Welcome to this Medical Appraisal Skills Video Workshop.
This is one of a series of short films intended to explore some of the challenges presented
by medical appraisal conversations, and to encourage you to consider helpful behaviours,
strategies, and mind-sets for these important meetings.
The purpose of this scene is to explore how we can ensure doctors are clear about what
scope of practice means, and what is required of them to ensure their work is well reflected
in appraisal documentation.
We join our doctor’s mid-appraisal.
INT: There are a couple of things I wanted to pick up from your portfolio; firstly, your
scope of practice.
M: Well that’s easy, full-time Consultant in Public Health in the employment of the
County Council.
Job done, next.
INT: I feel like letting this go, but I know there’s more to this doctor’s scope of
practice.
How can I raise this without rocking the boat?
What would you do?
Take some time now to discuss your options.
Let’s see what she tries.
INT: Well, I’m not sure the job is done.
I see from your CPD and other comments that you actually have a wide range of professional
interests but, I can’t see these reflected in your scope of practice.
So the appraiser’s response was to evidence information from another part of the appraisal,
and ask a question.
M: Well the Council pay me and that’s the work they’re interested in.
INT: As I see it, that is one of the key differences between managerial and professional appraisal.
In professional appraisal we need to make sure that you’re up-to-date and fit to practice
in all the roles you play as a doctor, not just your salaried job.
The GMC are very clear about this.
Er for example, you have mentioned in your CPD that you’re a Part A examiner but, I
can’t see this mentioned anywhere else in your folder.
This is a valuable professional role but presumably not something that the council requires you
to do?
M: No of course not, they like to keep my nose to the grindstone, it just… this whole
thing just seems a bit excessive that we have to record everything I do.
INT: What do you take from the examiner role?
M: Okay, I think it’s really important to have a… wider range of professional interests,
it helps to keep me up to date.
INT: Yeah, I agree entirely.
And it needs to be reflected in your scope of practice.
M: (Sigh).
INT: Did you see that?
He just sighed and looked at his watch.
I actually don’t know what to do about that, I feel really cross.
One approach here is to consider you have three options, you can: Express.
Suppress.
Or, move on.
Suppressing, might involve containing and not giving voice to what you’ve noticed,
and the motion it has engendered in you.
Moving on, might involve focussing on other information.
In this example, that might be reminding yourself of your goal for the conversation.
Expressing, might involve finding a way to reflect back what you’ve noticed, for a
position of curiosity.
Let’s see what this last option might look like.
INT: I noticed you sighed and looked at your watch when I suggested that the examiner role
should be included in your scope of practice.
M: (Sigh) Yeah I…
I’m sorry, I just think it’s a bit excessive that I have to record, you know, all of this
stuff.
INT: Okay, would it help if we discussed this a bit further?
Discuss your response to expressing, suppressing, or moving on.
In this instance the appraiser actually decides to move on.
INT: So how do you make sure that you’re up to date as an examiner, what about the
aspects of Public Health you don’t cover in your job for the Council?
M: Well I read extensively, I think that’s covered in my CPD.
INT: Mmm.
M: If I didn’t I suppose I’d only… potentially focus on the topics that are relevant to my
work.
INT: And are there any other roles in your scope of practice we should be discussing
today?
M: Well I don’t know because I’m not entirely clear what scope of practice is supposed to
cover.
INT: Mmm-mm.
M: Erm, I do some wilderness medicine for example, I’ve done less of that since the
kids came along but I don’t know whether that is considered scope of practice.
INT: Well, wilderness medicine is a… is a prime example of something that should be
covered in your scope of practice.
I mean it’s-it’s risky, and we need to make sure you’re up to date.
Erm, would it help if we spent some time discussing er what other roles you have, that could be
included in your scope of practice?
M: Yeah, fine.
INT: Yeah?
Erm, so I see from your CPD that you help out at your son’s football on a Saturday.
What would you want to know about your appraisee’s wilderness medicine practice?
Also consider, what examples could you give of the kind of work doctors should be documenting.
How did you get on?
Here are some of the roles doctors might like to think about, under scope of practice.
Finally, based on your discussions with your colleagues and what you’ve learned through
watching this film, what are some helpful ground rules or tips for these conversations.