Assessing and validating information
This section deals with a small but important part of the appraisal, examining the information presented with respect to the GMC’s requirements for revalidation. Most doctors engaged in the appraisal process will meet (and exceed) these requirements. The GMC document supporting information for appraisal and revalidation clearly lays out the supporting information required in a five-year cycle. Much of the focus around this information has been regarding the quantity and time frames. Looking deeper into the GMC document there is guidance around the context of this information with respect to the individual and their workplace.
It is incumbent on the appraiser to assess this information and, as appropriate, validate that it reaches the GMC requirements. This needs to be performed at every appraisal for certain items and at least once over the five-year cycle for others.
The bulk of the appraisal discussion should be around the doctor’s achievements, aspirations and work-life issues as appropriate. In many cases it will be self evident from the written material that the requirements have been met. Other doctors may not have represented the information well and the appraisal discussion may need to tease out the true developmental benefit of the information.
The supporting information the GMC require to be brought to appraisal lies under four broad categories
- General information - providing context about what you do in all aspects of your work
- Keeping up to date - maintaining and enhancing the quality of your professional work
- Review of your practice - evaluating the quality of your professional work
- Feedback on your practice - how others perceive the quality of your professional work
These categories underpin the more familiar six types of supporting information that need to be validated. The ethos of the GMC
document is entirely developmental and places great emphasis on self-awareness and reflection. The GMC do not talk about volume of information, rather quality, relevance and outputs of the developmental activity. The appraiser when assessing the adequacy of supporting information should therefore focus on these aspects rather than volume or numbers of certificates.
“A certificate only proves attendance, reflection proves attention, change demonstrates development and audit shows evaluation”
This module on reflective practice demonstrates some examples of information presented in a reflective manner.
Further guidance has been developed for the six strands of supporting information for appraisers in Wales. http://revalidation.walesdeanery.org/index.php/2013-03-18-14-51-17/quality-indicators
1. A doctor has a large number of CPD credits, these are represented in his appraisal folder by uploaded certificates and the titles of the meeting attended. Most comments are “good meeting”, “interesting update” and the like. At appraisal he states – “I don’t have a reflective bone in my body”. How do you approach this? Do you validate his CPD?
In this scenario the appraiser could postpone the appraisal before it takes place, the doctor could be asked to add more of the learning points and what it meant to them and their practice (yes not using the word reflection!). If as in this scenario the appraisal has gone ahead then the appraiser could attempt to elicit reflection at the meeting. Most ‘non-reflective’ doctors actually do reflect – but cannot write it down. Questions should introduce an element of challenge “why?” “So what?” “What changed?” or “are you now?”. If this does demonstrate outcomes from learning, then this can be recorded in the appraisal summary.
The doctor could be asked (possibly through the PDP) to produce 3 or 4 reflective entries in next year’s appraisal. This is most easily achieved by answering the questions posed in the MARS CPD entry template which asks:-
- What did I do?
- When did I do it?
- Why did I do it?
- What did I learn?
- What changes have I made?
- What will I do differently?
The question of whether to validate or not is a tricky one. The engagement at appraisal may guide you, if there is no engagement then it would be difficult to validate the information. If there was minimal engagement, then the PDP could be used for the following year as suggested above.
The process of validating information must involve mutual agreement. In this scenario, if agreement cannot be reached, the audit should be taken outside of appraisal and advice sought from your appraisal lead. This should not get in the way of the rest of the appraisal discussion.
You will need to find out the extent of the doctor’s engagement in the process. It could be quite legitimate for the doctor to have given a statement at the start and then let the colleague deal with the rest. On the other hand, the doctor may be refusing to co-operate with the complaints process.
If the doctor is refusing to engage the appraisal summary should not be completed until advice is taken from the appraisal lead. Each case would need to be examined on its merits.
You need to know the method of distribution and collection. These need to be totally independent of the doctor. The method by which they were aggregated, again must be independent of the doctor. How they were interpreted (e.g. have the results been compared to a bench mark?). The reflections of the doctor on the results and any changes made.
If the above conditions are met, then it is perfectly reasonable to validate this information.