Appraisal for T&O Surgeons

As a new or even established trauma and orthopaedic consultant the process of appraisal can be daunting bewildering and time consuming. It does not need to be any of these and in fact can prove supportive and rewarding.

Appraisal and Revalidation were first proposed by the GMC in 1998 as a way to win back the trust of the British public after a series of medical scandals.

The formal description is that it is a structured process used to evaluate the performance, competence and professional development of healthcare professionals. It is a mandatory requirement for all doctors with a license to practice.

It involves a discussion between the appraisee and the appraiser in conjunction with a review of supporting documentation. The discussion focuses on the doctor’s clinical practice, feedback, and continuing professional development.

The primary objectives are to:

1. Ensure that doctors remain competent and up to date in their clinical practice.
2. Identify areas for further development and improvement.
3. Support professional growth and career planning.
4. Provide a framework for reflection and self-assessment.

Following an appraisal a summary report is generated with agreed upon actions and objectives for the coming year. Appraisal is an annual process and the reports are used for the process of Revalidation that occurs every 5 years. 

There are a number of software programmes used by different Trusts for appraisal, each with their own peculiarities including Clarity and Allocate. The emphasis on and support for appraisal also varies widely.

Prior to COVID it was, in my experience, very information heavy. There was a requirement for considerable documentation to be collated and produced and it felt like you’d gone back to school and were at parent’s evening all over again. It was definitely a chore and very much like a stick.

Since then a ‘lighter’ and more doctor centred model has arisen. The information required is much less and there is more emphasis on the practitioner themselves.

Appraisal can be treated as a purely tick box exercise; another hurdle to jump as part of the daily grind of medical practice. Or it can be used to provide a moment to reflect on your own work, identify areas for development and lift your head above water, even if only momentarily.

A few tips to help:

1. The Royal Colleges of Surgeons do not have a CPD diary unlike other Colleges and neither is there a stipulated requirements for the number of hours. However, I would recommend keeping a separate file into which you keep the information about CPD as you go along. This avoids a panic at the last minute. Don’t forget all those online resources, webinars etc. It all counts. Keeping a short reflective note is a useful aide memoir and record. A useful structure would be to consider periodical updating on all areas of practice including non-clinical and clinical work. A guide is given in the appendix.
2. Keep a tin for the thank you cards or compliments. It is often too laborious to redact the patient data and put them in the appraisal itself but they can be shown to the appraiser.
3. Note complaints that you receive. None of us like to be criticised but rather than taking it personally we should see them as an opportunity to reflect and improve. This is the hallmark of a good professional.
4. Similarly with significant events or incidents. They are often extremely uncomfortable to reflect upon but can be very useful. If you are lucky enough to avoid one in the 5 year cycle it will be necessary to comment upon a departmental one. Similarly for complaints.
5. Outcomes and registry data; some areas of your practice are likely to have nationally voluntary or increasingly mandated data collection either individually or as part of the Unit. 
   Examples of this include National Joint Registry (or Scottish arthroplasty registry), British Spine Registry and National hip fracture database. Most subspecialty areas have outcome registries which will relate to your practice. The current reports from these bodies would be useful summaries to demonstrate of the outcomes of your or the Units work. A mandated implant outcome registry is imminent in England, the Outcomes and Registries Programme was established in 2022 to develop a single, unified registry solution – the Outcome Registries Platform. This is yet to implemented but may be soon.
6. Aim to get your patient and colleague feedback done in year three of your revalidation cycle which gives you plenty of time to accumulate the number of responses required. Be prepared to ask a wide range of individuals, not just those who you think will score you highly.
7. Utilise the revalidation/appraisal team at your Trust. They will be a mine of invaluable information and support should you have queries. 
8. Be open at the appraisal. Don’t hold back on things that are affecting your work life and be prepared to talk about your hopes and fears. The appraiser is not necessarily going to have magic wand but a discussion is often very fruitful.
9. Don’t leave it all to the last minute. The nearer you get to the deadline the more rushed the whole process will be. It will all be very painful, a nuisance and you will not get the most from it.

Appendix

CPD revalidation activity
Clinical aspects of consultant practice

1. Trauma; – consider general or specific areas of trauma practice. Examples may include BOA Annual Congress Trauma revalidation sessions or OTS specialist society annual conference. Joining a consultant colleague operating or external visits may be considered too.
2. Elective; – similarly BOA Annual Congress has all the subspeciality session delivering elective practice update sessions and the Specialist societies have extensive educational sessions within their annual programme. Perhaps have rolling programme over 5years to cover one thing per year.
3. Medico-legal practice;- if you are active in this area it is probably worth considering how you keep up-to-date with best practices. The BOA runs a medico-legal course – details on website.
4. Independent practice; with increasing amount of clinical practice being undertaken in the independent sector, private or nhs work. In addition to a letter of good standing from the hospital director it may be appropriate to show how you’ve maintained governance and good practice there too.

Non clinical;

1. Education and training; if you are a trainer or educational supervisor you will be expected to show how you have kept up-to-date. Most PGME offices will have local or Deanery course details. Alternatively the BOA Annual Congress also run sessions each year within its 3 day schedule.
2. Research; if you are active in research GCP is required to be updated every 4 years. Most hospitals will run the GCP course often on line. Once again this can be often also be undertaken at BOA Congress.
3. Culture/Behaviours/EDI/ human factors; all essential non-technical parts of consultant practice. These are the most common causes of problems and issues in departments and even referrals to the GMC. Cross sub-specialty updates and guidance sessions on these areas are a significant part of the BOA Annual Congress every year and increasing important and well regarded.
4. Leadership; we all have a leadership role as consultants- guidance is given within other areas of these guidance modules but if you are a clinical lead, clinical director or similar formal Trust leadership role then it is advisable to so what steps you have taken to appraise and develop this area of practice. This might be local trust development or nationally via British Orthopaedic Director society sessions/membership or indeed BOA Annual Congress runs a BODS in addition to many other leadership sessions.