Medical Appraisal 2020 was developed specifically for the context of the COVID-19 pandemic, with the attendant pressures on doctors and on clinical care. Now that we are moving beyond the pandemic phase, we need an approach that incorporates the best of the appraisal 2020 model and updates it for the foreseeable future.
There will be no going back to the model of appraisal pre-pandemic. If we want it to be unthinkable to suspend appraisal in a crisis, it has to offer sufficient support to doctors to be valued by the vast majority, and not take them away from patient care to a disproportionate extent.
Revalidation recommendations dates are usually set on a five year cycle, but you do not need any particular number of appraisals to revalidate. You must engage with the annual appraisal process (even if you do not have any appraisal due to a global pandemic, long term sick leave or parental leave) by keeping in touch with your responsible officer or your Suitable Person and letting them know what is happening. By the time your revalidation recommendation is due, you must have collated, reflected on and discussed at appraisal all the six types of GMC required supporting information as given in their guidance ‘Supporting information for appraisal and revalidation’. If you are organised and well-prepared, this could theoretically be done in one appraisal, although it is more likely you would need the support of your appraiser in the first appraisal meeting to help you plan to fulfil all the GMC requirements over the period before your next appraisal.
The GMC has never mandated a specific amount of CPD or number of credits per year. They expect doctors, as professionals, to do enough CPD to keep up to date at what they do. You will be expected to be able to demonstrate during your appraisal how you have kept up to date, with an appropriate spread of learning across the curriculum appropriate to what you do. You must reflect on the most important things you have learned since your last appraisal, and what difference they have made to your work. You will be asked to do a small amount of focused documented reflection on these key questions and supplement it with facilitated verbal reflection during the appraisal discussion.
The appraisal 2020 process has provided an opportunity for doctors to demonstrate their professionalism in their CPD. It provided the chance to move away from counting credits and collecting certificates to thinking about what learning has been meaningful and made a difference to patient care. We have shown that verbal reflection can provide acceptable supporting information about your CPD.
Of course, some doctors find simple record keeping and reflection on an ongoing basis, in some form of learning diary or log, the best way to learn and helpful to them personally. This is valid and valuable supporting information for your appraisal and probably the easiest way to demonstrate the breadth of your CPD. However, your Responsible Officer and appraiser will not be expecting you to have collected evidence, such as certificates, if they are of no value to you. You should spend your time on clinical care, CPD or time to rest and recharge, rather than on documentation that is not of any value to you.
There will be no requirement or expectation that you ‘catch up’ on CPD after an appraisal merely because you have not demonstrated it by counting credits or collecting certificates, providing you have kept up to date for what you do. The GMC have confirmed that appraisals conducted using these rebalanced appraisal processes will fulfil all their requirements for appraisal and revalidation.
The appraisal toolkit providers have been involved in the discussions around the implementation of the new appraisal processes and have provided assurance that they will be able to make appropriate adjustments to the electronic portfolios to ensure that the pre-appraisal documentation remains easier and less burdensome than pre-pandemic. There is an AoMRC Medical Appraisal Template which has been designed to support this process by indicating the key information to be collated by the doctor and the focused documented reflection required pre-appraisal.
Doctors in Scotland have a dedicated national toolkit (SOAR) and doctors in Wales have a dedicated national toolkit (MARS). In these devolved nations there was already a focus on the support of the doctor and their health and wellbeing, and the shift in emphasis will be more evident in changes in the training and expectations of appraisers.
During the COVID-19 pandemic, it was strongly recommended for public health reasons that all appraisals in primary care were carried out remotely using telecommunication assistance due to the risk of doctors acting as vectors of infection between healthcare settings. This did not require any additional documentation but the appraiser needed to include the information that the appraisal was facilitated remotely in their summary and doctors and appraisers were asked to provide their feedback.
It has become clear that appraisals conducted remotely can be wholly satisfactory in terms of establishing rapport and providing appropriate support and constructive challenge to the doctor. Indeed, in some sectors this has been the norm for many years and in the pandemic some doctors said they found it easier to explore difficult areas because they were not in the same room as their appraiser.
It also makes sense in moving towards greater sustainability and becoming carbon neutral to restrict in person appraisals to those where it is really needed or wanted by the doctor.
Top tips for appraisals done remotely:
Where IT facilities are not good, or the doctor really wants to meet in person for any other reason, there should be appropriate attention to social distancing and infection control measures to minimise the risk of virus transmission between individuals and between healthcare settings. An appraiser who is particularly vulnerable should pass back the allocation and restrict themselves to remote appraisals.
No specific video-conferencing platform is recommended for the purposes of a remote appraisal. In choosing a video-conferencing platform, consideration should be given to the purchase or subscription cost, the maximum allowed call-period, the confidentiality and security of the call and the requirements for bandwidth in ensuring there is a good quality picture and sound for the appraisal meeting.
You should safeguard people’s personal/confidential information in the same way that you would safeguard patient information in a consultation. If discussing identifiable sensitive information, then you must ensure the platform meets appropriate GDPR standards for doctors. You must also ensure that you are in an environment where you can maintain the privacy of the video-conference call.
If you continue to have a licence to practise you should continue to engage in annual appraisal even if you are not working. The rebalanced appraisal processes have been designed to support your professional development while reducing the pre-appraisal documentation required. In the context of current pressures on healthcare provision, you may wish to have an appraisal even if you are not currently working, especially if you are planning your return to work.
As the circumstances will vary, you should contact your appraisal administrative team to discuss your wish to have an appraisal and ensure that there is capacity in the system to accommodate your request.
If you are well enough to be working clinically, you will be expected to have an appraisal, particularly as the rebalanced medical appraisal processes have an increased focus on supporting you in maintaining your health and wellbeing. If you consider that your ability to care for patients is impaired in any way because of your health, it is very important that you are supported in receiving the help you need. You would be strongly encouraged to contact your appraisal administrative team at your earliest convenience (and possibly seek the support of your GP or a relevant organisation, depending on your specific needs). The Medical Appraisal Guide 2022 includes a focus on ensuring that appraisers are trained in signposting appropriate avenues of support and able to share lists of useful national, regional and local resources.
If you are not working due to ill-health, then please contact the appraisal office and follow the existing processes to explain your circumstances. Possible options include the responsible officer deciding to approve a missed appraisal, postponing your appraisal for a period while you recover, in order to have it later in the appraisal year, or even having an appraisal (see ‘I am not currently working. Should I still have an appraisal?’). You will not be required to have an appraisal but it may be possible to offer you one if you want one.
If you are due an appraisal whilst on parental leave, please contact your appraisal office at your earliest convenience in the usual way to discuss how you can best be supported. Some doctors choose to pull their appraisal forward to plan for their parental leave; others delay their appraisal and wait to have it on their return to work. This has not changed in the MAG 2022 process.
No! Appraisal has never been a pass/fail event. It is impossible to fail an appraisal.
If your appraiser identifies gaps in your portfolio of supporting information for revalidation they will probably suggest postponing your appraisal meeting to give you time to collate the information that you need to reflect on and to inform the discussion. Occasionally, you may both agree to go ahead and meet without any supporting information in order to enable you to access the advice and support you need.
Your appraisal should help you to plan how best to fill any gaps in your portfolio or how to access any support you may need. This has not changed.
If you engage with your annual appraisal process, you will be asked to do some focused reflection before the appraisal, and capture it in your portfolio. It should not take you long to document sufficient reflection to inform a rich discussion. You will also discuss your reflections on what you have learned and what changes you have made as a result during the appraisal meeting. Appraisers will be explicitly trained to adjust their expectations to take account of the reduction in the documentary burden of appraisal in the rebalanced processes and to give facilitated verbal reflection during the discussion equal weight with documented internal reflection.
You are always expected to declare and include your reflection on any complaints or significant events in which you have been personally named or involved since your last appraisal. This has not changed.
It is impossible to predict all the factors which will continue to affect and shape our professional lives. Responsible Officers will retain the ability to adapt local appraisal processes as needed in context, although the aim is to make it unthinkable to suspend appraisal in a crisis because of the importance of the opportunity for support it provides for doctors.
It seems likely that appraisal will continue to evolve. It is hoped that continuous quality improvement activities will inform further changes to the appraisal process in the future, so that it becomes as supportive and constructive as possible for all doctors. The changes in process due to the introduction of the Medical Appraisal Guide 2022 will continue to be evaluated to assess whether the changes are an improvement, and, if so, which elements should be carried forward. Please help if you are asked to provide feedback about the new processes.
Part of the value of your appraisal is the protected time and space to debrief with a trained colleague. Part of the value is the opportunity to plan for the next period and the challenges you face in your personal and professional development. Use this appraisal to discuss your goals and what is important to you with your appraiser and to help you access the support that you need. All doctors deserve the benefits that the best appraisals already provide.
© 2022 Academy of Medical Royal Colleges.