Examples
The following videos have been created and role played by Appraisers to demonstrate good added value through challenge, over challenge and missed opportunities. Watch each video and write down your thoughts of what went on:
- Were there missed opportunities?
- Did the appraiser engage the doctor in a way that would promote development (the elusive added value)?
- Did the appraiser overstep the mark?
- How would you have done it?
Scenario 1
Doctor has attended meeting on NOAC, has reflected on the functioning of the drugs but has no clinical experience of prescribing them in practice.
Information submitted:
Activity - attended meeting with local consultants, latest update on new drugs, indication and potential problems with the drugs in practice.
Reason - new class of drugs available to be initiated in primary care.
Reflection - Previously aware of the group of drugs but knowledge limited as not available to be initiated in primary care then had not feel the need to update. Change in guidance to allow for initiation in primary has stimulated interest. Since the meeting have become aware of the indications, side effects and problems in prescribing for patients with renal impairment.
Outcome
- Greater confidence in initiating the drugs
- Prepared to switch patients from warfarin to NOAC according to guideline
- Aware of problems with impaired renal function
Supporting documentation - certificate of attendance and notes made during the meeting
Video Clip 1
Ineffective discussion
Acknowledges new learning but no added value - at end of the discussion no changes agreed, no action plan, reproducing material in folder only
Appraiser - repeats information in folder - colludes over prescribing and moves on to another subject.
Video Clip 2
Poor judgement of level - leads to over challenge
Appraiser is over enthusiastic and starts to make suggestion on audit of all the patients on warfarin / or AF / suggests developing practice guidelines.
Jumps to level of evaluation when little practical evidence of use. Tries to push for audit and practice guideline but doctor has not yet prescribed - appears to recognise this to bring it back at the end to something more realistic.
Video Clip 2b
Poor judgement of level - leads to over challenge
Pushes for audit but recognises doctor feels uncomfortable and brings it back rather reluctantly.
Video Clip 3
Appropriate level
Appraiser encouraged doctor to reflect on learning - use the drugs, offers suggestion on how the doctor might apply and reflect on their use on selected patients. Encouraged reflection in next years appraisal - develops action point.
Scenario 2
Please read the Giant Cell Arteritis scenario here
Video Clip 4
Appraiser colluding
Not challenging - just reiterating that things with the processes for diagnosing the condition are not great-nothing needs to be done about it. The appraiser reiterated the knowledge and understanding of the doctor but does not do anything else. Does not help the doctor address the concerns the doctor has raised about the diagnostic process. The appraiser colludes with the doctor to avoid acting on concerns re diagnostic process.
Video Clip 5
Appraiser recognises potential
Appraiser recognises potential to make changes to the services. Challenges doctor to change the local protocol - get something to work - agree a realistic action plan. Same scenario but comes up with suggestions and a plan to address issues.
Video Clip 6
Appraiser takes it back to level of knowledge
Following on from previous discussion about GCA - doctor mentions issues with a patient presenting with DVT that did not have any investigations performed in secondary care to rule out an underlying cause. Appraiser demonstrates skills at appropriate level in the hierarchy for future development.
Follows on from previous video - takes it back to level of knowledge rather than starting at the top as in previous entry.
This section on EVE was written by Drs Peter Rowlands and Lynne Rees. The original project document can be downloaded in full here.