GP registrar appraisal in the Oxford Deanery

Click for registrars appraisal form. 

Background

As appraisal is now a part of general practitioners' contract with an annual appraisal for both principals and non-principals the norm, it is expected that GP registrars should experience the same process during their training year, and be well prepared to continue the process during their ongoing career.

Although this may seem another, extra commitment during an otherwise busy year there are strong educational reasons for this to occur and many educational principals and processes that are common to both appraisal and the educational process that underpins GP training. This paper describes the way that appraisal fits into training of GP registrars and the process that we expect of trainers in the Oxford Deanery to ensure that registrars have experienced an appraisal, understand the process of appraisal, are prepared to lock into the appraisal process undertaken by PCTs and ultimately are prepared for revalidation.

It is not our intention to require all registrars to be appraised by a PCT trained appraiser, but expect trainers, many of whom are already PCT trained appraisers to undertake this process. The concepts of appraisal will not be new to trainers and they will have been using the skills and tools during the training year, although the process is more formal than is experienced by registrars at present. To facilitate this we will be running some ‘Appraisal for Registrar’ workshops for those trainers not familiar with the appraisal process.

Although a principal in general practice preparing for appraisal for the first time may have to spend considerable time and effort collecting information and evidence into an easily digestible form for an appraiser, this data should already be stored in part of the registrar’s logbook. The preparation should not therefore be unmanageable.

For those that feel this is another burden imposed on trainers that will interfere with their training, the following are some thoughts about how it will fit into the training process.

Appraisal:
A process to provide feedback on doctors’ performance, chart their continuing professional development, and identify their developmental needs.

This is a personal process facilitated by a skilled facilitator leading to a personal development plan(PDP) that will map development during the following year. That plan will be based on evidence collected by that individual  from a variety of sources relevant to the individuals career. This is a process undertaken by an independent practioner.

Educational Appraisal: 
A process, which involves a trainee and an Education Supervisor, which is personal and reviews progress and plans future training.

Both trainee and educational supervisor have responsibilities in collected information, making judgements about attainments and negotiating an educational plan.  The educational supervisor will hold professional information and responsibilities that are not the same as those held by an appraisal facilitator

The following are some ideas about the stages that one expects a registrar to reach in their progress through the training year.

Initial stage of training

Priority: Safety

In this phase the focus is on safety. Can the registrar undertake routine general practice without jeopardising safety of patients, the practice or themselves? Much assessment will take place, both formal and informal with information gathered and shared with the registrar to underpin the process and reassure both trainer and registrar.
In this phase the majority of the responsibility lies with the trainer, who understands the context and competencies of general practice, to manage the assessments and communicate the results with regular feedback(educational appraisal).
Information gathered should be collected into the training log some of which will be signed of for use later in the trainers report.

Middle phase

Priority: Competence

Having reached safety the registrar can now focus his learning on developing the competencies that are needed to become a general practitioner. Much of his time will be working independently towards clear goals, and he will need the skills of his trainer to help identify those goals and to find the best way of achieving them. Help is available from the professional organisations that set out the criteria of competence and organise formal testing against those criteria (Summative Assessment), but there are many other competencies that a registrar will need to obtain that are not so easily assessed. Between them the registrar and trainer will work together to reach these competencies, obtaining feedback about that progress and recording information as they go(Educational appraisal). By the end of this phase the registrar should have gathered information, both formal and informal, that confirms his competence as a general practitioner.

Final phase

Priority: Independence

Having demonstrated competence the registrar can now focus on becoming an independent practitioner able to work independently, able to reflect on performance and gather evidence to reassure that performance is effective and competent. He will be eager to develop knowledge and skills to ensure, not just competence, but excellence.
These are the issues that the appraisal process for general practice is designed to facilitate. Although, we would expect that a registrar has been having discussions and negotiations about his progress at all stages of his training(Educational appraisal), during this final phase of training a formal appraisal interview would enable the registrar to take responsibility for learning, reflecting on progress to date and making plans for development, not just until the end of the training year, but for the start of a career in general practice and to record those plans into a personal development plan. The information and evidence that will underpin the interview and the plan should already be available in the training log.
 

Appraisal Process

At the end of the training year, GP trainers are expected to send confirmation to the Deanery of the appraisal process having taken place using the signed declaration page of Form 4,  together with a copy of the Registrar's personal development plan which will be used anonymously for planning the Deanery HPE programme. The Deanery will send to PCTs a list of all GP Registrars who have had an appraisal together with a clinical governance sign-off based on satisfactory completion of the structured trainer's report.

GP Registrars should keep the record of their appraisal in a portfolio as documentary evidence for future revalidation.