Yorkshire and the Humber Postgraduate Deanery (SYLO)
Exit Appraisal
Appraisal Folder
January 2013
Exit Appraisal Documentation
Appraisal Date: 22 January 2013
Name:GMC number:
Current Post:
Scheme:
Date started training programme:
Date due to finish training programme:
Appraisal Folder: Contents Checklist
Appraisal Documents
/ Document present / NotesForm 1.
Personal Details / Send to appraiser
Form 2.
Details of your current medical activities / Send to appraiser
Form 3.
Document on which appraisal discussion will be based / Send to appraiser
Form 3.
Record of Documentation Supporting Appraisal / Send to appraiser
Form 4.
Summary of Appraisal Discussion / Completed at appraisal
Form 4a.
Personal Development Plan / Send last PDP to appraiser
Portfolio of Evidence
1. Good Clinical Care
2. Maintaining Good Medical Practice
3. Relationships with Patients
4. Working with Colleagues
5. Teaching and Training
6. Probity
7. Management Activity *
8. Research *
9. Health / Bring to appraisal
* Some of these sections may not apply
[E.g. management, research and for some it may be difficult for trainees to collect evidence e.g. relationships with patients]
Guidance Notes
This folder consists of two parts:
· The Appraisal Documents Forms 1 to 4
· The Portfolio of Evidence
· We recommend completing as much as you can electronically as this is currently extremely similar to the documentation you will need to complete for your appraisal next year
Appraisal Documents
· Form 1: Personal Details
[Self-explanatory]
· Form 2: Details of your current medical activities
[Give a brief description of your current post]
· Form 3: Document on which the appraisal discussion will be based
[Will form the basis of your appraisal interview. The more thought that you put into this document, the more you will get out of your appraisal]
· Form 4: Summary of Appraisal Discussion
[This is the outcome of your work for this appraisal]
Instruction for Forms 1 to 3
· Forms 1 to 3 should be completed and emailed to the Deanery at least two weeks before the appraisal meeting
· The Deanery office will email them to your appraiser [This will be another GP Trainee within the Deanery]
· Form 4: Summary of Appraisal Discussion
This is completed on the appraisal day
o This us a key document which comes out of your appraisal
o It is jointly completed by you and your appraiser and should be signed off by both appraisee and appraiser
o This is the evidence that an appraisal has taken place and is necessary for Revalidation
o At the end of the ‘Exit Appraisal Day a copy of Form 4 twill be taken by the Deanery Office
o Keep a copy for your own folder [you will need this for your next appraisal]
o Your scheme administrator will be notified that you have had an appraisal
o Your form 4 will be kept confidentially at the Deanery
Portfolio of Evidence
· The portfolio is a collection of evidence that demonstrates that you are meeting the Good Medical Practice standards
· This is meant to be a carefully chosen selection of evidence, and should be readily available if records of training have been maintained
· In future, for most trainees, this will mean printing out selected documents from the e-portfolio
· Each piece should be listed in the Record of Documentation Supporting Appraisal [Form 3]
· The second part of this folder has a set of dividers
o One for each Good Medical Practice heading in which the evidence can be filed
· The Portfolio of Evidence should be brought to the appraisal meeting and not sent off to the appraiser with the Appraisal Documents
· On the Appraisal Day, time will be allowed for the inspection of the evidence before the appraisals
Form 1: Personal Details [complete and send to appraiser]
GMC Number:
Type Of Registration:
Date of Full Registration
Details of Last Appraisals
1st Date:2nd Date:
3rd Date:
Details of GP Speciality Programme Rotation
Description Of Post / Full or Part Time / Educational Supervisor Name / Practice name or hospital name1.
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Form 2: Details of Your Current Medical Activities
[Complete and send to appraiser]
The aim of this form is to provide you with an opportunity to briefly describe your post(s) in the NHS, in other public sector bodies, including titles and grades of any posts currently held, or held in the past year.
You should explain what you do and where you receive training.
You should explain what is the training component of your current post.
Your descriptions should cover your training and practice at all locations since your last Appraisal.
You may wish to comment on the environment in which you train, including:
§ The quality of training in your post
§ Level of supervision by whom and what grade
§ Factors which you believe affect the provision of good health care, including your views (supported by information and evidence) on the resources available
§ Action taken by you to address above issues
Instructions for filling out form 2
1. Obtain a copy of your job description and Training Agreement
§ If none is available contact the Deanery urgently as the job description is a contractual requirement
§ All trainees should have a Training Agreement
2. Fill out the sections with the help of the Job Description and add any supplementary information, which may be missing from the Job description
3. Do not include items from the Job Description if they do not really happen in your post
Form 2 should reflect what you actually do (Training / non training / locums)
4. In Details of “emergency, on-call “ a description of your rota (1:6 etc) whether you are full or part time (flexible %)
Note whether post is compliant or not with the number of hours worked (approx)
5. Fill out new Form 2 for each post you do and archive the previous one with the job description if the job description has changed
Also locum posts, shorter form for short term locums
Form 2: Details of Your Current Medical Activities
[Complete and send to appraiser]
Please provide:
1. A short description of your work and training in your specialty
What different types of activity do you undertake?
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2. Details of emergency, on-call and out-of-hours responsibilities:
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3. Details of outpatient work:
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4. Details of any other clinical work:
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5. Details of non-clinical work that you undertake, for example, teaching/academic work, management activities, research:
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6. Study Leave
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7. Work for regional, national or international organisations / other professional activities
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Summary of Additional duties / Locum Posts
Locum Work
For short term and ad hoc locums (< 2 weeks in duration)
Date / Hospital/Trust / Specialty / Grade / DurationNB: During GP Specialty Training, it would be unusual for a trainee to undertake locum work. A trainee should have a discussion with the Program Director if contemplating doing locum work as there might be future implications – such as limiting opportunities to undertake remedial training if an element of nMRCGP were failed
Form 3: Document on which the appraisal discussion will be based
[Complete and send to appraiser]
This form is designed to enable the sharing of information, to encourage a focused dialogue on all elements relevant to your appointment as a GP Trainee
Form 3: Personal Preparation Checklist
[Complete and send to appraiser]
This checklist is provided to help you to plan for the first and subsequent meetings:
1. During the last twelve months what would you consider to have been:
Achievements: / Disappointments:·
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2. What aspects of your work as a GPStR have given you the greatest satisfaction?
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3. What skills developed elsewhere are you using in your current post?
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4. What are your key skills and areas of strength?
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5. What parts of your training do you find most difficult?
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6. What do you consider you are doing well, and how do you know?
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7. Are there obstacles preventing your training being better? Yes No
If yes, how can they be overcome?
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8. What have been your highs and lows in the past twelve months?
Highs / Lows·
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9. What skills would you need to improve your effectiveness?
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10. During the next twelve months, what are your personal, educational and professional goals? (Eg courses, examinations, nMRCGP etc)
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11. Taking your goals into account, what support or resources do you need from elsewhere in order to achieve them?
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12. Any other comments not addressed above?
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Form 3: The Record of Documentation Supporting Appraisal
[Complete and send to appraiser]
1. Good Medical CareList below each document, in the order in your folder/ePortfolio
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
7. …………………………………………………………………………………..
[Please continue if further documentation available]
2. Maintaining good medical practice
List below each document, in the order in your folder/ePortfolio
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
7. …………………………………………………………………………………..
[Please continue if further documentation available]
3. Working Relationship with colleagues
List below each document, in the order in your folder/ePortfolio
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
7. …………………………………………………………………………………..
[Please continue if further documentation available]
4. Relations with Patients
List below each document, in the order in your folder/ePortfolio
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
7. …………………………………………………………………………………..
[Please continue if further documentation available]
5. Teaching and Training
List below each document, in the order in your folder/ePortfolio
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
7. …………………………………………………………………………………..
[Please continue if further documentation available]
8. Research
List below each document, in the order in your folder/ePortfolio
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
7. …………………………………………………………………………………..
[Please continue if further documentation available]
[Please see divider section for section 6: Probity & 9: Health for documentation]
[7: Management Activity not expected to have any documentation but feel free to include]
Form 4: Summary Of Appraisal Discussion [To be completed at Exit Appraisal Day]
Name of Doctor:
GMC no.:
Date of Appraisal Discussion: 22 January 2013
· This section includes the signed off Summary of the year’s appraisal activity and an outline of the developmental tasks to be undertaken during the next appraisal period
· It is based on and includes the standards laid out in Good Medical Practice and it should be agreed and signed by your appraiser
1. Good Medical Care
2. Maintaining Good Medical Practice
3. Working Relationships with Colleagues
4. Relations with Patients
5. Teaching and Training
6. Probity
7. Health
Sign Off
We agree that the information in Form 4 is an accurate summary of the appraisal discussion and agreed action, and of the agreed personal development plan.
Appraiser:
Name: ______GMC Number:______
Signature: ______
Appraisee:
Name: ______GMC Number:______
Signature: ______
Date: 22 January 2013
Record here the names of any third parties who contributed to the appraisal and indicate the capacity in which they did so:
Program Director:
Name: Jonathan Bundy Sandra Brinkley [cross through appropriate]
GMC Number: 3540312 2980672 [cross through appropriate]
Signature: ______
· The doctor must ensure that the documents are stored securely and retrievable for purposes of inspection for revalidation.
· A copy of Form 4 should be sent to the Deanery Office [FOA Janet Bell]
· It is not necessary to send Form 4a, which is the PDP
· The Program Administrators will be notified that your appraisal has taken place
January 2013
Yorkshire and the Humber Postgraduate Deanery
Exit Appraisal
Form 4a. Personal Development Plan
Learning & Development Needs / Development Objectives / Achievement Dates / Activities to be Used / Outcomes or EvidenceWhat broad areas do you wish to address? / What specific goals are you setting yourself for each need? (Remember to keep them “SMART”!) / When do you expect to achieve your objectives? / How will you achieve your objectives? / How will you show that you have achieved your objectives)
Yorkshire and the Humber Postgraduate Deanery
Exit Appraisal
Portfolio Of Evidence
Portfolio of Evidence
[Bring to the Exit Appraisal Day]
· The aim of this form is to record the background evidence and information that will help to inform your appraisal discussions
· You should list in Form 3 the documents in your Appraisal folder [access to the ePortfolio will mean that very little may need to be included here]: these provide evidence in the terms set out in the GMC’s Good Medical Practice
· You should include relevant information and evidence from your training and practice including outside the NHS; to help give an overall picture of you and your development needs
· You need to include a signed ‘probity’ & ‘health declaration’