Appraisal Folder: VTS Exit Appraisal 10.05
Name: date:
South Yorkshire & South Humber Deanery
Appraisal Folder
For use with VTS Exit Appraisal
NameGMC number
Post
Trust or Trainer and practice
Dates of post
Appraisal Folder: Contents Checklist
Appraisal Documents
/ Document present / commentsForm 1. Personal Details / Send to appraiser
Form 2. Details of your current medical activities / Send to appraiser
Form 3. Document on which appraisal discussion will be
Based / Send to appraiser
Form 3. Record of Documentation Supporting Appraisal / Send to appraiser
Form 4. Summary of Appraisal Discussion / To be completed at appraisal
Form 4a Personal Development Plan / Send last PDP to appraiser
Portfolio of Evidence
1. Good Clinical Care
2. Maintaining Good Medical Practice
3. Relationships with Patients
4. Working with Colleagues
5. Teaching and Training
6. Probity
7. Management Activity *
8. Research *
9. Health / Bring to appraisal
* some of these sections may not apply –eg management, research and for some it may be difficult for trainees to collect evidence eg relationships with patients.
Name of trainee…………………………………………...
Post………………………………………………………
Dates in post……………………………………………
Date of Appraisal meeting …………………………………..
Guidance Notes
This folder consists of two parts –the Appraisal Documents Forms 1 to 4 and the Portfolio of Evidence.
Appraisal Documents
Form 1: Personal Details is self explanatory.
Form 2: Details of your current medical activities. Give a brief description of your current post.
Form 3: Document on which the appraisal discussion will be based will form the basis of your appraisal interview. The more thought that you put into this document, the more you will get out of your appraisal.
Forms 1 to 3 should be completed and sent off to your appraiser two weeks before the appraisal meeting. The Deanery office will send you notification of the date and details of your appraiser –who will be another GPR in the Deanery
Form 4: Summary of Appraisal Discussion and is a key document which comes out of your appraisal – it is jointly completed by you and your appraiser and should be signed off by appraisee and appraiser. This is the evidence that an appraisal has taken place and is necessary for Revalidation. You should send a copy of Form 4 to the Deanery Office and keep a copy for your own folder. Your VTS administrator will be notified that you have had an appraisal, but will not see your Form4
Portfolio of Evidence
The portfolio is a collection of evidence which demonstrates that you are meeting the Good Medical Practice standards. This is meant to be a carefully chosen selection of evidence, and should be readily available if records of training have been maintained. Each piece should be listed in the Record of Documentation Supporting Appraisal -Form 3.
The second part of this folder has a set of dividers – one for each Good Medical Practice heading in which the evidence can be filed.
The Portfolio of Evidence should be brought to the appraisal meeting and not sent off to the appraiser with the Appraisal Documents. On the Appraisal Day, time will be allowed for the inspection of the evidence before the appraisals.
Contact: Eve Davies
SYSH Deanery, Don Valley House, Savile Street East, Sheffield S4 7UQ
Tel: 0114 226 4433 Fax: 0114 226 4442 Email:
Form 1 Personal Details
Description of Post: / Full Time/ Part Time % / Name of Trainer/ Consultant / Address:1.
2.
3.
4.
5.
6.
7.
FORM 2 – DETAILS OF YOUR CURRENT MEDICAL ACTIVITIES
The aim of this form is to provide you with an opportunity to describe your post(s) in the NHS, in other public sector bodies, including titles and grades of any posts currently held, or held in the past year. You should explain what you do and where you receive training.
What is the training component of your current post?
Your descriptions should cover your training and practice at all locations since your last Appraisal. You may wish to comment on the environment in which you train, including:
§ The quality of training in your post
§ Level of supervision by whom and what grade
§ Factors which you believe affect the provision of good health care, including your views (supported by information and evidence) on the resources available
§ Action taken by you to address above issues
Instructions for filling out form 2
1. Obtain a copy of your job description and Training Agreement
§ If none is available contact the Deanery urgently as the job description is a contractual requirement. All trainees should have a Training Agreement.
2. Fill out the sections with the help of the Job Description and add any supplementary information, which may be missing from the Job description.
3. Do not include items from the Job Description if they do not really happen in your post. Form 2 should reflect what you actually do (Training / non training / locums).
4. In Details of “emergency, on-call “ a description of your rota (1:6 etc) whether you are full or part time (flexible %)
Note whether post is compliant or not with the number of hours worked (approx).
5. Fill out new Form 2 for each post you do and archive the previous one with the job description if the job description has changed
- Also locum posts, shorter form for short term locums
Form 2
Please provide:
1. A short description of your work and training in your specialty. What different types of activity do you undertake?
2. Details of emergency, on-call and out-of-hours responsibilities
3. Details of out-patient work
4. Details of any other clinical work
5. Details of non-clinical work that you undertake, for example, teaching/academic work, management activities, research.
6. Study Leave
7. Work for regional, national or international organisations / other professional activities
Summary of Additional duties / Locum Posts
Locum Work
For short term and ad hoc locums (< 2 weeks in duration)
Date / Hospital/Trust / Specialty / Grade / DurationNB During vocational training, it would be unusual for a registrar to undertake locum work. A registrar should have a discussion with the Course Organiser if contemplating doing locum work as there might be future implications – such as limiting opportunities to undertake remedial training if an element of summative assessment were failed
Form 3: Document on which the appraisal discussion will be based
This form is designed to enable the sharing of information, to encourage a focused dialogue on all elements relevant to your appointment on the Vocational Training Scheme.
PERSONAL PREPARATION CHECKLIST
This checklist is provided to help you to plan for the first and subsequent meetings:
1. During the last twelve months what would you consider to have been:-
Achievements: Disappointments:
2. What aspects of your work as a GPR has given you the greatest satisfaction?
3. What skills developed elsewhere are you using in your current post?
4. What are your key skills and areas of strength?
5. What part of your training do you find most difficult?
6. What do you consider you are doing well, and how do you know?
7. Are there obstacles preventing your training being better? YES/NO
If yes, how can they be overcome?
8. What have been your highs and lows in the past twelve months?
9. What skills would you need to improve your effectiveness?
10. During the next twelve months, what are your personal, educational and professional goals? (e.g courses, examinations, Summative Assessment, MRCGP )
12. Taking your goals into account, what support or resources do you need from elsewhere in order to achieve them?
13. Any other comments not addressed above?
Form 3 - The Record of Documentation Supporting Appraisal
Good Medical CareList below each document, in the order they appear in your folder.
1. …………………………………………………………………………………..
2. …………………………………………………………………………………..
3. …………………………………………………………………………………..
4. …………………………………………………………………………………..
5. …………………………………………………………………………………..
6. .………………………………………………………………………………….
……………………………………………………………………………………….
……………………………………………………………………………………….
Maintaining good medical practice
List below each document, in the order they appear in your folder. Continue on a separate sheet if necessary.
1. ………………………………………………………………………………………..
2. ………………………………………………………………………………………..
3. ………………………………………………………………………………………..
4. ………………………………………………………………………………………..
5.etc …………………………………………………………………………………….
…………………………………………………………………………………………….
…………………………………………………………………………………………….
Working Relationship with colleagues
List below each document, in the order they appear in your folder.
1. ………………………………………………………………………………………..
2. ………………………………………………………………………………………..
3. ………………………………………………………………………………………..
4. ………………………………………………………………………………………..
5. etc …………………………………………………………………………………..
…………………………………………………………………………………………
Relations with Patients
List below each document, in the order they appear in your folder.
1. ………………………………………………………………………………………..
2. ………………………………………………………………………………………..
3. ………………………………………………………………………………………..
4. ………………………………………………………………………………………..
5.etc …………………………………………………………………………………….
…………………………………………………………………………………………..
Teaching and Training
List below each document, in the order they appear in your folder.
1. ………………………………………………………………………………………..
2. ………………………………………………………………………………………..
3. ………………………………………………………………………………………..
4. ………………………………………………………………………………………..
5. ………………………………………………………………………………………..
etc
…………………………………………………………………………………………..
…………………………………………………………………………………………..
Research
List below each document, in the order they appear in your folder.
1. ………………………………………………………………………………………..
2. ………………………………………………………………………………………..
3. ………………………………………………………………………………………..
4. ………………………………………………………………………………………..
Form 4. SUMMARY OF APPRAISAL DISCUSSION
Name of doctor:
GMC no.
Date of appraisal discussion:
This section includes the signed off Summary of the year’s appraisal activity and an outline of the developmental tasks to be undertaken during the next appraisal period.
It is based on and includes the standards laid out in Good Medical Practice and it should be agreed and signed by your appraiser.
The Summary of Appraisal will be the basis of the evidence to be submitted to the GMC for Revalidation purposes.
1. Good medical care
2. Maintaining good medical practice
3. Working relationships with colleagues
4. Relations with patients
5. Teaching and training
6. Probity
7. Health
SIGN OFF
We agree that the information in Form 4 is an accurate summary of the appraisal discussion and agreed action, and of the agreed personal development plan.
Appraiser:
Name ______GMC Number
Signature ______
Appraisee:
Name ______GMC Number
Signature ______
Date: ___/___/___
Record here the names of any third parties who contributed to the appraisal and indicate the capacity in which they did so:
Course Organiser / APD:
Name ______GMC Number
Signature ______
· The doctor must ensure that the documents are stored securely and retrievable for purposes of inspection for revalidation.
· A copy of Form 4 should be sent to the Deanery Office.(FAO Mrs Eve Davies). It is not necessary to send Form 4a, which is the PDP. The VTS administrator will be notified that your appraisal has taken place.
South Yorkshire & South Humber Deanery
Appraisal Folder: VTS Exit Appraisal 09.05
Name: date:
Form 4a. Personal Development Plan
Learning/development needs / Development objectives / Achievement dates / Activities to be used / Outcomes or evidenceWhat broad areas do you wish to address? / What specific goals are you setting yourself for each need? (Remember to keep them “SMART”!) / When do you expect to achieve your objectives? / How will you achieve your objectives? / How will you show that you have achieved your objectives)
South Yorkshire & South Humber Deanery
Appraisal Folder: VTS Exit Appraisal 09.05
Name: date:
Portfolio of Evidence
Good Medical Practice Section
1. Good clinical care
2. Maintaining good medical practice
3. Working with colleagues
4. Relationships with patients
5. Teaching and training
6. Probity
7. Management activity
8. Research
9. Health
Portfolio of Evidence
Divider Sheet
(Card)
1. Good Clinical Care
Clinical Logs
Significant Event Analyses
Audits
Referral Analysis / Admissions analysis
MCQs or PEPs assessing clinical knowledge
Out of Hours Log
Confidence rating scales
Portfolio of Evidence
Divider Sheet
(Card)
2. Maintaining good medical practice
Learning Plans
Courses / Study Leave / Diplomas / Certificates
Attendance Register (VTS Half-Day)
PUNS / DENS
Reflective Log
Portfolio of Evidence
Divider Sheet
(Card)
3. Working with colleagues
Formative forms used for feedback from colleagues/ summaries of these
360o Appraisal
Portfolio of Evidence
Divider Sheet
(Card)
4. Relationships with patients
Video Feedback
Attitude questionnaire or attitude discussion summaries
Patient letters of commendation etc.
Complaints / Patient Feedback
Patient Questionnaires
Portfolio of Evidence
Divider Sheet
(Card)
5. Teaching and training
Presentations / Case Studies / VTS
Feedback summaries from teaching given to peers or other professionals
7. Management activity
Might include involvement in registrar training committees steering groups etc.
8. Research
Research (Not expected to feature commonly!)
Portfolio of Evidence
Divider Sheet
(Card)
6. Probity
Contracts of employment
Probity –Guidance from Good Medical Practice
Probity Declaration
Probity Declaration Pro-forma
Probity
Providing information about your services
48. If you publish information about the services you provide, the information must be factual and verifiable. It must be published in a way that conforms with the law and with the guidance issued by the Advertising Standards Authority.
49. The information you publish must not make unjustifiable claims about the quality of your services. It must not, in any way, offer guarantees of cures, nor exploit patients' vulnerability or lack of medical knowledge.
50. Information you publish about your services must not put pressure on people to use a service, for example by arousing ill-founded fear for their future health. Similarly you must not advertise your services by visiting or telephoning prospective patients, either in person or through a deputy.
Writing reports, giving evidence and signing documents
51. You must be honest and trustworthy when writing reports, completing or signing forms, or providing evidence in litigation or other formal inquiries. This means that you must take reasonable steps to verify any statement before you sign a document. You must not write or sign documents which are false or misleading because they omit relevant information. If you have agreed to prepare a report, complete or sign a document or provide evidence, you must do so without unreasonable delay.
Research
52. If you participate in research you must put the care and safety of patients first. You must ensure that approval has been obtained for research from an independent research ethics committee and that patients have given consent. You must conduct all research with honesty and integrity. More detailed advice on the ethical responsibilities of doctors working in research is published in our booklet Good Practice in Medical Research – The Role of Doctors