year’s
appraisal, expressed where possible in positive
language.
• Meaningful statements that can be understood by a
third party, not present at the interview.
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• Specificity – avoid bland or ambiguous comments e.g.
“fine”; “OK”; “more of the same”.
Needs to be specific to the appraisee.
• Reference to reflective practice
• Records appraisee’s achievements, changes to
practice and progress
• Aide memoire for appraisee and future appraiser; sign
post for next appraisal
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Avoids Assumptions
a. “Dr X has a very healthy life style and obviously has
no health issues”
b. “Dr X described his life style as healthy & stated that
he had no health issues”
c. “Dr X has a very heavy & stressful work load & I
raised the possibility of burn out”
d. “ We discussed Dr X’s workload which she
described as full & varied. She stated that she finds
her work fulfilling and stimulating”
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Avoids Collusions
a) “given the nature of his speciality and location, Dr
X’s isolation limits his ability to reflect on his work”.
b) “we discussed Dr X’s view that his specialty and
location affected his ability to reflect on his work.”
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Achievements
• Use positive language
• Describe areas of work that give the appraisee
satisfaction and their feelings about what has been
achieved.
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Integrity
You must be satisfied that the summary you complete is
an accurate reflection of the key areas and supporting
information addressed & discussed at the interview, and
that you have not made assumptions or colluded with the
appraisee.
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