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Appraisal & Assessment. Dr Linda Prescott-Clements Educational Projects Manager NHS Education for Scotland. Introduction. Appraisal vs Assessment General principles of appraisal The performance appraisal process (e.g. consultant appraisal) Assessment in the workplace – gathering evidence.

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Appraisal assessment l.jpg

Appraisal & Assessment

Dr Linda Prescott-Clements

Educational Projects Manager

NHS Education for Scotland


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Introduction

  • Appraisal vs Assessment

  • General principles of appraisal

  • The performance appraisal process (e.g. consultant appraisal)

  • Assessment in the workplace – gathering evidence


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Definitions

  • Appraisal

  • “a process of helping individuals improve the way they work and the services they provide”

  • “A positive process to provide feedback on performance, chart progress and identify development needs”

  • “NOT assessment”


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Definitions

  • Assessment

  • “the measurement of performance or progress against defined criteria”


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Assessment vs Appraisal?

  • Assessment can provide the evidence necessary to inform the appraisal process

  • Without evidence, the appraisal process may lack validity and could become tokenistic

  • Appraisal can provide the framework in which to act on assessment feedback & improve performance


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Appraisal - Main Principles

  • Positive, constructive process

  • Mutually beneficial

  • Opportunity for reflection

  • Platform to identify training needs and set developmental goals


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Appraisal - Purpose?


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Appraisal - Types….

  • Differing degrees of formality

  • Developmental appraisal

  • Performance appraisal

  • Usually compulsory!

  • Links to clinical governance

  • Personal development or career progression???


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Consultant Appraisal - Background….

  • Higher expectations from patients/ public regarding monitoring skills & keeping up to date

  • GMC revalidation

  • Clinical Governance

  • Personal Development for Consultants


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Consultant Appraisal - Process….

  • Annual meeting between consultant (appraisee) and their clinical director (appraiser)

  • To be arranged well in advance to allow for data collection & preparation of paperwork

  • Structured - Based on headings within “Good Medical Practice”


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Consultant Appraisal - Process….

  • Need to prepare an appraisal ‘folder’ containing data, evidence etc


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Consultant Appraisal - Documentation….

  • Guidance from Royal Colleges – different for each specialty

  • Standard forms, plus…..

  • E.g.

    • Clinical activities & outcomes

    • Audit of personal & team work

    • Educational & professional development

    • Management roles

    • Research undertakings



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Assessment

  • Workplace assessment can provide essential evidence to inform the appraisal process.

  • International focus on performance assessment “in situ”.

  • PMETB tools introduced across the UK


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Workplace Assessment - Types & options



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Usually questionnaire type format, across several topics e.g. teamwork, communication, professionalism, organisation etc

Evaluators may include superiors, peers, subordinates, patients & families

7 – 10 raters recommended for reliability

Feasibility often a challenge, especially data reporting, confidentiality etc (improved if implemented electronically)

“Does” - Performance Assessment in vivo

360o Evaluation /

Multi-source

Feedback /

Team Assessment

of Behaviour


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Usually 12 – 20 standardised patient encounter “stations”, each lasting 15-20 minutes (in medicine).

Frequently to assess technical skills

High feasibility but expensive

“Shows” - Performance Assessment in vitro

Objective Structured

Clinical Exam

(OSCE)


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Use of professional actors, with standardised script and options for response.

Can be used to probe for knowledge, decision making etc

Scoring procedures use checklist or ratings form – performance criteria set in advance

e.g. History taking, communication skills, diagnoses, complex cases etc

“Shows” - Performance Assessment in vitro

Simulated Patients /

Standardised Patients


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e.g. options for response.

Mannequins & Models

Computer simulations

Patient Management Problems

Clinical Case Simulations

Frequently used as part of OSCE examinations

Expensive to create

“Shows” - Performance Assessment in vitro

Simulations


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Useful where an aspect of competency can be described as a specific list of steps / behaviours / activities.

Typical response from evaluator “Yes / No” or tick box.

Good for highly specific procedural feedback

Content & scoring rules require consensus by several experts, and trained evaluators needed.

Checklist Evaluation

“Shows how” - Performance assessment in vivo


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Rater judges general categories of ability, across various context specific cases.

Ratings usually provided on a scale.

Good when professional practice is heterogeneous and not always fitting a single, standardised approach.

Relatively easy to construct and complete.

Global Ratings Evaluation

“Shows how” - Performance assessment in vivo


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Documentation of each patient encounter by conditions seen, types of case etc.

NOT an assessment, but to document number and scope of cases completed. Does not necessarily indicate competence!

Case Logs

“Shows how” - Performance assessment in vivo


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Usually focussed on communication, professionalism etc. types of case etc.

Also “satisfaction” surveys including areas such as time spent, etc

Measures ‘softer’ skills from the patients perspective

Can be formative or summative

20 – 40 responses required for a reliability of 0.70 – 0.82.

Patient

Questionnaires

“Shows how” - Performance assessment in vivo


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Trained assessors review patients’ records using protocol & coding form based on predetermined criteria,

e.g. prescribed medications, tests ordered, procedures performed & patient outcomes.

Estimated 8-10 records required for reliable assessment of single procedure / diagnosis etc

Record Review

“Shows how” - Performance assessment in vivo


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