Consultant appraisal – a Clinical Director's perspective
All doctors in training are aware of the need to present an annual summary of their work to a panel
of clinicians who will, in turn, provide a summative assessment of their performance (Annual Review
of Competence Progression; ARCP). Once training is complete and doctors commence solo or
independent practice, the need to maintain a portfolio for review is retained although the processes
upon which it is then used differ. Whilst the ARCP is structured as a pass or fail exercise, the annual
consultant appraisal discussion is facilitated by a single trained appraiser and is a formative exercise
and therefore developmental rather than ‘pass/fail’. Since 2012, the requirements for the newly
‘strengthened’ medical appraisal have been dominated by the need for doctors practicing in the
UK to revalidate and therefore renew a licence to practice every five years.
Debate about the precise nature of medical appraisal has been
heated, with concern expressed in some quarters over the lack of
any formal assessment of knowledge, skills and task performance
and the absence of independent scrutiny of doctors. Despite
this, a revalidation process for UK doctors was developed based
largely on the completion of five annual appraisals. With the
addition of validated multi-source feedback exercises, a formal
link to an organisation and the requirement of a recommendation
from a ‘Responsible Officer’ (who can utilise information from that
organisation’s clinical governance systems [1]), it was hoped that
the public would be satisfied they would be treated by doctors that
are demonstrating ongoing professional development.
A ‘strengthened’ medical appraisal today is a process of ‘facilitated
self-review’ of the complete scope of their work [1], and requires
the doctor to show that they continue to meet the principles and
values of the GMC’s Good Medical Practice (GMP). An annual
portfolio of ‘supporting information’ from six categories (Table 1)
is used to demonstrate this with all submissions matched to four
GMP domains (Table 2). Medical Royal Colleges have produced
guidance frameworks that assist their members in covering
the breadth of their practice with their continuing professional
development activities such as the RCoA CPD Matrix. It is
understood that a broad portfolio is built over years and that each
subspecialty interest may therefore not be developed each year.
Table 1. Annual portfolio categories of supporting information
Category
|
Supporting Information
|
1.
|
Continuing professional development
|
2.
|
Quality improvement activity
|
3.
|
Significant events
|
4.
|
Feedback from colleagues
|
5.
|
Feedback from patients
|
6.
|
Review of complaints and compliments
|
Table 2. Good Medical Practice (GMP) domains:
Knowledge, skills and performance
|
Safety and quality
|
Communication, partnership and teamwork
|
Maintaining trust
|
The presentation of supporting information is less important
than the way it is interpreted by the appraisee through personal
reflection. Through this process, critical appraisal of the activities
described (CPD, significant event, feedback exercise, etc.) can be
used to consider how it could be used to enhance the quality of
patient care they can offer.
Alongside the supporting information and reflection provided,
doctors should use the appraisal process to continually improve
the quality of the practice they offer through a series of personal
objectives within an agreed Professional Development Plan (PDP).
The appraiser should ensure these objectives are well defined,
achievable and have a timescale for completion. The appraisal
meeting is concluded by an important discussion around their
career aspirations and anticipated challenges in the year ahead and
agreement with a number of declarations regarding the doctor’s
health and probity. Whilst time consuming in its preparation,
medical appraisal should be recognised as a positive experience
with the aim to support consultants to develop. The appraisers’ role
is to facilitate this development and aid the Responsible Officer in
ensuring doctors continue to provide the highest quality care for
the public once practicing independently as consultants.
Nick Parry
Consultant Anaesthetist
Clinical Director - Theatres, Critical Care, Anaesthetics and Pain
The Dudley Group NHS Foundation Trust
Reference
- NHS Revalidation Support Team. Medical Appraisal Guide (Version 4). NHS
England, 2013. https://www.england.nhs.uk/revalidation/wp-content/uploads/sites/10/2014/02/rst-medical-app-guide-2013.pdf (accessed 01/02/2019)