32046426Preparing thoroughly for an appraisal is vital. The organisation and structure of the appraisal meeting will set the tone for the discussion. If you are well prepared this will make the doctor feel valued and you will find it easier to undertake a high quality appraisal.

The appraisal summary consists, in the main, of three columns:-

Activity/ AchievementAvailable supporting documentationDiscussion and feedback from the appraiser
This column should contain a summary of the information presented. It should not simply be a copy of the appraisal information supplied. Standard headings are suggested later. This column should describe any supporting documentation provided. If electronic records are attached in the appraisal information a brief reference is all that is required. The absence of supporting documentation may also be significant (e.g. the doctor describes an audit but the documentation is absent) This column should contain a record of the discussion. It should be written in the knowledge that this may be examined by others (Responsible Officer) for the purposes of revalidation. It should be in the third person and appear professional. Judgemental comments should be avoided.

Standardised, thorough preparation provides a sound framework for the discussion. You may use preparation time to structure the information ready for the completed appraisal summary. This helps quality assurance and the appraisal summary feedback process. You do not need to prepare something from every appraisal information entry.

You may choose to group entries under themes if appropriate. Be flexible – you may need to add to this column after the meeting.

It is helpful to look at the previous appraisal summaries to see what was discussed in depth in previous appraisals so you do not repeat what has already been covered. It may also be apparent from the previous Form 4 and PDP that some things ought to be discussed again if there were specific points that needed to be addressed for this appraisal.

Focus on:

  • Themes
  • Material addressing last year’s PDP
  • Material supporting the doctor’s special roles
  • Material that the doctor has identified as being of particular importance in their reflections

Use standard headings in the Activity/Achievements columns:

  • Title
  • Activity (Brief description)
  • Reason (for activity) e.g. identified in last year’s PDP, learning need for special responsibilities
  • Reflection – the doctor’s (if present)
  • Outcome (there may not be one)

A challenging appraisal discussion is still one that is supportive, developmental and constructive. It is not critical, confrontational or performance management-oriented. The challenging appraiser makes use of the skills in the middle column below:

Acquiescent   Challenging Threatening/Confrontational
Submissive Exploratory Provoking
Loose Focused Rigid
Unquestioning Probing/Questioning Disbelieving / Cynical
Passive Assertive Aggressive

A challenging discussion is important for a range of reasons:

  • To show that the discussion has added value for doctors
  • To encourage self-motivation and contribute to improved performance
  • To encourage the doctor to examine reflection and planning, and instil a new focus in doctors on outcomes i.e. what has been learned and how this has informed practice
  • To help doctors to progress and develop and ultimately improve patient care
  • To ensure PDPs are based on learning needs (as opposed to wants)
  • To facilitate an objective review of learning and progress
  • To provide assurance that appraisals are ‘robust’ and meet requirements for revalidation

There are links between challenge and improved performance.

Use your feedback skills to introduce challenge into the appraisal discussion:

29038267Probe the doctor to ensure that they:

  • Reflect on their activities rather than just detailing them
  • Identify what they have learned and how they have (or could) put this into practice
  • Are familiar with and have applied any relevant educational standards e.g. audit cycle
  • Identify any new learning needs and think about whether these should be included in the PDP
  • Make sure you explore at least some issues, themes or entries in depth
  • Ask the doctor to explain why they undertook specific activities or used certain approaches
  • Offer ideas for discussion, encourage the doctor to consider alternatives and options
  • Focus the doctor on specific action points or learning targets and encourage them to think about how they will achieve these

You will have to decide on an appropriate level of challenge. This might not be the same for all doctors / appraisals. It need not be the appraiser who challenges – the doctor may challenge themselves. Through appraisal we hope to help doctors to develop their skills of reflection and self-direction, which could lead to self-challenge.

Factors influencing development

Constraints are considered to be external factors, outside the doctor’s control and that are perceived by the doctor to limit their own development or their delivery of healthcare. However anything the doctor perceives as a constraint may be discussed.

The doctor can enter constraints under headings for Personal, Practice/Hospital, or Service Constraints. You should clarify these where necessary.

Encourage the doctor to be specific about the nature of the constraint and facilitate discussion on problem solving and how the constraint might be managed.

Download Module 4