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A Practical Approach To Appraisals Mr Mark Golder PhD, MB BChir [Cantab] FRCS [Gen] General and Colorectal Surgeon Senior Medical Appraiser BMA presentation 20.7.16

Aims

Overall approach to an appraisal An Appraisers appraisal Appraisal quality assurance Reflection on activities across the 4 Domains of GMP PDP Patterns of risk

Approach and Framing Support and motivate Positive experience avoid confrontation, criticism or negative statements, including on appraisal outputs Guide / challenge / facilitate reflection Patient safety

PDP The Appraisers Appraisal Domain 1: update workshops, appraiser network meetings, courses plus reflection, add to PDP Domain 2: audit of appraisal outputs, complaints, SEs, plus reflection, add to PDP

Domains 3 and 4: formal appraisee feedback questionnaires plus reflection, add to PDP Good Medical Practice Surveys .com 1.1.1 Setting the scene and overview of supporting information

1.1.2 Reflection and effective learning 1.1.3 The PDP and developmental progress 1.1.4 General standards and revalidation readiness TOTAL SCORE (OUT OF 50) Reflection

Reflection The General Medical Councils core guidance, Good Medical Practice, requires doctors to reflect regularly on [their] standards of medical practice, and evidence of personal reflection is critical for revalidation. Appraisal, personal learning plans, assessment of critical incidents, and educational

portfolios are just a few of the areas in which doctors are encouraged to reflect. Reflection

Linking past, present, and future experience Integrating cognitive and emotional experience Considering the experience from multiple perspectives Reframing the experience

Stating the lessons learnt, and Planning for future learning or behaviour Hatton N, Smith D. Reflection in teacher education: towards definition and implementation. Teach Teach Educ 1995;11:33-49 Reflection Appraisees Approach

Reflection - Appraisees Approach Domain 1 GMP

Evidence of CME / CPD Written reflection not just a topic heading Verbal discussion / reflection / challenge Add elements to PDP

Reflection - Appraisees Approach Domain 2 GMP

Evidence of QIAs: Audit, CBDs, SIAs Written details and reflection need to demonstrate QI Verbal discussion / reflection / challenge Add elements to PDP Reflection - Appraisees Approach

Domain 2 GMP

Evidence of Complaints and SEs Letters / Incident reports / RCA Written details and reflection formulate plan for risk reduction Verbal discussion / reflection / challenge Add elements to PDP Reflection Appraisees Approach Complaints - recurring themes

Communication verbal and written: advanced communication skills workshop, assertiveness/ conflict resolution course, emotional intelligence course Team work vs working in isolation: leadership and team work courses Consent: Material risk - Montgomery (Appellant) v Lanarkshire Health Board (Respondent) [2015]

Confidentiality: patient notes, computer screens and bed side curtains Reflection Appraisees Approach Significant events recurring themes Diagnoses (delayed / misdiagnoses): Imps vs differential diagnosis Documentation / patient hand overs: medical record keeping, communication skills, time management, due diligence

Recognizing and working within limitations: team work, discussing [complex] cases, shared management, calling for help Reflection Appraisees Approach Domains 3 and 4 GMP Evidence of MSF and patient feedback: survey company reports,

references and compliments Written reflection: strengths / potential weaker areas what, why and how? - not just what the strengths are Verbal discussion / reflection / challenge Add elements to PDP PDP

PDP - Appraisees Approach There are clear links between the summary of discussion and the agreed PDP The PDP has SMART objectives (specific, measurable, achievable, relevant, timely) The PDP covers the doctor's whole scope of work and personal

learning needs and goals The PDP contains between 3-6 items A Final Thought - Patterns of Risk Recurring themes of Complaints and SEs Could we use the information gained from appraisals, to add to

information collected from National Audits of Complaints and SEs? [email protected]

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