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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 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
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”
Definitions • Assessment • “the measurement of performance or progress against defined criteria”
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
Appraisal - Main Principles • Positive, constructive process • Mutually beneficial • Opportunity for reflection • Platform to identify training needs and set developmental goals
Appraisal - Types…. • Differing degrees of formality • Developmental appraisal • Performance appraisal • Usually compulsory! • Links to clinical governance • Personal development or career progression???
Consultant Appraisal - Background…. • Higher expectations from patients/ public regarding monitoring skills & keeping up to date • GMC revalidation • Clinical Governance • Personal Development for Consultants
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”
Consultant Appraisal - Process…. • Need to prepare an appraisal ‘folder’ containing data, evidence etc
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
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
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
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)
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
e.g. 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
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
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
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
Usually focussed on communication, professionalism 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
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
