What Makes a Good Summary of Appraisal?

Item 29

Completing Form 4 Guidance

What makes a good summary of appraisal?

Appraisal is a pivotal part of the revalidation process and Form 4 the core tangible outcome of the appraisal process. Appraisers need to put as much effort into drafting the summary form as other components of appraisal and have a duty to their colleagues to produce an accurate summary of the areas covered in the appraisal meeting.

Quality of information

A review of summary forms suggested that the forms omitted relevant information discussed at the interview. Whilst avoiding a ‘tick box’ exercise, the new electronic system with ‘check’ boxes aims to reduce the volume of data without compromising the quality of the information stored.

Appraisals are professional interviews, which must be robust, and wherever possible based on attributable supporting information. The record of the appraisal interview has to be accurate, comprehensive, clear and effective. While the Form 4 is a contemporaneous document, it is vital to recognise that the form is a dynamic document with a lifespan of 5 years. In effect, it is a sign post for the next appraisal.

We have compiled some practical tips to help appraisers complete the form and hopefully avoid some common pitfalls.

An effective Form 4 is a summary of the appraisal discussion, which is:

Clear

·  Clarity of the language used is essential for understanding.

·  Form 4s should be written in the 3rd person, active voice; e.g. Dr Cameron stated he will ….

·  Abbreviations should be explained in full in prior text. Avoid jargon, this is becoming increasingly speciality specific.

·  The language must be understandable to a lay person. This is important because NHS Board appraisal steering groups may have lay representation. The GMC has 50% lay representation.

·  Use positive language which acknowledges the appraisee’s achievements. Examples are ‘achieved’, ‘evaluated’.

·  Avoid negative terms such as ‘failed to’, ‘was unable to’

Comprehensive

·  While there is no need to list every single piece of information each section should have a concise but informative summary of that part of the appraisal interview. This should not list all information submitted but include observations and conclusions arising from the discussion.

·  It is helpful to summarise and prioritise those activities which have made the greatest impact on practice, highlighting key learning points and evidence of implementation of the learning and impact on patient care.

·  The commentary should include reference to supporting information seen and reviewed by the appraiser. Absence of required supporting information or failure to address previously identified PDP objectives should be noted and linked to specific action points to improve the situation before the next appraisal (giving thought to the requirements of revalidation) or to an agreement that they should be dropped.

·  This detail can be used for future reference as an aide memoir or benchmark for measuring progress towards agreed goals. This is vital when there is a change of appraiser.

Avoids Assumptions and Collusion

·  Whilst the role of the appraiser is to support the clinical practice and theprofessional development of the doctor, the appraisal process may be flawed by making assumptions or colluding with the appraisee. These issues can arise in all aspects of the appraisal process eg Accepting without question that an appraisee’s CPD was appropriate without any reference to impact or development.

·  Appraisers may be tempted to rescue and collude with an appraisee when discussing sensitive areas such as complaints, critical incidents or negative feedback.

·  The appraiser should avoid judgemental statements, which include either effusive or critical adjectives.

Accurate

·  Information inadmissible in a Form 4 based on an appraisal interview includes speculation ‘We’re the best surgical team’, or anecdotal information from colleagues ‘My partner is lazy’.

·  Suitable information to document in a Form 4 includes scope of practice information, lists of CPD certificates viewed at the appraisal meeting, performance data, and achievement towards national quality improvement targets.

Describes the PDP and Learning needs

·  Reference should be made to how development needs (rather than wants) have been identified. PDPs should describe a learning cycle starting with a goal in mind and then define a SMART objective, which would achieve the desired outcome. Action points should be agreed between the appraiser and doctor.

Specific, Measurable, Achievable, Relevant and in an appropriate Timeframe.

Meaningful

·  Crucial to the Form 4 is reference to reflective practice, changes to practice and progress.

·  Strengths and achievements should be highlighted.

·  Should be “owned” by the doctor.

·  No sections should be left blank, however not applicable/see above etc may be appropriate.

PROGRESS*
– Self Assessment Tool / Score
0 = absent from summary
1 = room for improvement
2 = done well / Comments
How can I improve the Form 4 documentation
Appraisal identifier
Professional – is typewritten, objective, free from bias or prejudice, describes a professional appraisal: venue, time taken, good information governance, no identifiable third party info.
Reflects a good appraisal discussion
– demonstrates support, challenge and focus on the reflection and needs of the doctor.
Overview – includes a description of the whole scope of work and context for the doctor, the appraisal and the revalidation cycle.
Gaps – identifies any gaps in requirements for revalidation or scope of work and specifies how they will be addressed (or states if no gaps).
Reviews supporting information (SI) and lessons learned – reviews SI in relation to Good Medical Practice; comments on SI not supplied electronically and any information the doctor was asked to bring. Reviews lessons learned, changes made and actions agreed.
Encourages excellence – affirms good practice, celebrates achievements and actions accomplished, gives examples of good practice and records aspirations (some of which may have a timescale over one year).
Statements – ensures the input and output statements , including health and probity, have been completed, commented on, and, where appropriate, explanation made to the RO.
SMART – PDP objectives arising from the supporting information and appraisal discussion are SMART: Specific, Measurable, Achievable, Relevant and have a Timescale.
Total
Overall impression:

*Based on material from Revalidation Support Team training resources and the Wessex Deanery