Looking ahead to 2020/2021
Let’s take a moment to celebrate the successes of 2019/2020:
The MARQA review has found that Appraisal completion rate in Scotland for 2018/2019 was the highest it has reached at 96%;
Development work on SOAR is now taken on fully by the inhouse NES Digital team which represented significant savings; and
We had doubled the attendance for Refresher training this year (132 compared to 66 last year) despite the cancellation of the last Refresher of the year due to COVID-19.
Prompted by the findings from the MARQA review, we conducted a Scotland-wide Medical Appraisers Survey to gauge the workforce’s views on appraisal and their suggestions for improvements and support (see previous section).
Additionally, we had been engaged in research and discussions with NES Digital colleagues on improving our training course applications process. In parallel to this we had also been reviewing the way the training courses are run and their content with help from our Tutors cohort and Appraisal Leads. Changes were made to the Refresher Appraiser programme which we had hoped to pilot in April 2020.
All in all, 2019/2020 was a busy and productive year, with lots of projects planned for 2020/2021… and then in an instant, everything changed.
Impact of COVID-19
On 26 March 2020, on the back of the GMC announcement that all those due for Revalidation before end of September will have their revalidation dates deferred automatically by a year, the CMO sent out a communication to cancel and postpone all Medical Appraisal activities until further notice, including the annual MARQA review.
We cancelled the last Refresher training of 2019/2020, along with the 2020 annual Scottish Medical Appraisers Conference and all the Appraiser training courses up to end of September.
Our focus changed from providing Appraiser training to planning our post-COVID recovery. The plan to trial the new Refresher programme was pushed back. Across the whole of the Medical Directorate within NES, scores of teams were scrambling for ways to deliver their respective training by utilising the technology available to us. We expedited our plans for updating the New Appraiser training accordingly, and also took time to review the proposed changes to the Refresher.
The GMC then extended the deferral of revalidation dates by one year to anyone due before 16 March 2021.
Up until this point we still had 60% of our training events scheduled but – with in-person attendance required on all our training and none of our external (nor internal) venue providers able to provide suitable ways of working given the social distancing rules – we had no choice but to cancel all training courses for the rest of 2020, leaving us with 8 training events still scheduled for January to March 2021 (pending further review and national guidance).
The decision to cancel all 2020 Medical Appraiser training was not taken lightly, but it falls within NES and other health and safety policies. However, where there are challenges, there are opportunities… and just like you would in an Appraisal meeting, COVID-19 has presented us with a unique opportunity to take stock, reflect, and explore what learning opportunities we have ahead.
Review of Appraiser Training
As previously mentioned, work had already begun last year on the review of our Appraiser training content and format - and clearly, changes must be made to ensure the delivery format is safe and suitable in the new COVID-19 world.
One event we did not cancel was the Tutors Conference, but rather than attending in person at a physical venue, it will be facilitated via Microsoft Teams. As part of this, we have already engaged with our tutor cohort to canvas their views on how post-COVID training may look, and we aim to formalise a plan to present and discuss at the “at-distance” conference scheduled for 16 September 2020.
Early feedback suggested the use of online learning to help facilitate the training, which would tie in quite nicely with the course applications project we had been looking at.
Naturally, technology will be at the forefront of everyone’s mind. Some of you have already adopted the changes in your consultation work. The way you see patients is now different; the same for patients too in how they gain access to medical assistance. The way we work at NES has also changed. Most colleagues, as with everyone else, have now switched to working from home where possible. Through one form or another we are now all experienced in the use of online conferencing technology such as Microsoft Teams, NHS Near Me, Zoom or Skype. There is no denying that online at-distance learning will play an important part in our future.
One thing I am conscious of is to ensure that the new training is not “technology-focused”, but rather “technology-enabled” learning. Whilst a decision has yet to be made on the course content and delivery, all options will be thoroughly explored to ensure that the use of technology is not just for adapting to our current situation, but to enhance the learning experience for all so that it is suitable for delivery in the post-COVID era.
Beyond COVID-19
The current plan is to focus on the review and redevelopment of the Appraiser training courses for the rest of 2020, with the intention of piloting them in early 2021. But what about longer term strategies for Medical Appraisal? When will appraisal restart? What will it look like?
At a COVID-19 reflection workshop I attended in April, about a month after lockdown began, I was challenged to consider what we could learn from the COVID-19 “journey”:
In the last few years, some Appraisers have fed back to me that Medical Appraisal has become too much of a tick box exercise for Revalidation or Recognition of Trainer etc; something also mentioned by a few Appraisers in the Appraiser survey. Phrases like “Appraisal has been hijacked” have been said to me at various training courses. Whilst this is quite challenging and an unfortunate impact of Revalidation, it does give me a degree of comfort in knowing that our Appraisers still recognise what the original intention and purpose of Medical Appraisal was – and still is – to support our colleagues.
Over the course of the last few months I have heard of instances where Appraisees have sought out their Appraisers for an appraisal, keen to speak to someone about their current workload and pressures (e.g. redeployment, or reduced capacity at work due to colleagues in isolation or shielded category etc).
To me it highlights just how crucial a role appraisal will play in the medical profession’s recovery.
At the time of writing (June 2020) we are still awaiting national guidance from Scottish Government, the CMO and the GMC on policies around restarting appraisals. Updates on this will be circulated via SOAR. That aside, the content of the appraisal discussion will also likely to be changed.
Whilst discussions around what the Appraisee needs to do to help them renew their licence through Revalidation would still be expected, it is important to remember the role of the Appraiser is NOT to police this – it is to aid the Appraisee in their reflections about their achievements and challenges in their past year.
As recognised by many of the Appraiser survey respondents, reflection and the protected space and time to discuss things in confidence with a peer afforded in appraisal is what is valued the most by our Appraisees.
The focus of the Appraisal meeting itself should be (and always has been) focused on the Appraisee.
Directly or indirectly, Appraisal will become a significant tool to help our colleagues cope throughout this pandemic and beyond as we recover from this crisis.
William Liu Training Manager (Medical Appraisal)