Guidance to Appraisers undertaking a first appraisal following the pandemic
In March of this year all appraisals in Wales were suspended until the end of September 2020. The suspension of appraisals has, in all likelihood, had the knock-on effect of lulling doctors (even those who normally record prospectively through the year) into not considering what current day to day activities might be relevant for adding to their appraisal folder.
Covid related contingencies, employed in practices, hospitals, other healthcare settings and at an individual level, are likely to be the dominant influences on a doctor’s development over the intra-appraisal period. Appraisal folders are likely to reflect this influence and may not look like a “traditional MARS folder” if appraisees choose to focus reflection more on themselves rather than on traditional CPD type learning. The following appraiser guidance will seek to ensure that appraisers in Wales take a consistent approach when reading and discussing folders in the post Covid period.
Communication with Appraisees
The “Guidance to Doctors undertaking their first appraisal following the Covid pandemic” is available to appraisees to assist with preparation for the first appraisal following the pandemic. Appraisers will need to be responsive to the needs of appraisees during this period and are more likely to receive communications regarding the current expectation of the appraisal process, with regard to what to include or how much material to include for example.
Social distancing measures are likely to result in a larger number of appraisal meetings taking place virtually. A separate guide has been developed to support appraisers with preparing for a virtual appraisal.
How much material is enough
Reading the appraisal folder two weeks before the appraisal date will allow appraisers to make a judgement on whether enough material is present to allow an appraisal to go ahead. This current guidance asks appraisers to have a low threshold for making that judgement, on the basis that the forthcoming discussion will identify more material that will then develop into the summary.
Preparing for discussion
Folders that contain very little written evidence in the appraisal information section, (for example as few as three or four entries) should still go ahead. During the discussion such folders will require appraisers to draw out more information from appraisees in a way that enhances that folder. This introduces both an element of supportive challenge and adds value to the process both for the current appraisal and future appraisals. Appraisers can also add entries as a result of the discussion that were not originally put forward by the appraisee.
Adding value and offering challenge
Appraisees should set the tone of their appraisal meeting and be prompted to discuss their appraisal year by open questioning – for example “What have been your high points?", "What have you found most challenging?".
Such an open approach is likely to identify those elements of the year most important to the appraisee and will make a good start to the summary. Other prompts should be used if appropriate to the discussion.
Developing the discussion
Having an appraisal discussion may be the first opportunity for doctors to talk about their experiences of the pandemic at both a professional and personal level. The appraiser should facilitate this discussion bearing in mind those elements of Good Medical Practice that the Appraisee is likely to have participated in, but not necessarily thought to include in their folder. There may be an onus on the appraiser to tease out examples, if missing and if appropriate, of elements such as CPD, teamwork and safety considerations to name but a few. The discussion also offers the appraiser an opportunity to identify work that could fall into the themes of quality improvement or significant events. The model examples of appraisal folder entries of a first appraisal following the pandemic (for a GP but applicable across specialties) can be used by appraisers to help develop the discussion.
Appraisers will as usual need to discuss and verify essential information such as QIA and 360 should such elements be present in the doctor’s submission.
If your appraisee is imminently coming up for revalidation, but are not revalidation-ready, please advise them to contact their Health Board Revalidation Team to discuss this further.
Constraints /insights and reflections
The period of the pandemic will have meant that some colleagues have worked under significant pressure, had to alter the way they work and have put themselves at risk of developing Covid. Appraisees may use the constraints or insights sections to write about these experiences.
A significant amount of time may be needed to discuss these issues and indeed appraisers may find that these sections provide the basis of the majority of the discussion. The appraisal discussion is an opportunity for appraisers to explore these issues in depth, in a supportive way and to signpost appraisees to resources if appropriate.