The Appraiser's Handbook a guide for doctors Nick Lyons BSc (Med Sd), MB ChB, MSc (Med Ed), DRCOG, FRCGP Susanne Caesar MA (Cantab), MB ChB (Hons), DRCOG, DCH, MRCGP and Abayomi McEwen MBBS (London), MSc (London) With illustrations by Sarah Akigbogun Foreword by Maurice Conlon CRC Press Taylor &. Francis Group Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business Radcliffe Publishing Ltd 18 Marcham Road Abingdon Oxon OX14 1AA United Kingdom www.radcliffe-oxford.com Electronic catalogue and worldwide online ordering facility. © 2007 Nick Lyons, Susanne Caesar and Abayomi McEwen Nick Lyons, Susanne Caesar and Abayomi McEwen have asserted their right under the Copyright, Designs and Patents Act 1998 to be identified as the authors of this work. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the copyright owner. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN-10: 1 84619 083 5 ISBN-13: 978 1 84619 083 4 Typeset by Anne Joshua & Associates, Oxford Printed and bound by TJ International Ltd, Padstow, Cornwall Contents Foreword vii About the authors viii Acknowledgements ix List of abbreviations x 1 The purpose of appraisal 1 The definition of medical appraisal 1 Introduction 1 What is meant by appraisal in society? 2 Appraisal for all? 3 Appraisal for doctors 4 What appraisal for doctors is ... and is not 7 References 9 2 Appraisal and professional development 11 Doctors and learning 11 Adults and learning 12 The environment of learning 14 Needs and learning 14 Appraisal and learning 16 The Yosuni Windows 17 Learning styles: we are all different 18 Development plans 18 The effectiveness of appraisal 19 The areas covered in appraisal 19 The evidence informing appraisal 21 Appraisal and re validation 22 The importance of the organisation 22 The challenge 24 References 24 3 The role of the appraiser 27 Introduction 27 What does the appraiser do? 27 The functions of an effective appraiser 28 What an effective appraiser is not 30 Why become an appraiser? 32 Reflections on being an appraiser 33 Conclusion 34 References 34 iv Contents 4 Becoming an appraiser 35 Introduction 35 Recruiting a new appraiser 35 The support of early appraisals 39 Ongoing support for appraisers 39 Matching of appraiser and appraisee 42 How long should an appraisal take? 43 Appraising the appraisal role 44 Conclusion 44 References 45 5 The appraiser training curriculum 46 Introduction 46 The medical appraiser's curriculum 47 Ground rules for appraiser training 48 Training new appraisers: knowledge 49 Training new appraisers: skills 52 Training new appraisers: attitudes 66 How the curriculum should be evaluated 70 Conclusion 70 References 71 6 Preparation for appraisal 72 Introduction 72 Getting the process going 72 Timetable for the appraisal process 74 Where to meet 74 When to meet 75 Producing Forms 1-3 and the supporting documentation: how long should it take? 76 How to look at the forms and paperwork 77 Being seen to be prepared 86 Potential issues relating to the documentation 86 The last-minute checklist: the appraiser 89 The appraiser pack 89 Punctuality 90 Conclusion 90 References 90 7 The appraisal discussion 92 Introduction 92 Calgary-Cambridge model 93 Initiating the session 94 Providing structure 96 Building the relationship 97 Exploring the appraisee's statements, ideas and aspirations 97 Agreeing the Form 4 and PDP 97 Closing the session 98 Contents v Signing off the previous year's PDF 99 Discussion of Forms 1, 2, 3 and 'any other business' 99 Skills for facilitating the appraisal discussion 99 Curtailing the appraisal 110 Conclusion 110 References 110 8 The paperwork for appraisal 112 Introduction 112 A guide to the paperwork 113 Form 4 summary document 113 The personal development plan (PDF) 115 Evaluating Form 4 and the PDF 118 Form 5 for secondary care 118 Detailed confidential account of appraisal discussion 118 The signing-off process 119 Evaluation forms 119 Conclusion 119 References 119 9 Complex appraisal situations 120 Introduction 120 Appraisees in the context of the team 120 Doctors like Maria 121 Appraisees with particular challenges 123 Declining an appraisee 124 Doctors in various sorts of difficulty 124 Alternative appraisal models 126 Conclusion 133 References 133 10 Quality assurance of appraisal: doing it well 135 Introduction 135 Quality assurance: an overview 136 The NC GST checklist 13 7 The appraiser's role in quality assurance 143 The appraisal lead's role in quality assurance 145 The organisation's role in quality assurance 147 Conclusion 150 References 150 11 Developmental resources 152 Ground rules for running small groups 152 Preparation form for appraisers 153 Giving feedback: the dos and the don'ts 154 Appraisal scenarios for individual reflection or group discussion 156 Exercises and resources for appraisal leads 158 Tool to reflect on difficult appraisals 163 vi Contents Form 4 assessment tool 164 Personal development plan assessment tool 164 Appraiser training day: reflective notes 165 Appraiser training day: evaluation 166 Websites and e-learning resources 167 References 170 12 Administrative resources 171 Person specification for appointment of a medical appraiser 171 Specimen job description for a medical appraiser 173 Specimen primary care trust appraiser contract 174 Specimen appraisal evaluation form for appraisee to complete 177 Appraisal evaluation form for appraiser to complete 181 Specimen example of health checklist and sign-off statement 183 References 184 Index 185 Foreword Putting appraisal in the water? I have read that if the whole population were treated so as to reduce average blood pressure by 2 mmHg, the net benefit in terms of population health gain would be immense. This is partly explained by the inverse care law: those who stand to gain the most from an intervention are the last to whom it is applied. By making appraisal for doctors a statutory obligation, the NHS has attempted something similar for doctors. Appraisal was lifted out of the domain of enthu- siasts and applied to all. This created a challenge: to demonstrate to a profession trained to be scientifically sceptical that appraisal is of value. One key to this is the proficiency of appraisers. A skilful appraiser can reassure an anxious colleague that appraisal is for their personal benefit, and show a sceptical colleague that appraisal can unlock conundrums which, alone, they have not penetrated. This book, written by a trio steeped in appraisal, is a valuable resource for appraisers. It will help doctors learning to be appraisers, and experienced appraisers. It will also help those organising appraisal, to remind them of the aims of the process. Teachers of appraisal will be able to use it to supplement and support their curricula. I believe revalidation, when it arrives, will be the single biggest step towards improvement taken by the profession since the introduction of the medical register. I also believe this depends upon the inclusion of appraisal within the revalidation package. Putting high-quality, developmental appraisal 'in the water' for the medical profession will bring about a whole-profession shift in terms of lifelong professional development. This book will support that aim. Maurice C onion FRCGP Appraisal and Revalidation Lead NHS Clinical Governance Support Team www.appraisalsupport.nhs.uk September 2006 About the authors Dr Nick Lyons spent a short time in the RAF before training in general practice and settling as a GP in rural Dorset. He gets great fulfilment from his work in medical education, originally as a GP tutor and now as an associate director in Severn and Wessex Deanery. He believes that encouraging and supporting other doctors in their professional development leads to improvements in patient care. He is the appraisal lead for his PCT and works as a member of the editorial team for www.appraisalsupport.nhs.uk. He believes appraisal is at the core of continu- ing professional development and as vice-chair of the National Association of Primary Care Educators works to raise the profile and quality of education for all those working in primary care. Dr Susanne Caesar studied in Cambridge and Edinburgh before becoming a GP in Cheshire. She has always enjoyed the variety and wisdom of her patients. Motivated by the desire to make a difference to all GPs, not just the enthusiasts, she has been an appraisal champion since its introduction. Her work as an appraisal training and support provider brings practical experience to this book. The more highly skilled appraisers become, the better they can help motivate individual doctors in their continuing professional development. She gave up a part-time partnership last year in order to have the flexibility to pursue the other branches of her portfolio career, and particularly to have school holidays with her children. In sessional work she has learned the truth that all doctors, no matter where they practise, have something that they can teach others to do better. If, through appraisal, some of this can be captured and shared, she would count it as a major achievement. Dr Abayomi McEwen was born in Nigeria and inherited her parents' sense of independence and service to society. At the age of 14, her parents sent her to the UK to complete her secondary schooling, and she subsequently trained at the Royal Free Hospital School of Medicine, London University. She gave up her practice in order to devote more time to medical education, specialising in communication and consulting skills. Apart from teaching the teachers, she also works with doctors who have been deemed poorly performing in this area. When appraisal was introduced, the formative and developmental aspect appealed to her natural desire to help others and she gladly accepted the role of Appraisal Lead for Epping Forest PCT. She would like her colleagues to seize appraisal and maximise its potential fully for their benefit and that of their patients. She particularly values the educational input from the National Associ- ation of Primary Care Educators in building her knowledge about appraisal. Her family is very important to her and she continues to be truly appreciative of the encouragement her husband, children and extended family give her, even when it means they have to do without her, yet again. Acknowledgements The Chinese say 'A journey of a thousand miles starts with one step'. The journey of writing this book has been supported by the encouragement and feedback of many colleagues to whom the authors are genuinely grateful and indebted. Particular mention must go to: John Bibby, Henning Caesar, Maurice Conlon, Julie Draper, Geoff Edwards, Katie Evans, Robin Gleek, Steve Holmes, John Howard, Di Jelley, Keith Judkins, Madeleine Kenny, Peter Leigh, Malcolm Lewis, Anoopam Moar, Bob Royle, Amar Rughani, Stephanie Seller, Vik Tanna, Jane Whitworth and Dave Young. The greatest thanks, however, must go to our families, who have tolerated far too many hours of writing and discussions about appraisal. Thank you!