Demonstrating Your Competence

v. 4

Ruth Chambers, Gill Wakley, Alistair Pullan

• Publisher: CRC Press
• Year: 2018
• Print ISBN: 9781857756135
• eBook ISBN: 9781315343297
• Edition: 1
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

This volume, focusing on breast cancer, is part of a survey of health care needs for specific conditions, published on behalf of the Department of Health. This study overall considers questions such as the population's needs, the services available or unavailable to them, the effectiveness of these services, and other perspectives in disease and service areas. This is the second series of needs assessment reviews.

1

Making the link: personal development plans, appraisal and revalidation

The nexus of personal development plans, appraisal and revalidation

Learning involves many steps. It includes the acquisition of information, its retention, the ability to retrieve the information when needed and how to use that information for best practice. Demonstrating your learning involves being able to show the steps you have taken. Learning should be lifelong and encompass continuing professional development.

Continuing professional development (CPD) takes time. It makes sense to utilise the time spent by overlapping learning to meet your personal and professional needs with that required for the performance of your role in the health service.

Many doctors have drawn up a personal development plan (PDP) that is agreed with their local CPD or college tutor. Some doctors have constructed their PDP in a systematic way and identified the priorities within it, or gathered evidence to demonstrate that what they learnt about was subsequently applied in practice. Tutors do not have a uniform approach to the style and relevance of a doctor’s PDP. Some are content that a plan has been drawn up, while others encourage the doctor to develop a systematic approach to identifying and addressing their learning and service needs, in order of importance or urgency.¹

The new emphasis on doctors’ accountability to the public has given the PDP a higher profile and shown that it may be used in other ways. The medical education establishment and NHS management argue about the balance between its alternative uses. The educationalists view a PDP as a tool to encourage doctors to plan their own learning activities. The management view is of a tool allowing quality assurance of the doctor’s performance. Doctors, striving to improve the quality of the care that they deliver to patients, want to use a PDP to guide them on their way, perhaps towards postgraduate awards of universities or the quality awards of the Royal College of General Practitioners. These quality awards are built around the standards of excellence to which a GP should aspire, as described in the publication, Good Medical Practice for General Practitioners.²

Your personal development plan

Your PDP will be an integral part of your future appraisal and revalidation portfolio to demonstrate your fitness to practise as a doctor.

Your initial plan should:

• identify your gaps or weaknesses in knowledge, skills or attitudes
• specify topics for learning as a result of changes: in your role, responsibilities, the organisation in which you work
• link into the learning needs of others in your workplace or team of colleagues
• tie in with the service development priorities of your practice, the primary care organisation (PCO) or the NHS as a whole
• describe how you identified your learning needs
• set your learning needs and associated goals in order of importance and urgency
• justify your selection of learning goals
• describe how you will achieve your goals and over what time period
• describe how you will evaluate learning outcomes.

Each year you will continue or revise your PDP. It should demonstrate how you carried out your learning and evaluation plans, show that you have learnt what you set out to do (or why it was modified) and how you applied your new learning in practice. In addition, you will find that you have new priorities and fresh learning needs as circumstances change.

The main task is to capture what you have learnt, in a way that suits you. Then you can look back at what you have done and:

• reflect on it later, to decide to learn more, or to make changes as a result, and identify further needs
• demonstrate to others that you are fit to practise or work through:
  • – what you have done
  • – what you have learnt
  • – what changes you have made as a result
  • – the standards of work you have achieved and are maintaining
  • – how you monitor your performance at work
• use it to show how your personal learning fits in with the requirements of your practice or the NHS, and other people’s personal and professional development plans.

Organise all the evidence of your learning into a CPD portfolio of some sort. It is up to you how you keep this record of your learning. Examples are:

• an ongoing learning journal in which you draw up and describe your plan, record how you determined your needs and prioritised them, report why you attended particular educational meetings or courses and what you got out of them as well as the continuing cycle of review, making changes and evaluating them
• an A4 file with lots of plastic sleeves into which you build up a systematic record of your educational activities in line with your plan
• a box: chuck in everything to do with your learning plan as you do it and sort it out into a sensible order every few months with a good review once a year.

The context of appraisal and revalidation

Appraisal and revalidation are based on the same sources of information - presented in the same structure as the headings set out in the General Medical Council (GMC) guidance in Good Medical Practice.³ The two processes perform different functions. Whereas revalidation involves an assessment against a standard of fitness to practise medicine, appraisal is concerned with the doctor’s professional development within his or her working environment and the needs of the organisation for which the doctor works.

Appraisal is a formative and developmental process that is being introduced by the Departments of Health for all general practitioners (GPs) and hospital consultants working in the NHS across the UK. While the details of the appraisal system vary for consultants and GPs and for each of the countries, the educational principles remain the same. The aims of the appraisal system are to give doctors an opportunity to discuss and receive regular feedback on their previous and continuing performance and identify education and development needs.

The drive to introduce formal appraisals came initially as part of the programme to introduce clinical governance across the NHS as laid out in the 1998 consultation document A First Class Service.⁴ Momentum was gained with the publication of Supporting Doctors, Protecting Patients (1999) in England which outlined a set of proposals to help prevent doctors from developing problems.⁵ Appraisal was at the heart of the proposals as:

a positive process to give someone feedback on their performance, to chart their continuing progress and to identify development needs. It is a forward looking process essential for the developmental and educational planning needs of an individual. Assessment is the process of measuring progress against agreed criteria .... It is not the primary aim of appraisal to scrutinise doctors to see if they are performing poorly but rather to help them consolidate and improve on good performance aiming towards excellence.⁵

The document went on to suggest that appraisal should be made comprehensive and compulsory for doctors working in the NHS and form part of a future revalidation system.

In addition, appraisal should also address other areas of particular importance to the individual doctor. A standardised approach has been developed that utilises approved documentation. This should ensure that information from a variety of NHS employers is recorded consistently. The format of the paperwork is slightly different for consultants and GPs.

Appraisal must be a positive, formative and developmental process to support high quality patient care and improve clinical standards. Appraisal is different from, but linked to, revalidation.⁶ Revalidation is the process whereby doctors will be regularly required to demonstrate that they are fit to practise. Appraisal feeds into this by contributing to the information that a doctor supplies for the revalidation process. Appraisal will provide a regular structured recording system for documenting progress towards revalidation and identifying needs as part of the doctor’s PDPs. Both the NHS appraisal and the revalidation structures are based on the same seven headings set out in the GMC’s guidance Good Medical Practice.³ The GMC claims, therefore, that ‘five satisfactory appraisals equals revalidation’.⁶ The GMC has also pledged that doctors not taking part in appraisal will be able to provide their own information for revalidation, providing this evidence meets the same criteria as in Good Medical Practice.

Appraisal is, however, a two-way process. Not only time, but also resources will be needed to make appraisal systems successful. In addition, appraisal will identify issues that will require extra investment by the NHS in the educational and organisational infrastructure.

Appraisal and revalidation processes are being increasingly integrated. The PDP is a central part of the appraisal documentation, which will in turn be included in the portfolio of information available for revalidation. It seems that the evolution will continue so that revalidation is met by supporting the appraisal documentation with additional documents about clinical governance activity and CPD. These supporting documents will be a mix of subjective and objective information that will include doctors’ self-assessment of their performance and other work-based assessment.

The revalidation and appraisal processes need to be quality assured to be able to demonstrate that they can protect the public from poor or under-performing doctors. Such quality assurance will relate to the appraisers, their training and support, as well as systems to examine the quality of evidence in the documentation relating to a doctor’s performance and outcomes of their PDP. You should regard your PDP and supporting documentation as central to the way in which you can show, to anyone who requires you to do so, that your performance as a doctor is acceptable and that you are trying to improve, or striving for excellence.

Demonstrating the standards of your practice

The GMC sets out standards that must be met as part of the duties and responsibilities of doctors in the booklet Good Medical Practice.³ Doctors must be able to meet these standards with a record of their own performance in their revalidation portfolio if they want to retain a licence to practise. The ...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Preface
• About the authors
• Chapter 1 Making the link: personal development plans, appraisal and revalidation
• Chapter 2 Practical ways to identify your learning and service needs as part of the documentation of your competence and performance
• Chapter 3 Dem onstrating common components of good quality health care
• Chapter 4 Asthma
• Chapter 5 Chronic obstructive pulmonary disease
• Chapter 6 Depression
• Chapter 7 Dementia
• Chapter 8 Diabetes
• Chapter 9 Thyroid disease
• Chapter 10 Dermatology
• And finally
• Index