1. New Appraiser Training
Medical Appraisal Scotland
Welcome
Day 1

2. Introductions Name Specialty
Reasons for attending / wanting to be an Appraiser
Expectations of course

3. Aims of the course Equip Appraisers with the necessary skills to:
conduct an appraisal with a colleague with confidence
deliver the appraisal process to the required standards (to ensure consistency and quality)
Self-evaluate appraisal skills following feedback and observation from participation in ‘focussed’ appraisal sessions
Support, share and reinforce Appraisers’ good practice
Enable participants to feed back on the training programme

4. Structure of Day 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

5. 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

6. Ground Rules Participate positively Time keeping Mobile phones
Avoid jargon
Respect confidentiality

7. New Appraiser Training
Medical Appraisal Scotland
Appraiser Assessment process

8. We need your feedback Secure on-line feedback facility
Auto activate at 6pm after day 2 via e- mail
Please complete it as part of your post- course reflections within a week of completing the course

9. New Appraiser Training
Medical Appraisal Scotland
Delivering a High Quality Appraisal

10. 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

11. Learning and Challenge / 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

12. Comfort / Stretch / Panic Zones
Comfort Zone
Stretch Zone
Panic Zone

13. Communication Skills for Appraisal (1/2)
Listening Skills
Open and closed questions
Looking for cues – verbal/non-verbal
Reflecting
Summarising

14. Communication Skills for Appraisal (2/2)
Acknowledge feelings and be accepting of the person
Allow silence
Be prepared to challenge
Facilitate reflection

15. Beware of blocking behaviour
Closed questions too soon
Leading questions
Rescuing or problem solving
Switching topics
Overly task orientated
Jollying along
Ignoring cues

16. Supporting Information (1/2)
Used to demonstrate that the values and principles set out in Good Medical Practice continue to be met
Reflects the scope of the Appraisee’s particular specialist practice and other professional roles

17. Supporting Information (2/2)
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?

18. Information for Appraisal
Four Domains of Good Medical Practice:
Knowledge, Skills and performance
Safety and Quality
Communication, Partnership and Teamwork
Maintaining Trust

19. Annual Requirements CPD and PDP Quality Improvement Activity
Significant Events
Review of Complaints and Compliments
Health
Probity

20. Required once every 5 years
Feedback from colleagues – MSF
Feedback from patients – PSQ (CARE/GMC)

21. Evaluation and reflection on the results?
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

22. Quality Improvement Activity
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
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
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
audit and monitor the effectiveness of a teaching programme
evaluate the impact and effectiveness of a piece of health policy or management practice

23. 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

24. 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?

25. Role of Appraiser (1/2) 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 or labelled
Use descriptive language
Consider carefully before offering specific advice

26. Role of Appraiser (2/2) Share information and make suggestions
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 and goals are addressed in each section

27. 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

28. Communication Skills Exercise
Practice in managing an appraisal
Questioning
Giving Feedback
Practice before the “mini appraisals” session on day 2

29. 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’!

30. 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

31. Form 4: Appraisal Summary (1/2)
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 (e.g. Responsible Officer)

32. Form 4: Appraisal Summary (2/2)
Appraisals are professional interviews
Must be robust, based on attributable supporting information
Record of appraisal interview to be accurate, comprehensive, clear and effective

33. Current Summary Forms Reviews of summary forms have suggested:
Too short
Omitted relevant information discussed at the interview
Did not reference supporting information

34. An Effective Summary (1/3)
Meaningful
Specific
Objective
Avoids assumptions
Avoids collusion

35. An Effective Summary (2/3)
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

36. An Effective Summary (3/3)
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 post for next appraisal

37. Avoid Assumptions
“Dr X has a very healthy life style and obviously has no health issues”
“Dr X described his life style as healthy & stated that he had no health issues”
“Dr X has a very heavy & stressful work load & I raised concerns about burn out”
“ We discussed Dr X’s workload which she described as full & varied. She stated that she finds her work fulfilling and stimulating”

38. Avoid Collusions
“given the nature of his speciality and location, Dr X’s isolation limits his ability to reflect on his work”.
“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.”

39. Achievements Use positive language
Describe areas of work that give the appraisee satisfaction, and their feelings about what has been achieved

40. 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.

41. Form 4 write-up exercise
Produce an anonymised summary based on the previous practicing session
Take turn reading it (aloud) to your Appraisee
Remember…
Meaningful, Specific, Objective,
Avoid Assumptions, Avoid Collusion

42. New Appraiser Training
Medical Appraisal Scotland
Plenary
Reflection on the day?
Reminder before you go…

43. Before you go… Complete Self-reflection exercise
Swap paperwork with Appraiser/Appraisee pairings
Homework before Day 2:
Review video clips on MSF, Probity and Health
Review PDP scenarios
Tutors will make contact before Day 2 to provide feedback