1. Advice, appraisal and assessment
Dr John Potter
There is an enormous amount of detailed information about contracts, GMC registration etc. that you have already understood enough about to get yourself into a job. There is a lot more that will come from your Trust and Departmental induction meetings.
This module is intended just to look briefly at some of the general points that you need to think about in getting used to working in the UK.

2. Advice
Appraisal
Advice is defined as a recommendation as to the most appropriate choice of action.
We all look for advice from time to time. The best advice is given by individuals who have a thorough understanding of the subject and who understand the whole picture as to why you are asking for advice.
For instance “Should I take the M1 when I drive to London ?” seems like an easy question with an obvious answer. But the answer is not so obvious if you are not setting out from Hull, but from Liverpool.
Advice is just that, it is a recommendation, ultimately YOU have to make the decision as to the course of action
By “Appraisal” in this context, we mean educational appraisal.
All trainees in the NHS are expected to continuously undergo educational appraisal.
This is a process to help you to maximise your development as a doctor. You will have an educational supervisor and a clinical supervisor (sometimes the same person, sometimes different) who will help you through this process, ensure that you are setting appropriate educational and developmental goals, and that you are developing in your post.
We describe this process as “Formative”.

3. Assessment
Assessment in contrast is a judgement of how you are doing and inevitably is a part of the process of ensuring that you are developing in post.
This will be an ongoing process whilst you are working. There will be mandatory assessments that you have to complete to progress.
Your relevant College will describe the minimum assessment standards as part of its role in setting standards. It is important that you know what you are expected to do, and that you arrange to do it.
Because this process looks at all that you have done during a set period of training, it is called “Summative”.

4. Getting Advice & Guidance
The main aim of this module is to describe the different resources available to you for advice and guidance.
There will be a repeated theme reminding you to be clear about what you need to know, and to ensure that you seek advice from the most appropriate resource.

5. Getting Advice & Guidance
Royal Colleges
HEE YH
Associate Deans
Specialty Training Committee
Director of Medical Education
College Tutors
Clinical Supervisors
Educational Supervisors
Postgraduate Education Manager
Medical Personnel Department
Mentors
Here is a list of many of the resources available to you. Many of the larger organisations will have websites at which you can gain the answer to most questions at any time of the day.
We will go through each in turn looking at the type of advice available.

6. The Royal Colleges CCT / regulations Curriculum Assessments Exams
The Royal Colleges Most are involved in the licensing process for CCT, setting the curriculum and summative assessments and examinations.
It is obvious therefore that this is where to start to find out about what you have to do to complete your speciality training.
There will usually be guidance and signposts to relevant training courses and materials.
Take time to look at the Royal College website relevant to you and in particular the sections relating to doctors in training.

7. HEE YH Training Posts Trainers Structure
Each PGMDE office are responsible for the management and delivery of postgraduate medical education at a local level. This includes ensuring that all training posts provide the necessary opportunities for doctors and dentists in training to realise their full potential and provide high quality patient care. They are also responsible for appointing trainers, educational supervisors and educational leaders, and supporting their training needs and educational development.
HEE YH has a Postgraduate Dean who leads the organisation. In HEE YH there are three offices, each with a Deputy Postgraduate Dean.
HEE YH has a very informative website which you should take time to explore

8. Associate Deans Associate Deans work part time for HEE YH.
They have special areas of responsibility, as described on the HEE YH website.
There is an Associate Dean with responsibility for each specialty e.g. GP.
You will not have much personal contact with them. (Unless you need advice on something specific e.g. "Less Than Full Time Training”)

9. Speciality Training Committee
Oversee training in speciality – ST1 to CCT
Oversee Assessment in speciality
Includes Training Programme Directors (TPDs)
Specialty Schools are PGMDE structures for managing specialty training that will bring together the relevant Royal College/College/Faculty, the PGMDE, the NHS and other providers of training.
Each Specialty School has a management committee drawn from the institutions and groups that contribute to training, as well as other stakeholders.
This provides the structure for educational governance, and sets the direction for the development of Postgraduate Medical and Dental Education (PGMDE) in that specialty.

10. Director of Medical Education
Postgraduate Education Centres in each Trust
Overview of training in Trust
Organise Programmes
Career advice & counselling
Now we are getting closer geographically to you.
You will have a Director of Postgraduate Medical Education in each acute trust.
He/She leads the medical education committee in your trust and has overall responsibility for the educational contract for all specialities within your trust.

11. College Tutors Specialist representatives of Royal Colleges
In the workplace / Trust
Oversight of programmes
Career advice & counselling
Quality assurance
May also be DME
Link between Trusts and Colleges
College Tutors
Whereas the PGMDE has responsibility across all of the Schools at a local level, the College Tutor will have special responsibility for one specialty/School.
Each speciality in every Trust organise education and courses, career advice, counselling and exam feedback.
Responsibilities
Implementing the Colleges curricula for trainees in the workplace.
Educational supervision, appraisal and feedback.
Career Guidance.
Overseeing competency based assessment.
Participation in HEE YH / GMC quality visits

12. Clinical Supervisors Local representative of HEE YH
In the workplace / Trust
Responsible for programmes and training
Career advice & counselling
Clinical Supervisors

13. Educational Supervisors Appraisal - confidential Assessment - open
- developmental
- what do you need?
Assessment - open
- external
- how good are you?
- are you ready to progress?
Educational Supervisors
You will have an Educational Supervisor identified early in your post, and often he/she will be your supervising consultant.
They will be involved in your educational appraisal and some of your workplace based assessments.
Educational supervision is a vital part of your development in your training programme. Your Educational Supervisor will help you develop your individual personal learning plan and will be part of the assessment process to ensure that you are developing and progressing.
The differences in assessment and appraisal are highlighted here. You can see that it is difficult to completely separate the two. Despite that it is still important to be clear which process you are engaged in at any moment. If that is not clear to you, ask your supervisor – partly to check that they are not also unclear.

14. Appraisal Identify needs Set goals Review progress Feedback
Plan for future

15. Postgraduate Education Manager Runs postgraduate centre
Administers study leave
Good starting point for advice
Your education centre will contain key individuals who will be able to offer day to day information on what teaching is available in your Trust.
They will monitor and administer study leave.
Your Trust website will provide detailed information on study leave as well.

16. Medical Personnel Department Trust employment process
Looking after employees
Now we are moving away from education and development to contract and employment issues.
If you have questions about your contract, annual leave then medical personnel will have resources to help.

17. Mentors In HEE YH there is at least one mentor in each Trust
Senior doctors available to help overseas doctors
Each doctor has their own personal view of what mentorship is, and how they want to get it.
It means a voluntary relationship that you form with someone whose opinion you value, who is familiar with the problems that you are facing, and who can give you independent and impartial advice. This may be someone within your network of peers, or often a more senior figure who you find easy to relate to. In some Trusts there are recognised mentorship figures with special experience and expertise in particular areas, for instance doctors with disability, or International Graduates. The process of making the mentor an ‘official’ figure immediately takes away some of its personal flavour. Some doctors no not feel a need for mentorship, and some make whatever arrangement suits them. A minority of doctors who encounter problems will have the creation of a mentorship relationship offered to them as part of remediation of the problem.

18. Other useful contacts: British Medical Association (trade union)
Defence Societies
General Practitioner (personal health)
Occupational Health
Confidential Counselling (“Take Time”)
The BMA can help you and give advice if you have problems with your contract and are unable to resolve them locally.
Medical defence organisations provide medical indemnity to doctors.
Most doctors employed by NHS Trusts (and all junior doctors) are covered for the duties listed in their contract by the Hospital and Community Health Services indemnity scheme (often called NHS or Crown Indemnity), and are not obliged by law to take out additional medical defence cover. However, the BMA strongly recommends that you take out supplementary insurance with one of the medical defence bodies or provide yourself with other personal indemnity insurance. This is because the NHS indemnity scheme ONLY covers medical negligence claims which arise from contracted NHS duties.

19. Get your advice from the right person
Clearly it is important to go to the right resource to get advice and guidance.
Most important and relevant information is available online and you should take time to locate the most important websites e.g. your College, HEE YH and Trust websites.
Get to know the staff in your education centre. Above all treat them with respect – they can do a lot to make your life easier if you relate to them properly.

20. Get your advice from the right person
If you want to know about GMC registration, then ask the GMC
If you want to know about prospects in a particular specialty, then speak to the relevant College Tutor or Regional Advisor
If you want to know about your contract, then speak to Medical Staffing Dept. of your employer
Be wary of advice from your friends and relatives
Make sure your decisions are based on accurate information
Use your appraisals for discussion about what you should do

21. The end? Any questions? It’s not the end it is the beginning!
You are setting out on what hopefully will be a fulfilling and successful journey in the NHS.
Take time to ensure that you can access:
Your College website and the pathway that you need to follow in your training post.
Your HEE YH website, in particular the pages relevant to your School.
Your Trust intranet and the pages relevant to doctors in training.