With the help of the Course Validation & Review (CVR) group, the structure and content of the New Appraiser courses were updated. The new changes were piloted with the courses in the last quarter of 2018 / 2019. These have since been made live and we will continue to monitor and review this as we progress into the new fiscal period. We intend to engage with the CVR group and our course tutor cohort to review and further update the content and structure for both New Appraiser and Refresher courses in the coming year.

Currently the Appraiser courses’ application process and data is managed outside of SOAR. We have an ambitious project to integrate this into SOAR to help with Appraiser tracking and, by combining the two data sources, to ensure there are no duplicate records and allowing the data to be updated collaboratively between NES and the health board teams. Additionally, it will also help better inform future MARQA reports; maintain a better and more accurate Appraiser dataset; and it will certainly streamline the application process and help us set up a platform for other future development.

At the time of writing, the next MARQA review is well on its way. Following feedback and suggestions from designated bodies, several small changes were made to the 2018 / 2019 MARQA Self-Assessment pack. This was sent out to all designated bodies in Scotland in April, and we look forward to receiving the returns in June, prior to the review panel meeting up in July. The final report, when published, will be available on the Medical Appraisal Scotland website.

Despite training up 12 new Appraiser Course Tutors on 4 October 2018, we lost a number of experienced course tutors through retirement and other clinical commitments. Whilst the total number of tutors we can call upon has increased to 53, only around 40 are active. As such, another Appraiser Tutors Training Day has been organised to take place on 4 September 2019.

Due to the unusually high turnover of Responsible Officers (ROs) in Scotland in the last 18 months, we are working with Scottish Government and the GMC to organise a development day targeted at the newer ROs. Additionally, we hope to organise a development day for ROs and Appraisal Leads as well, offering them an opportunity to network and discuss any potentially emergent themes.

In the few years I have been involved with Recognition of Trainers, the processes have changed and adapted as we work to bed down this relatively new process with the IT systems. When originally developed, SOAR was used to facilitate the initial recognition processes. This has now changed and the initial recognition process sits outwith SOAR and Turas (the system where Trainer information is stored).

 

SOAR is now used to help facilitate the continuing-recognition processes, where the Director of Medical Education can review which of their Trainers are due for review (based on the Trainers’ Revalidation Due Date), and make a recommendation, which is countersigned by the Educational Organisations. Irrespective of the Trainers’ status, they are expected to complete the RoT Form as part of their annual appraisal submission.

 

The “Year of the Trainer” was launched as part of the Scottish Medical Education Conference earlier this year (May 2019). A workshop was run to celebrate successes, and offered delegates an opportunity for their input into the processes and setups. There was a suggestion to reintroduce a development on SOAR that allows Trainers to highlight which of their supporting information belonged to which area of the Trainer framework. Workshops are being organised to explore how we might facilitate this development.

My predecessor has mentioned this in his past reports, but the biggest challenge we face continues to be the forecasting of potential course demand and developing an appropriate schedule to meet it. Demands for new Appraisers, particularly in Secondary Care, continue to be an issue for health boards in the challenging climate of sustained service pressures. Obviously we are in no position to influence this but where courses are undersubscribed we do release our course tutors, who are clinicians themselves, back to the service to help ease the pressure wherever we can. But this is not always possible if course participants simply DNA on the day.

 

The national guidance for Secondary Care Appraisers is to undertake around 10 appraisals per annum; although in practice, from the information in the Workforce numbers section, this is closer to 6. From the same data analysis, there does not appear to be significant Appraiser shortages in any one area as far as we can ascertain. But the analysis would not take into consideration specific individuals who are appraising more than the average ratio in their area; nor would it indicate the number of Appraisers who are close to retirement etc.

 

Through a different dataset on the Workforce analysis, we found that 30 newly trained Appraisers (from April 2016 to June 2018) no longer have Appraiser roles on SOAR; and 14 of them did not carry out an appraisal on SOAR. These numbers represent a significant loss of resources, and unfortunately we have no easy way to analyse this data further (at this time).

 

One of my goals for next year is to work with health boards to manage the Appraiser application process better to ensure only suitable people are put forward to the training courses, so that the trained Appraisers are used more efficiently, and we are not training individuals who would not be taking up the role of Appraiser in NHS Scotland.

One particular challenge I have experienced in my short tenure is the capacity of Refresher training, with the courses often running undersubscribed. The original purpose of the Refresher training programme was designed as a QA process, to help ensure that NES-trained Appraisers continue to appraise at a high, standardised level; and more crucially, ensure the Appraisers are supported by giving them a platform to share their experience with colleagues outwith their own specialty and health board.

 

We are inviting Appraisers to attend a 1-day Refresher training once every 5 years. I would strongly urge all Appraisers who were last trained more than 3 or 4 years ago to consider attending the Refresher training. From my experience of supporting the admin of these events, one of the common comments at the start of the day is around the uncertainty of “how am I doing as an Appraiser?”, and “how to manage difficult appraisals”.

 

If you are in similar circumstances, I hope the feedback below will encourage you to sign up:

 

“The most valuable part of the course was being able to test out ways of tackling difficult scenarios with feedback, feeling able to usefully contribute to feedback for others, and being reassured that my practice is in step with others.”

R24 participant, 4 June 2018.