Quality Assurance of Medical Appraisers

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1 Quality Assurance of Medical Appraisers Recruitment, training, support and review of medical appraisers in England

2 Contents 1. Introduction 3 2. Purpose and overview 4 3. Background 5 4. Recruitment 7 Appraiser capacity 7 Recruitment process 8 Contractual arrangements 9 Commissioning an external medical appraisal service 9 5. Training: general principles 10 Medical appraiser competencies 10 Training specification for medical appraisers 11 Commissioning medical appraiser training Support and review: general principles 14 Annual review of performance 15 Assessment of medical appraiser competencies 16 Appendices Appendix 1 Role description 18 Appendix 2 Person specification 20 Appendix 3 Competency framework for medical appraisers 23 Appendix 4 Medical appraiser competency self-assessment tool 27 Appendix 5 Sample medical appraisal feedback questionnaire 30 Appendix 6 Methods of assessment of medical appraisers 32 Page 2 of 34

3 1. Introduction Revalidation of doctors is a key component of a range of measures designed to improve the quality of care for patients; it is the process by which the General Medical Council will confirm the continuation of doctors licences to practise in the UK. The purpose of revalidation is to assure patients and the public, employers and other healthcare professionals that licensed doctors are up to date and fit to practise. Through a formal link with their organisation, determined usually by employment or contracting arrangements, doctors will relate to a senior doctor in the organisation, the responsible officer. The responsible officer will make a recommendation about the doctor s fitness to practise to the General Medical Council (GMC). The recommendation will be based on the outcome of the doctor s annual appraisals over the course of five years, combined with information drawn from the organisational clinical governance systems. Following the responsible officer s recommendation, the GMC will decide whether to renew the doctor s licence. The responsible officer is accountable for the quality assurance of the appraisal and clinical governance systems in their organisation. Improving these systems will support doctors in developing their practice more effectively, which will add to the safety and quality of health care in the UK. It will also enable the early identification of those doctors whose practice needs attention, allowing for more effective intervention. All doctors wishing to retain their GMC licence to practise will need to participate in revalidation. This publication has been prepared by the NHS Revalidation Support Team (RST). The RST works in partnership with the Department of Health (England), the General Medical Council and other organisations to deliver an effective system of revalidation for doctors in England. All RST publications have been created in collaboration with partners and stakeholders across the UK, including testing with over 4,000 doctors. Page 3 of 34

4 2. Purpose and overview The purpose of this document is to provide a practical framework for assuring the quality of the medical appraiser workforce. It outlines processes for the recruitment, training and support of medical appraisers and methods by which their performance in the role can be reviewed. It is targeted at responsible officers and those who will be responsible for designing information systems to support revalidation. It may also be of interest to doctors, appraisers, and managers. It will be reviewed in March The guidance contains advice on the following: Recruitment This section provides advice for responsible officers and designated bodies on the recruitment and selection of medical appraisers. It is supported by appendices 1 and 2, covering the role description and person specification. Training This section provides advice for responsible officers and designated bodies on the training of medical appraisers. It is supported by appendices 3 and 4, covering the competency framework, and a competency self-assessment tool. A training specification for medical appraisers covering the new elements of medical appraisal for revalidation which includes illustrative training programmes suitable for new and current medical appraisers is available on the RST website. Support and review This section provides advice for responsible officers and designated bodies on methods for the support and development of medical appraisers. Routine monitoring of medical appraiser performance and annual performance review are described as well as situations where concerns about the performance of a medical appraiser require a more formal evaluation of skills and competence. Page 4 of 34

5 3. Background Medical appraisal is a process of facilitated self-review supported by information gathered from the full scope of a doctor s work. The following diagram describes the process which is explained in detail in the Medical Appraisal Guide (NHS Revalidation Support Team, 2012). Figure 1: The process of medical appraisal Page 5 of 34

6 Medical appraisal can be used for four purposes: 1. To enable doctors to discuss their practice and performance with their appraiser in order to demonstrate that they continue to meet the principles and values set out in Good Medical Practice (GMC, 2006) and thus to inform the responsible officer s revalidation recommendation to the GMC 2. To enable doctors to enhance the quality of their professional work by planning their professional development 3. To enable doctors to consider their own needs in planning their professional development and may also be used: 4. To enable doctors to ensure that they are working productively and in line with the priorities and requirements of the organisation they practise in. The responsible officer must ensure the medical appraisal system is of sufficient quality to support their recommendations and the quality of the medical appraiser workforce is a major determinant in this. In any revalidation cycle a responsible officer may need to rely on appraisals performed in a number of different designated bodies and so it is essential that all medical appraisers have the right level of competence to perform this important professional role. The term medical appraiser in this document refers to all those who perform medical appraisals that contribute to revalidation. The role of appraiser may be a separate role or an integral part of a wider medical management role (for example, clinical director or head of service). The principles outlined in this document apply irrespective of the other roles performed. The designated body should explain whether these roles are separate or combined in the appraisal policy. When the role of medical appraiser is combined with a medical management role it is possible for conflicts of interest to occur and for the appraisal to focus on performance review and organisational objectives. Appropriate safeguards to mitigate this risk should be described in the appraisal policy. Page 6 of 34

7 4. Recruitment The quality and consistency of medical appraisal relies heavily on the skills and the professionalism of the medical appraiser and recruiting the right individuals is an important starting point. The following issues should be considered when recruiting medical appraisers: Appraiser capacity It is important that the designated body s medical appraiser workforce is sufficient to provide the number of appraisals needed each year. This assessment may depend on the total number of doctors who have a prescribed connection, the geographical spread, the speciality spread, conflicts of interest and other factors. Depending on the needs of the designated body, doctors from a variety of backgrounds should be considered for the role of medical appraiser 1. This includes locums and salaried general practitioners in primary care settings and staff and associate specialist doctors in secondary care settings. An appropriate specialty mix is important though it is not possible for every doctor to have an appraiser from the same specialty. 1 The appraiser will normally be a licensed doctor with knowledge of the context in which the doctor works. This is particularly important for doctors in clinical roles. However, doctors work in many different roles and settings and there are situations where it may be more appropriate for the appraiser to be from a nonmedical background. This already occurs, for example for some doctors in senior management positions who do no clinical work. It would be inappropriate to compel such doctors to have a second appraisal by a licensed doctor purely to satisfy the requirements of revalidation. The appraiser should therefore: be the most appropriate appraiser for the doctor, taking into account their full scope of work understand the professional obligations placed on doctors by the GMC understand the importance of appraisal for the doctor s professional development have suitable skills and training. The GMC has made it clear that to satisfy the requirements of revalidation, appraisers do not need to be licensed doctors and that local decisions should determine the overall suitability of the appraiser workforce, but it is essential that both the doctor and their responsible officer have confidence in the appraiser s ability to carry out the role to the required standard. Page 7 of 34

8 The designated body should consider the number of appraisals each appraiser is expected to perform. There is a significant investment of time and resources in training and supporting a medical appraiser to an appropriate level of skill and experience and it is reasonable to assume that a minimum number of appraisals will be delivered each year to justify this input and to maintain competence. A maximum number of appraisals should also be considered to ensure the medical appraiser s other roles are not compromised and to protect the organisation and doctors from the consequences of unavoidable absences. Each designated body should consider whether such limits are appropriate and describe them in the medical appraisal policy. The role of appraiser may be a separate role or form an integral part of a wider medical management role. The principles outlined should apply to appraisers irrespective of the other roles performed. Where it is felt that the role of manager and medical appraiser can be combined without conflict of interest, the job description and person specification of the wider management role must always include the core elements relating to the role of medical appraiser. Recruitment process Those performing the role of medical appraiser, either in a separate role or when the role is combined with a wider medical management role, should be selected through a structured recruitment process. A suggested role description and person specification which incorporate core elements are shown in appendices 1 and 2. The recruitment process should be fair, open and accessible to all eligible doctors. It is important to consider whether medical appraisers should be appointed before training (subject to satisfactory completion of training) or on demonstration of competence once training has been completed. This is a local decision, but in either case a supported probationary period or an early review after the first few appraisals should be considered. Page 8 of 34

9 Contractual arrangements Contractual arrangements should describe indemnity arrangements for the appraisals performed on behalf of the designated body. For example, the medical appraiser is covered by the designated body for their actions in the role unless and until they are shown to have acted with negligence. Periodic renewal of the contract or appointment subject to a satisfactory review of performance should be considered. Sufficient time should be allowed in the role description for administration, preparation, carrying out the appraisal, post-appraisal sign-off and the necessary support and review arrangements. This will usually require the allocation of contracted time to the role of medical appraiser (for example, supporting professional activities or a specified sessional commitment). If the appraiser role is combined with a wider medical management role it is important that sufficient time is allocated for performing appraisals. Commissioning an external medical appraisal service When a designated body commissions the medical appraisal service from an external appraisal provider (for example, from a deanery, a primary care trust cluster or an independent body) the designated body should specify the quality standards for recruitment in a contract or service level agreement. The responsible officer retains overall responsibility for the quality of the appraisal system and should ensure there is a periodic review of the performance of the provider against the agreed quality standards. Page 9 of 34

10 5. Training General principles Medical appraisers should develop skills to ensure that appraisal is a positive process that drives quality improvement through the development of the individual doctor. It is important that all medical appraisers, irrespective of the environment within which they appraise and the other roles they perform, should have a set of core competencies that enables appraisal for revalidation to be delivered fairly and consistently. As noted in the previous section, it is important to consider whether medical appraisers should be appointed subject to satisfactory completion of training or on demonstration of competence once training has been completed. In either case, consideration should be given to whether a supported probationary period or an early review after the first few appraisals is necessary. Medical appraiser competencies Doctors will have a baseline level of competency in many of the key areas as a result of their background and training. Some competencies will be selected for at recruitment, but the additional core competencies should be acquired through appropriate training, development and support arrangements. The majority of medical appraiser skills are generic; however there may be specialtyspecific elements which should be covered, particularly those relating to continuing professional development requirements and quality improvement activities. An example competency framework for medical appraisers has been developed which includes new competencies relating to the role of the medical appraiser in revalidation (see appendix 3). Page 10 of 34

11 Medical appraiser competencies can be grouped into the following areas: professional responsibility to maintain credibility as a medical appraiser knowledge and understanding to understand the role and purpose of the medical appraiser and to be able to undertake effective appraisals professional judgement to analyse and synthesise information presented at appraisal and to judge engagement and progress towards revalidation communication skills to facilitate an effective appraisal discussion, produce good quality outputs and to deal with any issues or concerns that might arise organisational skills to ensure the smooth running of the appraisal system, including timely responses and sufficient computer skills to be an effective medical appraiser. All appraisers will need to gain experience of the new elements of medical appraisal for revalidation and necessary skills will develop and mature as the medical appraiser s experience grows. To facilitate this, it is essential that medical appraisers are involved in ongoing support and development activities (described in chapter 6) so they can improve their skills and demonstrate they are keeping up to date and fit to practise in the role of medical appraiser. Training specification for medical appraisers Medical appraisers from all medical disciplines should have the same core competencies and the training programme should be suitable for cross-specialty training. Organisations may require a flexible approach to ensure the capacity and capability of their medical appraiser workforce is developed in the way that is most appropriate for their needs. A training specification for medical appraisers covering the new elements of medical appraisal for revalidation which includes illustrative training programmes suitable for new and current medical appraisers is available on the RST website. The purpose of the training specification is to provide assurance to responsible officers that medical appraisers are aware of the important position of appraisal within the revalidation process and to ensure that the quality and consistency of appraisal is sufficient to support revalidation. In addition, it is to provide assurance that the medical Page 11 of 34

12 appraiser has sufficient communication skills to facilitate an effective developmental appraisal and to deal with any issues or concerns that might arise. The core training specification for all medical appraisers should include the following broad areas: core appraisal skills and skills required to promote quality improvement and the professional development of the doctor skills relating to medical appraisal for revalidation and a clear understanding of how to apply professional judgement in appraisal skills that ensure an effective appraisal is performed in the setting within which the doctor works, including both local context and any specialty-specific elements. There should be flexibility within the programme to allow for understanding of the local appraisal process. The detailed content of the training programme may also be informed by a preliminary needs-assessment using a competency-based selfassessment tool which takes account of the prior experience and skills of the medical appraisers (see appendix 4 for an example). Decisions regarding the precise content of training for new medical appraisers are for the designated body and responsible officer. During the period of preparation and implementation of revalidation, current appraisers who have previously received training may require an additional module of training which explicitly covers the new elements of medical appraisal for revalidation. An illustrative training programme suitable for current medical appraisers is included in the training specification available on the RST website. This forms the basis of a programme of training for current medical appraisers organised by the RST through the strategic health authorities and strategic health authority clusters. Further information on the training programme is available from the strategic health authority revalidation project leads. Page 12 of 34

13 Commissioning medical appraiser training Designated bodies commissioning medical appraiser training should ensure the training complies with the training specification. At a local level designated bodies may also wish to specify training which covers royal college or faculty advice on the specialty-specific aspects of continuing professional development and quality improvement activities. Specific organisational priorities and common development needs may also be covered. It is important that selected training providers are capable of delivering high quality medical appraiser training. The training providers should be able to demonstrate they have: high quality facilitation/training skills experience of delivering and facilitating effective medical appraiser training programmes good knowledge of the new elements of medical appraisal for revalidation (for example, through attending an RST event for training providers) involvement of an experienced medical appraiser or appraisal lead in the delivery of training. Page 13 of 34

14 6. Support and review General principles The role of medical appraiser is an important professional role and designated bodies should ensure there are clear arrangements to support medical appraisers with leadership, feedback, structured continuing professional development and opportunities for peer support. Support for medical appraisers should include: access to leadership and advice on all aspects of the appraisal process from a named individual (for example, an appraisal lead) access to training and professional development resources to improve medical appraiser skills peer support with opportunity to discuss handing the difficult areas of medical appraisal in an anonymised and confidential environment. specialty-specific support where necessary annual review of performance in the role of medical appraiser (see below) Some medical appraisers may need access to external peer support because of their role within the organisation (for example, if they are the medical director or appraisal lead) and/or their relationship to the other medical appraisers. The medical appraiser s development needs should be discussed at their appraisal and reflected in their personal development plan. A periodic self-assessment using a competency-based self-assessment tool (see appendix 4) may be useful in helping individual medical appraisers identify their development needs. There are a number of important but rare situations (such as significant patient safety concerns, important health or behavioural problems, fraud or probity issues) which every medical appraiser will need to know how to manage, should they arise. These topics should form the basis of regular refresher training and development activities. Page 14 of 34

15 Designated bodies may wish to take an opportunity to perform a regular structured review of their medical appraiser workforce capacity and capability. The competency self-assessment tool may be useful in helping organisations identify training needs in their medical appraiser workforce. Organisations may choose to meet these support needs in different ways depending on the organisational setting and other factors (for example, geographical isolation). As a minimum, a named appraisal lead should be available for advice and support to all medical appraisers. Designated bodies may also provide one or more of the following: a medical appraiser support group led by a suitably skilled appraisal lead or support group facilitator a supported or self-directed action learning set for medical appraisers a wider medical appraiser network including regular communications and webbased discussion groups a medical appraiser buddy system where appraisers have a colleague with whom they can discuss areas of concern. Appraisal leads and responsible officers should be alert for signs of concern about the performance and capability of all medical appraisers. This may require particularly close attention immediately after training and during any probationary period. If the medical appraisal service has been commissioned from an external appraisal provider the responsible officer retains overall responsibility for the quality of the appraisal system. The quality standards for support and review of appraisers should be specified in a contract or service level agreement and a periodic review of the performance of the provider against the agreed standards should take place. Annual review of performance An annual review of performance should be carried out for all medical appraisers to ensure that medical appraisers are appropriately supported, their development needs are being addressed and that appraisals are being performed to the required standard. Participation in annual performance review should be a contractual requirement of working as a medical appraiser and be included in the job description and appraisal policy. Page 15 of 34

16 Performance review of medical appraisers should be the responsibility of a named individual (such as the appraisal lead). The annual review should ideally take place in a face-to-face interview, though it may occur by or telephone. It is suggested that this review of performance should as a minimum cover: consideration of the scope of the appraisal work undertaken the number of appraisals undertaken by the medical appraiser and the timeliness of completion of documentation a review of the quality of the outputs of the appraisals the results of structured feedback from doctors and, where available, colleagues (see appendix 5 for a sample feedback questionnaire) a discussion of any complaints and significant events (for example, a missed or incomplete appraisal caused by the appraiser s lack of time or personal organisational skills) an opportunity for the medical appraiser to consider their progress and development needs in the role of medical appraiser and actions to be included in their personal development plan. It is important that complaints and significant events are dealt with at the time they arise and not delayed until the annual performance review. Assessment of medical appraiser competencies The structured evaluation of a medical appraiser s competence or capability is an important way of providing individual feedback to a medical appraiser about their performance in the role. It may be used as part of routine organisational quality assurance procedures, for example: during, or at the end of, initial medical appraiser training at the end of a probationary period prior to the renewal of the medical appraiser s contract, or once in each revalidation cycle as a part of a local accreditation process. Page 16 of 34

17 It is also appropriate for an assessment to be performed where there are concerns about the performance of a medical appraiser arising from: annual performance review complaints or significant events feedback from doctors or colleagues quality assurance of outputs of appraisal, or through medical appraiser support group activities. Medical appraiser competence should be assessed using: performance in the role: wherever possible assessment should be based on performance in the role. evidence from more than one source. criterion-referenced assessment: this involves assessing the appraiser in relation to pre-determined standards through formal exercises and simulations rather than competitively in relation to other appraisers. The choice of assessment tools will depend on the competency being assessed and the standard to which it should be demonstrated (some options for assessment are described in appendix 6). It is important to ensure that the assessment method is fair and proportionate. Innovation and development of resources to support assessment should be encouraged. The measures put in place to quality assure medical appraiser performance should be reasonable and proportionate. The training, development and review of medical appraisers should recognise that this will not be the doctor s main role and should be compatible with that undertaken for other clinical or management roles. It must be recognised that some medical appraisers may fail to maintain the necessary attributes, knowledge and skills to be an effective medical appraiser and if appropriate remedial processes fail, these individuals should not continue to perform this important role. Page 17 of 34

18 Appendix 1 Role description Core elements of a job description for a medical appraiser The role of medical appraiser may be a stand-alone role or an integral part of a wider medical management role (such as clinical director or head of service). To ensure quality and consistency the job description of all medical appraisers should include core elements which relate to the role of medical appraiser but the final content is to be determined by the designated body and responsible officer. The following is an example: The job description of the postholder includes the following core elements in relation to the medical appraiser role: 1 Description of key accountabilities for the role which include accountability to the responsible officer 2 Communications and key working relationships (for example medical director/responsible officer, appraisal/revalidation lead, appraisal manager, clinical directors, service leads, postgraduate tutors, royal college advisers, other medical appraisers) 3 Description of probationary period or provisional appointment subject to satisfactory evaluation/assessment after initial training 4 Purpose and description of the role and key responsibilities of medical appraiser (including the minimum and maximum number of appraisals) 5 Undertake pre-appraisal preparation in line with principles from the medical appraiser training and current guidance 6 To conduct the appraisal interview in line with principles from the medical appraiser training and current guidance. This will include: agreeing an agenda with the doctor which should include an appropriate balance of personal, professional and local objectives building a positive working relationship with the doctor supporting the doctor in considering practice over the last year and agreeing objectives and a development plan with the doctor agreeing a summary of the appraisal meeting Page 18 of 34

19 7 Complete post-appraisal documentation in line with current local and national guidance and quality standards in a timely fashion 8 Duration of appointment as an appraiser (for example, description of arrangements for periodic renewal or formal extension of contract subject to a satisfactory review process should be considered) 9 Requirement to attend initial training 10 Requirement to participate in ongoing support and development to address development needs in the role of appraiser (including minimum number of sessions to be attended each year, participation in update training, completion of any agreed personal development plan items related to the role of appraiser) 11 Requirement to participate in performance review in the role of appraiser 12 Requirement to participate in the management and administration of the appraisal system (including reporting the progress and completion of allocated appraisals) 13 Requirement to participate in arrangements for quality assurance of the appraisal system 14 Description of confidentiality of appraisal process and specific circumstances in which confidentiality should be breached including the process to be followed where there are early warning signs that a doctor may require support/early intervention and where concerns regarding a doctor arises within the appraisal 15 Indemnity arrangements for appraisers 16 Local recruitment policies and procedures (for example compliance with health and safety policy, equality and diversity policy, information management policy) Page 19 of 34

20 Appendix 2 Person specification The role of appraiser may be a stand-alone role or an integral part of a wider medical management role (such as clinical director or head of service). To ensure quality and consistency the person specification of all medical appraisers should include core elements relating to the role of appraiser but the final content is to be determined by the designated body and responsible officer. The following table is an example of a personal specification for a medical appraiser. Core elements of a person specification for medical appraiser No distinction has been made between essential and desirable as the importance of each of these qualities should be determined by the designated body in relation to local context. Probationary periods or provisional appointment subject to satisfactory completion of training and/or demonstration of competence should be described in the job description. Qualifications 2 Medical degree, plus any postgraduate qualification required GMC licence to practise Where appropriate, entry on GMC specialist or general practitioner register Consider for general practitioners: entry on a medical performers list Consider: completion of initial medical appraiser training (this may not be a requirement prior to appointment but would need to be completed before appraisals are performed) 2 See Section 4: Recruitment. The appraiser will normally be a licensed doctor with knowledge of the context in which the doctor works. This is particularly important for doctors in clinical roles. However, doctors work in many different roles and settings and there are situations where it may be more appropriate for the appraiser to be from a non-medical background. The GMC has made it clear that to satisfy the requirements of revalidation, appraisers do not need to be licensed doctors and that local decisions should determine the overall suitability of the appraiser workforce, but it is essential that both the doctor and their responsible officer have confidence in the appraiser s ability to carry out the role to the required standard. Page 20 of 34

21 Experience Experience of managing time to ensure deadlines are met Experience of applying principles of adult education or quality improvement Consider: has been subject to a minimum of three medical appraisals, not including those in training grades (There may be situations where this is not possible, for example where medical appraisal has not occurred in the organisation in the past) Knowledge Knowledge of the role of medical appraiser Knowledge of the purpose and process of medical appraisal Knowledge of the principles of revalidation Knowledge of educational principles and techniques which are relevant to medical appraisal Knowledge of responsibilities of doctors as described in Good Medical Practice Knowledge of principles of clinical governance, evidence based medicine and clinical effectiveness Knowledge of the health sector (e.g. primary care, secondary care, mental health, independent sector) in which appraisal duties are to be performed Knowledge of relevant local and national healthcare context Knowledge of local professional development and education structures Understanding of principles of equality and diversity Understanding of principles of information governance Understanding of legislation and guidance relating to data protection and confidentiality Consider: knowledge of relevant speciality specific elements, including continuing professional development requirements and quality improvement activities Page 21 of 34

22 Skills Motivating, influencing and negotiating skills Good oral communication skills, including active listening skills, the ability to understand and summarise a discussion, ask appropriate questions, provide constructive challenge and give effective feedback Good written communication skills, including the ability to summarise clearly and accurately Objective evaluation skills Adequate computer skills for the role this may include familiarity with web-based appraisal support systems Attributes Excellent personal integrity, personal effectiveness and selfawareness Motivated, enthusiastic, positive role model Ability to adapt behaviour to meet the needs of the doctor Commitment to ongoing personal education and development Good working relationships with professional colleagues and relevant stakeholders Ability to work effectively in a team Page 22 of 34

23 Appendix 3 Competency framework for medical appraisers The core competencies for medical appraisers are summarised in the table below: Competency framework for medical appraisers 1 Professional responsibility: to maintain credibility as a medical appraiser Competency 1.1 High standards of professional responsibility, personal integrity, effectiveness and self awareness 1.2 Develops professional competence as a medical appraiser Behaviour Maintains high professional credibility Acts as a champion and role model for appraisal and revalidation Demonstrates insight and self-awareness Reflects on feedback Declares conflicts of interest Undertakes appropriate development in all professional roles including as a medical appraiser, reflecting development needs in their personal development plan Supports efforts to evaluate and improve local systems and processes 2 Knowledge and understanding: to understand the role and purpose of the medical appraiser to be able to undertake effective appraisals Competency 2.1 Understands the purpose of appraisal and revalidation and understands the role and responsibilities of the medical appraiser 2.2 Understands quality and safety systems and relates this to the context of the doctor s work Behaviour Demonstrates understanding of the purpose of appraisal and revalidation Understands and works within the limits of the medical appraiser role and responsibilities, setting appropriate boundaries Applies knowledge of quality and safety systems to appraisal Adapts approach to the work context of the doctor Page 23 of 34

24 2.3 Understands relevant legislation and guidance including equality and diversity, bullying and harassment, data protection and confidentiality 2.4 Understands educational principles sufficiently to inform the appraisal discussion and the design of professional development objectives 2.5 Understands the Good Medical Practice framework and GMC supporting information requirements, including relevant specialty-specific guidance Maintains knowledge of relevant policies and legislative frameworks and applies the principles in practice Demonstrates fairness and equality and makes allowance for differing backgrounds Always deals with confidential data in accordance with information governance policies and guidelines Demonstrates a learner-centred approach to the doctor s professional development. Supports the role of professional development in quality improvement Facilitates review of the doctor s practice Demonstrates awareness of the Good Medical Practice framework and GMC supporting information requirements, including relevant specialty specific guidance 3 Professional judgement: to analyse and synthesise information presented at appraisal and to judge engagement and progress towards revalidation Competency 3.1 Maintains and applies skills in evaluating the portfolio of supporting information 3.2 Ability to judge whether the supporting information shows that the doctor is on track to revalidate Behaviour Applies GMC standards and specialty specific guidance appropriately Demonstrates ability to evaluate the supporting information Makes judgements about the cumulative quantity and quality of supporting information related to different stages of the revalidation cycle Demonstrates ability to support the doctor in developing a portfolio covering the full scope of the doctor s work Page 24 of 34

25 3.3 Ability to judge whether there is a patient safety issue or emerging performance concern 3.4 Ability to judge whether the doctor has appropriately engaged in the appraisal process and the review of their full scope of work 3.5 Ability to evaluate achievement of the previous years personal development plan objectives and to confirm that the new personal development plan reflects the doctors development priorities Responds appropriately to patient safety issues and early signs of emerging performance, conduct or health concerns Demonstrates the ability to suspend the appraisal process where necessary and take appropriate further action Makes appropriate judgements about the engagement of the doctor in appraisal Communicates concerns about the doctor s engagement to the doctor and responsible officer (or their deputy) appropriately Reviews outstanding items in previous personal development plans with the doctor Ensures that the new personal development plan addresses the doctor s development priorities arising from the appraisal and gaps in the accumulating revalidation portfolio 4 Communication skills: to facilitate an effective appraisal discussion, produce good quality outputs and to deal with any issues or concerns that might arise Competency 4.1 Ability to manage the appraisal discussion effectively Behaviour Prepares effectively for the appraisal discussion Sets the context and agrees the priorities for the appraisal discussion Demonstrates the ability to facilitate a wellstructured and focused appraisal discussion, centred on GMC standards and the doctor s professional development Demonstrates appropriate time-keeping within the appraisal discussion Page 25 of 34

26 4.2 Develop and apply good communication skills including appropriate levels of support and challenge 4.3 Ability to manage a difficult medical appraisal 4.4 Ability to produce high quality written appraisal records and outputs Builds rapport Demonstrates good communication skills including active listening, questioning and summarising Reviews achievements, challenges and aspirations Provides effective feedback and constructive challenge Understands the factors that might contribute to a difficult medical appraisal Demonstrates a range of strategies in managing a difficult medical appraisal Completes appraisal documentation to a high standard 5 Organisational skills: to ensure the smooth running of the medical appraisal system, including timely responses and sufficient computer skills to be an effective medical appraiser Competency 5.1 Effective management of time and workload 5.2 Sufficient computer skills to perform the role of medical appraiser 5.3 Familiarity and comfort with computerised support systems for appraisal and revalidation Behaviour Completes appraisal caseload and documentation in a timely manner Responds in a timely way to doctors, managerial staff and the responsible officer (or their deputy) Demonstrates sufficient computer skills to perform the role of medical appraiser Demonstrates effective use of computerised support systems for appraisal and revalidation Page 26 of 34

27 Appendix 4 Medical appraiser competency self-assessment tool Medical appraiser competency self-assessment tool Appraiser name: Date: Need training Insecure Adequate Confident Able to teach 1 Professional responsibility I demonstrate high standards of professional responsibility, personal integrity, effectiveness and self-awareness 1.2 I develop my professional competence as a medical appraiser 2 Knowledge and understanding I understand the purpose of medical appraisal and revalidation and understand the role and responsibilities of the medical appraiser 2.2 I understand quality and safety systems and can relate this to the context of the doctor s work 2.3 I understand relevant legislation and guidance including equality and diversity, bullying and harassment, data protection and confidentiality 2.4 I understand educational principles sufficiently to inform the appraisal discussion and the design of professional development objectives 2.5 I understand the Good Medical Practice Framework for Appraisal and Revalidation, GMC supporting information requirements and relevant specialty-specific guidance Page 27 of 34

28 Need training Insecure Adequate Confident Able to teach 3 Professional judgement I maintain and apply skills in evaluating the portfolio of supporting information 3.2 I am able to judge whether the supporting information shows that the doctor is on track to revalidate 3.3 I am able to judge whether there is a patient safety issue or emerging performance concern 3.4 I am able to judge whether the doctor has appropriately engaged in the appraisal process and the review of their full scope of work 3.5 I am able to evaluate achievement of the previous years personal development plan objectives and confirm that the new personal development plan reflects the doctors development needs 4 Communication skills I am able to manage the appraisal discussion effectively 4.2 I demonstrate good communication skills including appropriate levels of support and challenge 4.3 I am able to manage a difficult medical appraisal 4.4 I am able to produce high quality written appraisal records and outputs Page 28 of 34

29 Need training Insecure Adequate Confident Able to teach 5 Organisational skills I manage my time and workload effectively 5.2 I demonstrate sufficient computer skills to perform the role of medical appraiser 5.3 I am familiar and comfortable with computerised support systems for appraisal and revalidation Page 29 of 34

30 Appendix 5 Sample medical appraisal feedback questionnaire This questionnaire should be completed by the doctor and sent to the appraisal lead or appraisal manager when the post-appraisal sign-off has been completed. Name of designated body Medical appraisal feedback questionnaire Name of doctor Name of medical appraiser Date of appraisal meeting Duration of appraisal meeting Poor Borderline Satisfactory Good Very good The organisation Management of the appraisal system Access to the necessary supporting information Comments The appraiser Their preparation for my appraisal Their ability to conduct my appraisal Their ability to review progress against last year s personal development plan Their ability to help me review my practice Comments Page 30 of 34

31 Poor Borderline Satisfactory Good Very good The appraisal discussion Usefulness for my professional development Usefulness in preparation for revalidation Usefulness of my new personal development plan Comments Page 31 of 34

32 Appendix 6 Methods of assessment of medical appraisers The use and application of assessment methods is for the designated body and the responsible officer to decide and should be described in the appraisal policy. There is a spectrum of assessment techniques from soft and informal to structured and formal and the application of these will depend on the particular circumstances. 1. Self-assessment This can be undertaken using the appraiser competency self assessment tool (see appendix 4). 2. Observation during training Many competencies may be evaluated by direct observation during training by an experienced appraiser training facilitator, especially those competencies relating to professional responsibility, knowledge and understanding and communication skills 3. Peer review This may be performed within an appraiser support group or a learning set. It may be useful for: communication skills including building rapport, listening, feedback, questioning and challenge review of supporting information professional judgements and behaviour information governance and confidentiality issues familiarity with an computerised support systems being used for appraisal Page 32 of 34

33 4. Knowledge-based assessments This may involve online modules or written exercises to assess specific items of knowledge (for example, legislative framework for revalidation, conflict of interest, information governance, computerised support systems). 5. Feedback Feedback on the appraiser s performance in the role can be obtained from a number of sources, including: doctors (using a structured feedback questionnaire see appendix 5) colleagues administrative staff an appraiser support group. 6. Observation This includes: direct observation of appraisal or video/audio recording of appraisal (with appropriate consent) simulations using peers, actors, video (with real or fictitious scenarios) familiarity with a computerised support systems being used for appraisal. 7. Objective assessment This can include: quality assurance of the appraiser s appraisal outputs (for example, personal development plans and appraisal summaries) against quality standards, within a peer group or by the appraisal lead Page 33 of 34

34 quality assurance of the appraiser s review of supporting information (sampling of portfolios to check supporting information meets GMC requirements) within a peer group or by the appraisal lead information relating to performance in the role of appraiser: o appraisal activity and scope o attendance at appraiser support group meetings o appropriate handling of patient safety issues o complaints o meeting deadlines, completing administrative tasks, response to s, ease of contact. Page 34 of 34

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