New Appraiser Training Medical Appraisal Scotland Appraiser skills

New Appraiser Training Medical Appraisal Scotland Appraiser skills Module 04 This Power. Point has no audio nor animations. The audio has been transcribed in the Notes section for your reference. 1

NHS Education for Scotland List of Modules – Appraisal Overview – Supporting Information – Personal Development Plan & Introduction to Form 4 – Appraiser Skills – Using a Coaching Approach in Appraisals – Challenging Appraisal Situations – Appraisal in Trainer Roles 2

NHS Education for Scotland Aims of this module • Approaches and techniques an appraiser can use in an appraisal discussion – Judgement – Communication skills – Feedback 3

NHS Education for Scotland Learning outcomes • Understand how to use challenge appropriately in an appraisal that supports the appraisee • Understand what professional judgement means in the context of appraisals • Understand what communication skills to use in an appraisal discussion • Understand the role of feedback in appraisals and be aware of feedback models an appraiser could use 4

NHS Education for Scotland Consider your thoughts on • How and when you would use these skills as an appraiser? 5

New Appraiser Training Medical Appraisal Scotland Role of the appraiser 6

NHS Education for Scotland Qualities of a good appraiser Consider: • What are the qualities of a good appraiser? – Make notes on your thoughts (to be used on training day 1) • Group answers under the three headings: – knowledge – skills – attributes Based on Bloom’s Taxonomy: Cognitive; Psychomotor; Affective 7

NHS Education for Scotland Role of Appraiser (1/2) • Encourage appraisee reflections and solutions – only consider offering your own if the appraisee is struggling • Be evaluative but avoid an overtly judgmental approach where appraisee feels criticised or labelled • Use descriptive language • Consider carefully before offering specific advice or making suggestions 8

NHS Education for Scotland Role of Appraiser (2/2) • Act as a resource and help appraisee identify areas which could be used for further development • Be specific when commenting and offering own view • Focus on aspects of appraisee’s behaviour which can be changed • Structure discussion so that specific outcomes and goals are addressed in each section – owned by the appraisee 9

NHS Education for Scotland Video Review • https: //www. appraisal. nes. scot. nhs. uk/be-anappraiser/training-videos/pdp-(2). aspx • Review above video and consider: • Is the video a “High-Quality” appraisal? – If yes, what did the appraiser do that you thought was good? – If no, why not? • How would you have facilitated the discussion? • What feedback would you give th appraiser? 10

NHS Education for Scotland Learning and Challenge / Support Low challenge + High support High challenge + High support = warm / safe but unsatisfying = optimal learning Challenge Low challenge + Low support High challenge + Low support = safe but unsatisfying and boring = Anxiety provoking / defence response 11

NHS Education for Scotland Comfort / Stretch / Panic Zones Comfort Zone Stretch Zone Panic Zone 12

NHS Education for Scotland Challenge – Tr. UST model • • Trust Understanding Safe exploration Task – setting goals/actions 13

New Appraiser Training Medical Appraisal Scotland Judgement in appraisal 14

NHS Education for Scotland Judgement? • Appraisal supporting information reflects the doctor’s scope of work and has been presented in accordance with GMC Guidance • Information has been reviewed and summary agreed • Appraiser has no reason to believe that the doctor is not practising in line with the principles of Good Medical Practice • ‘On track’ for Revalidation 15

NHS Education for Scotland Professional judgement • The equivalent of the clinical judgements that we are all used to making everyday as clinicians (not a judicial process) 16

NHS Education for Scotland What might you need to develop? Professional judgment relating to the doctor’s: • Engagement • Adequate CPD and other Supporting Information • Scope of practice • Reflection and insight • PDP progress and new PDP • Progress towards revalidation • Patient safety issue or emerging concern 17

NHS Education for Scotland What may need practice? • Professional responsibility: to maintain credibility as a medical appraiser • Knowledge and understanding: of the appraiser role • Communication skills: to facilitate an effective appraisal discussion, produce good quality outputs and to deal with any issues • Organisational skills: to ensure the smooth running of the appraisal, including timely responses and sufficient computer skills (covered in Module 1) 18

NHS Education for Scotland Key message 1: First, do no harm… • The appraisal should be a positive experience for the doctor • The effort needs to be proportionate • Appraisers must not take on inappropriate roles even if they have the skills 19

NHS Education for Scotland Key message 2: If in doubt – ask • The doctor being appraised is the expert • Supporting information needs to be set in context • Appraisers need access to professional support structures including local appraiser meetings and Appraisal Leads • Appraisers should have a low threshold for seeking advice (and know the appropriate contact details) 20

New Appraiser Training Medical Appraisal Scotland Communication skills (for appraisal) 21

NHS Education for Scotland Communication Skills for Appraisal (1/2) • • • Listening Skills Open and closed questions Looking for cues – verbal/non-verbal Feedback Summarising 22

NHS Education for Scotland Communication Skills for Appraisal (2/2) • • Acknowledge feelings and be accepting of the person Allow silence Be prepared to challenge Facilitate reflection 23

NHS Education for Scotland Beware of (your) blocking behaviour • • Closed questions too soon Leading questions Rescuing or problem solving Switching topics Overly task orientated Jollying along Ignoring cues 24

NHS Education for Scotland What communication skills might you use at the appraisal? Some examples: • Listening • Open questioning • Repeating back what they have said • Body language for example, mirroring • Coaching (and mentoring) skills • Motivational interviewing • Adult-Adult interaction 25

NHS Education for Scotland Questions, questions… • Open to funnel – Open, probe, re-cap, close • Paired (for example, good/bad) • Real detail – Difficult decisions – Stressful events • Be inquisitive • No assumptions 26

NHS Education for Scotland Practical advice for giving feedback • Invite self appraisal and reflection – “What do you think of the feedback you have received? ” • Start with the positives – “Let’s start with all the positive comments? ” • Be factual – “Two appraisees last month commented that you seemed to rush the discussion. ” 27

NHS Education for Scotland Two feedback models to consider Pendleton’s rules* • Appraiser start with positives, then moves to what might require improvement • Provides some ‘emotional credit’ • Can seem false – waiting for the negative Silverman’s ALOBA** • Agenda Led Outcomes Based Analysis • Doctor indicates where they feel they need help and seeks guidance • Feedback is driven by the doctor • They may not be aware of what is really important *Pendleton D, Schofield T, Tate P, Havelock P. The Consultation: An Approach to Learning and Teaching. Oxford: Oxford University Press; 1984. 28 **Silverman JD, Kurtz SM, Draper J. The Calgary-Cambridge approach to communication skills teaching 1: Agenda-led, outcome-based analysis of the consultation. Educ Gen Pract 1996; 4: 288– 299.

NHS Education for Scotland Practical advice for giving feedback • Be specific not general – “In fairness, only one patient commented that they felt you did not explain things to them clearly enough” • Be challenging but not judgemental – “Several colleagues independently mentioned this. Do you think it might be an issue? ” 29

NHS Education for Scotland Practical advice to help doctors accept feedback • Talk about ‘intention and impression’ – “I realize that wasn’t your intention, but maybe the impression you created was different” • Make it seem easy to resolve issues – “These things often happen to new appraisers. I am sure you can overcome them!” 30

NHS Education for Scotland Pendleton’s rules (to be used on Day 2 sessions) • • • Clarify any matters of fact The learner describes what they did well The observer(s) describes what was done well The learner describes what could be improved The observer(s) describes what could be improved and offers suggestions on how it could be improved 31

NHS Education for Scotland Pendleton’s rules of feedback • Appraiser clarifies matters of fact, and prompts… • Doctor to identify what went well • Appraiser highlights observations that confirm what went well, and asks… • Doctor to discuss what did not go well and how they could improve this aspect of performance • Appraiser confirms/refutes doctor’s feelings and shares observed areas for improvement • Appraiser and doctor agree areas for improvement and formulate an action plan, ending on a positive note 32

NHS Education for Scotland Feedback summary • • • Establish empathy Balance challenge with support Have the evidence: specific examples If resistance is encountered point it out and ask why Review specific incidents in detail Point out patterns of behaviour Don’t duck issues: collusion causes problems Allow time out if necessary Negotiate if appropriate 33

NHS Education for Scotland Questions to prompt reflection • What went well? • What could have been done better? • How will this learning/case/experience affect you personally and your practice? • How will it improve your patient care and how can you demonstrate that objectively? • How can you share this learning with your colleagues? 34

NHS Education for Scotland What kind of appraiser do you want to be? • Focus on ticking off all required supporting information is present? • Provide feedback on submitted information? • Lead the discussion or give doctors the lead? • Use a coaching approach? 35

NHS Education for Scotland Further reading • Pendelton D, Schofield T, Tate P, Havelock P (1984) The consultation: An approach to Learning and Teaching: Oxford University Press • Silverman JD, Kurtz SM, Draper J (1996) The Cagary-Cambridge approach to Communication skills teaching 1: Agenda-led outcomebased analysis of the consultation: Educ Gen Pract • Bloom, B. S. , Engelhart, M. D. , Furst, E. J. , Hill, W. H. , & Krathwohl, D. R. (1956) Taxonomy of educational objectives: the classification of educational goals; Handbook I: Cognitive Domain New York, Longmans, Green 36

NHS Education for Scotland Next steps • Complete other modules • Place allocation • Microsoft Teams 37