The appraiser's handbook : a guide for doctors

203 Pages·2007·153.64 MB·English

by  Caesar

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!