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Consultant appraisal – a Clinical Director's perspective

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Top Five Tips!

  1. Reflection is crucial – but doesn’t have to be on everything! Try to write some reflections at the time of the ‘event’ – be it CPD, significant event, multisource feedback etc. It is preferable to have high-quality reflection on a limited number of supporting items (including impact on personal practice in the future) than a few hurried words on everything. 
  2. Consider your prospective Professional Development Plan (PDP) ahead of the appraisal meeting. This will enable the items selected to more accurately reflect your aspirations and ambitions for the future. Chosen items could be CPD courses/qualifications, but could reasonably also include relevant Quality Improvement projects, development of new clinical skills, shadowing of other colleagues, etc. They also do not have to be completed within 12 months as long as progress is monitored. 
  3. How many of these do I need? There are few set requirements about the number of supporting information items that need to be inputted into the appraisal. You do not need a set number of incidents reported, audits undertaken, and items in your PDP. Much more important is the extent to which you demonstrate engagement with clinical governance systems, quality improvement etc. as well as showing how these activities affect your ongoing personal practice through reflection. 
  4. Ensure you cover the full extent of your scope of practice in your appraisal. In respect of your supporting information, CPD, reflective writing, PDP etc., you should ensure that each area of your clinical and non-clinical work (and place of work) is represented. Clearly, you cannot undertake CPD to cover all areas of your practice every year, for example, but this should be considered over each 5-year revalidation cycle. 
  5. Think positively! It is important to have supporting information that reflects positive events in the appraisal. Positive incidents that you are involved with as well as compliments, good multisource feedback, good clinical outcomes etc. should all be included alongside any adverse events or incidents that relate to your practice.

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 

  1. 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)