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Medical Appraisal in Scotland

Part 1

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Introductions …..

• 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

• And the skills necessary to deliver the appraisal process, to the required standards in terms of quality and consistency.

• To self-evaluate appraisal skills in the light of feedback and observation following participation in ‘focussed’ appraisal sessions.  

• 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

• 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 and time for appraisee to talk & reflect

• Emotional issues can be addressed

• Challenges thinking, stimulates insight

• Encourages meaningful personal and professional

development

• Probity and Health explored meaningfully

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The Appraisal Interview Appraiser BehavioursIs well structured 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 to talk about and reflect on their work as a doctor

Focuses the discussion without inappropriate interruption and without blocking the appraisee. 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 opportunity for appraisees to address emotional issues arising from their work

The appraiser is attuned to the emotional content of the material the appraisee is talking about, both explicitly and implicitly.Is able to make non-collusive, empathic interventions which encourage 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 think more deeply about their work and in particular to think about anything they could do which might have a positive impact on patient care

Asks appropriately probing open questions.Asks the appraisee to think about what they could do to develop and improve their work.Helps the appraisee to formulate an action plan to address or implement any developments or improvements identified.

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Encourages the appraisee to develop a meaningful PDP for the year ahead which is SMARTieSpecificMeasurableAchievableRealisticTime 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.

Offers the opportunity for the appraisee to meaningfully explore issues around their ongoing health status

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.

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Learning and Challenge / Support

High challenge/ high High challenge/ high support = support =

optimal learningoptimal learning

Low challenge/ Low challenge/ high support = high support = warm/safe but warm/safe but unsatisfyingunsatisfying

Low challenge/ Low challenge/ low support = safe low support = safe but unsatisfying but unsatisfying and boringand boring

High challenge/ High challenge/ low support = low support = Anxiety provoking/ Anxiety provoking/ defence responsedefence response

SupportSupport

ChallengeChallenge

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Comfort / Stretch / Panic Zones

Panic Zone

Stretch Zone

Comfort 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

Communication Skills Exercise

• Practice in managing an appraisal

• 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

• Clinical or organisational

• 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

Reviews of summary forms have suggested:

• Too short

• Omitted relevant information discussed at the interview

• Did not reference supporting information

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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 interview37

• 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 if demonstrated

• Records appraisee’s achievements, changes to

practice and progress

• Aide memoire for appraisee and future appraiser; sign

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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 concerns about 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”39

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 and

discussed how this could be addressed.”

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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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