RCGP guidance on appraisal myths
Dr Ravi Ramanathan hand-picks key extracts from the RCGP's revalidation `Mythbusters' document. The document lists common misunderstandings about appraisal and revalidation to help promote a fair, supportive and constructive revalidation and appraisal process.
Myth: `Appraisal is a pass/fail event'
Appraisal is not a pass/fail assessment. Appraisal is, or should be, part of a formative and developmental process. It provides an annual chance to reflect with the help of a trained appraiser, in protected time. Beyond helping you to collect a portfolio of supporting information that meets your needs and enables your responsible officer to make a recommendation to revalidate, it is about facilitating your reflection and encouraging you to consider your personal and professional development needs and how best to meet them.
Myth: `I need to scan certificates to provide supporting information'
The GMC has not set any requirements about exactly how CPD should be evidenced or recorded.
The RCGP guide to supporting information for appraisal and revalidation makes clear that GPs should consider the definition ‘one CPD credit = one hour of learning activity demonstrated by a reflective note on lessons learned and any changes made as a result'. Recording and demonstrating your CPD by scanning and storing certificates that only record time spent, without indicating what you learned, is unlikely to be a profitable use of your time. For appraisal and revalidation, the RCGP recommends that a reflective note on the learning, which can in some cases be written in the same time as would be taken to locate and scan the certificate, is preferable and all that is needed.
The RCGP recommends keeping a simple learning log in a way that is convenient to you so that you can capture your key learning points and their implications for the quality of your care.
Myth: `Documented reflection has to be longwinded'
Documented reflection should be brief and to the point as far as possible. Capturing the key learning points that have influenced, or will influence, your practice, and thinking about any changes that you may make as a result can be recorded in bullet points, a couple of sentences, or a short paragraph. Some doctors are experimenting with recording brief audio reflections. Do what is appropriate for the particular reflection. Experiment with a variety of styles. Some methods may work better for some types of learning than others.
Some doctors find structured reflective templates that walk you through a process of reflection helpful. Others prefer not to be constrained. The RCGP recommends that you keep it simple and record what is meaningful to you.
Myth: `Only courses and conferences count as CPD'
CPD activities should be very broadly defined and include personal, opportunistic and experiential learning as well as activities targeted at identifying 'unknown unknowns'. Any learning activity where you spend time learning something relevant to your current, or proposed, scope of work, and working out how to put your learning into practice, can be counted as CPD, but you should only expend time and energy in documenting a proportionate amount of your most relevant and important learning.
The aim is to demonstrate a balance of learning across the curriculum relevant to your scope of work over the five-year revalidation cycle. GPs should be choosing to demonstrate reflection on their most valuable learning events across a variety of ways of learning, including personal reading and elearning from looking things up, as well as online modules, learning from professional conversations about clinical care and all the everyday sources of learning that arise from their work, and feedback about their work, not just from time taken out to go to courses and conferences.
Myth: `My appraiser will be impressed by my hundreds of credits'
The GMC does not set any specific revalidation requirements in relation to CPD or particular types of training. You need to demonstrate that you have done sufficient relevant CPD to keep up-to-date at what you do.
The RCGP does not recommend that you spend time that would be better spent on your patients, family or relaxation on documenting credits over and above the recommended amount (that is, sufficient to keep up-to-date).
If you wish to demonstrate more than 50 credits, rather than being more selective about what you include, it is your responsibility to ensure that the way that you record and demonstrate your CPD is proportionate and reasonable and does not become burdensome. Your appraiser should be trained to challenge you to keep your documentation proportionate and ensure that your recording of your reflection is done in a way that is useful to you. You should not expect your appraiser to review huge amounts of supporting information over and above what is required to demonstrate that you are keeping up-to-date and fit to practise.
Myth: `I have to do all of my Quality Improvement Activity (QIA) myself'
You do not need to do all the background work and data collection or analysis for your quality improvement activity yourself. Delegating someone else to run a search, or do some of the research, is a reasonable and proportionate use of your time. The RCGP recommends that you select quality improvement activities that allow you to review what you do. Your personal reflective notes should include an explanation about your role in the quality improvement activity and a description of the findings, including any lessons you have learned and the impact they have had on the quality of care that you provide.
GPs work in teams and much of the quality improvement activity that it is important for us to reflect on arises from teamwork. Significant Event Analysis in primary care is a team activity. You can learn from the review of data, incidents or events, and the RCGP recommends that you try to learn from the mistakes and near misses of others. The questions to ask yourself are about what you have learned about the quality of the care you provide and what, if any, changes you should make as a result.
Myth: `I have to have 3/4/5 Personal Development Plan (PDP) or clinical PDP goals'
The GMC requires you to agree a new PDP each year that reflects your needs as defined by the portfolio of supporting information and the appraisal discussion. This is a matter for agreement between you and your appraiser. There is no GMC requirement about how many PDP goals are appropriate, or about whether the goals are clinical or non-clinical.
Some doctors like to record lots of PDP items – it is your PDP. Most doctors find three or four are sufficient to capture their top priority goals.
The above is a small selection of the excellent mythbusters in the full RCGP document below, which would make useful reading for all appraisees.