Appraisal

Personal Development Plan

A Personal Development Plan (PDP) is an important tool in self-directed professional learning.  All doctors are expected to create and maintain a PDP and this is an essential skill in the process of appraisal and revalidation.

This also covers Continuing Professional DevelopmentSmall GroupsPostgraduate Centre ActivityAppraisal and RevalidationClinical Information & GuidelinesResearch Tools & Medical LiteratureCommunication Tools, Employment Issues, Libraries, Medico-Legal Support, CPD, GP Training Information & Resources, Revision for Exams & Diplomas, and Learning Needs Assessment.

Identify Objectives

A PDP is a statement of learning objectives or goals, with a plan of how and when these will be addressed. Learning Needs Assessment is essential, rewarding and deserves a page to itself.  Most people refresh their PDP annually or at the start of a new job, but initial goals are just that and a PDP should be an evolving document into which you can add new needs as you identify them.  A PUNS&DENS log is a good way of catching new needs big or small.

Get SMART

The next step is to set SMART goals, i.e. Specific, Measurable, Achievable, Relevant and Time-based.

You should plan, as specifically as possible, what you are going to do to achieve each goal.  In the example above, this may include attending dermatology talks, going to out-patient clinics, completing online learning modules and setting aside time for personal reading.

You should be able to define when you will meet your objective and how you will demonstrate that it has been met (e.g. a certificate from an on-line learning module, or a case study showing increased confidence in managing a particular problem).

Keep Records

Keep evidence such as certificates or course programmes for your appraisal portfolio.  You should also have a way of recording day to day learning such as a PUNS, DENS & reflection diary (PUNS are Patient Unmet NeedS, DENS are Doctors Educational NeedS.  You don’t have to have a PUN to have a DEN, though).  This can be kept at your desk or in your pocket, on paper or in a PDA.  One method is to record, date, patient number, learning need and subsequently where you found your answers or what changes you made.

The RCGP ePortfolio contains a PDP template to fill in online.  Other internet-based PDP tools are available e.g. on doctors.net, onmedica and iGPnotebook.  Have a look at different on-line PDP tools to see which you find most helpful, or use a paper-based record if you prefer.

PDPs can encompass many areas, both clinical and non-clinical.  For example, one of the areas covered in yearly appraisal is personal health, so you could include a goal related to personal fitness or wellbeing.

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Continuing Professional Development & Helping Your Daily Practice

The information and links below are designed to provide easy access to commonly used and useful resources for:

  • Daily practice, e.g. checking the latest guidelines for investigating dyspepsia
  • Continuing professional development, e.g. e-learning modules in primary care orthopaedic examinations
  • Professional support services, e.g. medico-legal advice, employment issues

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Small Groups

GP Tutors are very keen that GPs new and older form small groups to support each other, learn together and let off steam!

If you’re already doing this, we’d like to know of your existence!  We would like to help facilitate things for you to help recruit new members provide ideas and offer support spiritual and temporal.  WGPET will support you with an organiser’s fee of £40 per meeting and we can send out fliers for you, etc..  If you have need for a speaker we may be able to help in providing funds to pay them.

Contact your GP Tutor or postgraduate centre for an application form & more details.

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Postgraduate Centre Activity

Bournemouth, Dorchester and Poole Education Centres all run dynamic programmes to provide a wide range of educational activity.  We hope to provide something for everyone.

Please ensure that you let your local tutor know your contact details so you can be kept in the information loop.  Emails are quick and convenient but we are happy to send out mail shots as well.

Each centre runs an annual refresher course, topic afternoon meetings, bite sized lunchtime sessions and some evening meetings.  It’s a great way to meet peers and secondary care doctors as well as brushing up on a whole range of current topics.

If there is something you are aching to learn about please speak to your tutor who would do their best to arrange a local course or find out how you can best access the information.

Keep a healthy dialogue going!

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Appraisal and Revalidation

There are a number of online tools that can be used for appraisal purposes:

  • Fourteen Fish (previously My Revalidation Toolkit). Integrates with the LMC website.
  • The Wessex Deanery has a lot of useful appraisal information on its web site.
  • The original appraisal toolkit – “For GPs, consultants, and staff grade and associate specialist doctors, a secure online service to support annual appraisal.”  (£50 + VAT per year)
  • RCGP Revalidation Portfolio – “The Revalidation ePortfolio has been developed by the RCGP, working closely with GPs, to ensure that it will support the needs of GPs, GP appraisers and primary care organisations (PCOs) as a comprehensive appraisal and revalidation toolkit.”  Free to RCGP members, Primary Care Organisations & GP Appraisers.
  • GPTools – “My initial motivation for designing GPTools was due to being fed up with the other ‘appraisal sites’ out there.  They were very poor on features and usability and to top it off we were being asked to pay for the privilege of using them.  I felt that I could make something a lot easier , intuitive and modern (as in Web 2.0) myself.”  Free to all GPs.

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Employment Issues

  • Maternity – website about rights for mothers and fathers (and mums and dads-to-be) at work, on leave and on return to work
  • Accounting – all GPs, but locums especially, could benefit from specialist GP accounting services.  Two local firms are listed below (but this is not an advertisement and they are not sponsoring the site – they are purely firms that I know are used by GPs locally)
  • Pensions – always a good idea to know what scheme you’re part of and how to find useful info about your contributions, etc.  There is also a pensions calculator that helps you work out the benefits between the 1995 and 2008 pension schemes.

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Libraries

  • Royal Bournemouth – Full range of library services
  • Poole Hospital – Full range of library services
  • Dorchester Hospital – Full range of library services
  • East Dorset NHS Library Services – Updates and a blog about the local NHS Library services
  • RCGP Library – Literature searches, some online journals.  Free to RCGP members
  • BMA Library – “Specialises in current clinical practice, medical ethics and education and providing expert information to members and staff.  We offer a wide range of services for members to access at any time from any location”
  • King’s Fund – Health and Social Care Management and Policy

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Medico-Legal Support

  • MDU – “The MDU is a mutual, not for profit, organisation owned by our members.  Established in 1885, we were the world’s first medical defence organisation and have led the way ever since.  We defend the professional reputations of our members when their clinical performance is called into question.”
  • MPS – “The Medical Protection Society: Professional support and expert advice.  MPS is the world’s largest medical defence organisation, providing the best possible protection and peace of mind for medical professionals throughout their careers.”
  • GMC – “Our statutory purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.  We are not here to protect the medical profession – their interests are protected by others.  Our job is to protect patients.”

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CPD (Continuing Professional Development) – online learning modules, courses…

  • RCGP Professional Development – Courses and Conferences, RCGP E-learning, First5 information
  • Doctors.net.uk Education Modules – “Modules written for GPs to help you fulfil your learning needs and can be added to the Doctors.net.uk online PDP.”
  • E-Learning for Health – “an e-learning programme providing national, quality assured online training content for the healthcare profession.”  Learning modules that link straight into your eportfolio learning log once you’ve completed them.  The video guides to clinical examinations (e.g. performing a neuro or shoulder exam in a 10-minute GP consult) are especially useful.
  • BMJ Learning – Online training and courses to help GPs and trainees prepare for exams and for life as a GP.

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GP Training Information & Resources

  • Dorset GP Website – A website for Wessex GPs in training and those post-certification.  For all things “education”, day release related, and locally based.
  • RCGP Curriculum – Up to date information on the RCGP Curriculum and the MRCGP examinations.
  • GP Training.net – An educational resource for GPs, GP trainers and doctors in specialty training for general practice.  Written by a GP in Cumbria.
  • Medical Mind Maps – “A new way of mastering the RCGP Curriculum for GPs, trainees and Medical Students.  This not only educates people, but inspires them also.”
  • Eportfolio – The RCGP online portfolio for GP Trainees.

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Learning Needs Assessment

Every GP and trainee should be engaged in an ongoing process of learning needs assessment (LNA).  Doing so saves you time and energy and could save lives or legal costs!  The process should help you direct your energies towards the study areas that will be most relevant and productive rather than (as sometimes occurs) the areas you happen to enjoy.  Learning needs assessment can be roughly divided into intermittent and continuous methods.  It can alternatively be divided into reflective processes and external feedback.  It is essential that you use all 4 combinations.

The 4 quadrants of Learning Need Assessment

The divisions between quadrants are blurred but the important thing is to be aware of the quadrants and address each.  Keep records for the future! Janet Grant’s excellent paper (BMJ 2002, 324, 156-159) lists over 40 different sources for needs assessment.  Below are just a few.

SOME EXAMPLES OF LNA TOOLS BY QUADRANT INTERMITTENT CONTINUOUS/
FREQUENT
REFLECTIVE Confidence Rating Scales
Appraisal
Significant Event Analysis
Reviewing the GP curriculum
Personal reading (Journals etc)
PUNS & DENs Book
Reflection on good/difficult consultations
Reflection on emotions in practice
Reflection on relationships with colleagues or patients
Clinical outcomes
EXTERNAL Multiple Choice Papers
Appraisal
Significant Event Analysis
Patient Questionnaires
Feedback from other disciplines
Random Case Analysis
Directly Observed Procedures
Colleague Feedback on Cases

 

Unknown Unknowns

How do you know what you don’t know?  This may seem a strange question, but it lies at the core of learning needs assessment.  We may be well aware of some gaps in our clinical knowledge, and paradoxically this is fairly safe – we know when to call for help or advice.  However, there may be areas where we don’t realise that our knowledge is out of date, or even non-existent.  When you last puzzling patient presented with a set of symptoms, were there diagnoses you didn’t consider because you simply didn’t know they were relevant?  These unrecognised gaps, sometimes called “unknown unknowns” or “unconscious incompetency” are the scary ones.  Without external input, you may never know or may find out in unpleasant circumstances.

GP Appraisal or Starting New Training Posts – Some Useful Resources

The tools mentioned here are aimed at registrars but are excellent for established GPs too.  Take the results along and impress your appraiser!

For trainees, each hospital post and the registrar year should feature some form of LNA early in the placement.  Going along to your appraisal or tutorial with some LNA preparation already done will make the process much more fruitful.  The GP Curriculum itself is a little dense but useful to dip into.  For hospital posts, NHS Education Scotland have published an excellent booklet The Curriculum in Hospital suggesting areas from the GP curriculum to be addressed during the common VTS hospital posts.  For registrars, this can be enlightening when posts they have not done are reviewed.

Registrars may like to use the nPEP assessment tool to identify gaps in their knowledge.  For AiT members of the RCGP the first use is free.

Reflective tools include the Wolverhampton Grid and Manchester Rating Scale.

The Honey and Mumford questionnaire helps to evaluate your individual learning style and optimise your learning. 40- and 80-question versions are available to purchase and complete on-line for £10.

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