Appraisal for doctors in the spotlight

The topic of appraisal, particularly in relation to revalidation, has been a focus of discussion at the British Medical Association’s Annual Representative Meeting this week.

Although doctors were keen to stress that they had welcomed and embraced what they believed would be a valuable process, which would make better doctors and benefit patients, the report on BMA news relays numerous negative comments.  Appraisal has become “burdensome”, “too time consuming”, “hijacked and made part of revalidation”, and is “no longer meaningful”.  There are “hoops to jump through and boxes to tick”, plus the process takes “both appraisee and appraiser away from spending time with patients”.  One delegate even told of his personal experience where his recent appraisal “found he had not reflected enough, nor reflected enough on his reflection.”  His summary stated “It’s not what we signed up for and it’s not what we developed.”

This final quote in particular begs the question:  Is it the principle or the implementation which is at fault?

There are responsibilities all round here, from the Responsible Officer developing and maintaining the appropriate culture, supported by effective processes, through to the appraisee adopting a positive approach to the process.  The initial and ongoing training of appraisers has to be a critical factor here.

The GMC’s revalidation requirements for doctors are dependent upon sufficient numbers of medical appraisers to be trained to a high and consistent standard in order to ensure a robust, effective process.  Before being absorbed into NHS England, the NHS Revalidation Support Team emphasised  in their document Quality Assurance of Medical Appraisers (Version 5: January 2014, that all medical appraisers “should demonstrate the same level of core competencies, so training programmes should be based on a strong core of material”.  In addition, doctors who work as medical appraisers are required to undertake continued professional development in this area, keeping up to date, enhancing skills and calibrating practice with other appraisers.

These are positive statements, which the RST has backed up by making outline training materials available.  However, to avoid appraisal and revalidation descending into the reported hoop jumping, box ticking, pointless exercise, it is essential that Responsible Officers ensure that quality appraiser training be delivered by expert facilitators.  This applies to both the initial training and to the ongoing improvement.

Can the current appraisal/revalidation system be implemented in a way which will achieve the intended goal of making better doctors and benefitting patients?  Or do we need a major rethink?