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 film is to explore how we can encourage doctors to reflect on their
practice, and use multisource feedback to help create a personal development plan.
We join our doctor’s mid-appraisal.
INT: So you’re 5 years into your career as a consultant.
F: That’s right.
INT: I can see you’ve got a really wide range of interests.
Erm, you spend a lot of time outside of the Trust, you’re rapidly becoming known as
an expert in your field.
Tell me about… tell me some more about your private practice.
F: Well it’s thriving.
Erm, I have patients here in the UK, I also have patients overseas, and it’s very valuable
to me.
I’m being commissioned to write chapters for many publications erm these days, so to
see a wide variety of patients erm is very useful.
INT: Okay, great.
So, quite a lot going on.
F: Indeed.
INT: Erm the writing, the writing commissions must take a lot of your time up.
How do-how do you divide your time?
F: Well erm, I’m just very sensible about it; I have my patient lists erm but I also
spend a lot of time at conferences and meetings, they can be here, Europe, erm the US.
INT: Okay.
What’s the impact of-of the travel, er of the time away out of the country on your NHS
work?
F: Oh I think its negligible, erm if anything its positive.
As I build my reputation, er as I become a leader in the field, I think I become even
more valuable to the Trust.
Bariatrics as you know is a very young surgical area for the NHS, so to have somebody with
my calibre I think is very important.
INT: Okay, this is interesting.
What this doctor is telling me sounds great and very plausible, and at the same time there’s
something missing; because I’ve noticed in her multisource feedback that a number
of her surgical team, her colleagues have reflected on the strain that’s been put
on them by her absence.
Now at the moment it doesn’t sound like she’s willing to, or able to recognise or
acknowledge that, and I’m wondering what I can do to raise this.
What would you do?
Take some time now to discuss your options.
Something you might have identified is that our doctor may have a blind spot here.
Given that this may be the case, what could you do to explore this possibility?
Let’s see how our appraiser checks out the doctor’s awareness around this.
F: So, as you know Bariatrics is a very young surgical field within the NHS.
So to have somebody of my calibre on the team, for the Trust is very important.
INT: Yeah, I can-I can absolutely appreciate that.
F: Mmm.
INT: Erm, your reputation will be something that ref…reflects well on the Trust.
F: Yeah, exactly.
INT: Yeah.
I think another consideration around this is you-you... some of the information that’s
contained in your multisource feedback, have you had a chance to have a read of that?
F: I’ve glanced through it; I haven’t looked at it in detail to be honest.
INT: Alright, okay.
And erm, what were your reflections based on what you have seen?
F: Well I noticed a few comments er around frustration of my colleagues, which I find
very odd, erm I haven’t had those conversations directly with those individuals, so I-I think
it’s a slightly obtuse comment.
INT: Okay, alright, so-so say some more about you said you found… you found those comments
very odd.
F: Well I think if somebody has an issue, you talk to them directly rather than wait
for some paperwork to come round.
So er yes, I would like to think that my colleagues could talk to me directly, I feel I’m a
very approachable person and very fair, so I- I am…
I’m disappointed with that.
INT: Alright.
So, approachable and fair.
F: Yes, I think so.
INT: In that case, what do you think might be behind the fact that your colleagues haven’t
had those conversations with you, that you’d have liked them to have?
F: Well, if-if we assume that they are assertive individuals who want to talk to me, erm I
don’t spend a lot of time erm (pause) just hanging around waiting for conversations.
So… so yes, I am a very busy person so I might be difficult to track down occasionally
to have a conversation with.
INT: Okay, yeah.
So I guess the fact that when you’re in the Trust I-I imagine a lot of your time is
spent with patients.
F: Oh yes, I’m patient facing whenever I’m there.
INT: Yeah, alright.
So-so that could be contributing.
F: Possibly.
INT: Connected to this er, I also noticed that your post-op complication rate is higher
than the rest of the team.
F: Yes.
INT: What might be behind that.
F: Yes, I make no apologies for that, erm I get the difficult patients as I’m the
most experienced on the team, so I don’t think that’s surprising or worrying in any
way.
INT: Yeah, absolutely that-that might well be part of the explanation for that.
I also, I’d really encourage you to reflect on whether what we’ve discussed in terms
of the time you spend away from the Trust might also be being reflected in your post-op
complication rate.
So in other words, if you’re-if you’re not around to-to plan and to review your-your
surgery, then erm that might erm be what we’re seeing here.
F: Erm, (phew) there might be an element of that, I’m relying on the team for post-op
care.
INT: Mmm.
F: And obviously they’re relying on er my patient notes, which occasionally won’t
be as up to date as-as they would like them to be.
So there may be an element of that.
INT: Okay.
So there’s something about your notes not being up to date, your written work.
F: Yes, I… you know I’m-I’m busy, you know I-I input what I think is essential which
other people might want more information than that.
INT: Okay.
And that’s one aspect of communication with the rest of the team, I was wondering what
other thoughts you had around other-other ways you might communicate with the team?
F: Well obviously talking to people but, erm as I’ve already alluded to, I-I don’t
(pause) have time for chatter.
Erm, (pause) you know, I’m Happy to talk to the members of my team, erm but you know
I have a busy and very full schedule, so yes it would be good to have more conversation
I-I would think.
INT: Okay, great so I think if-if that’s the case…
F: Mmm.
INT: … If you’d like to be able to have more conversation with the team, my…
my suggestion to you is that you care out some time in your diary to set up some meetings
with your team…
F: Right, okay.
INT: To start to talk about how you can use your time at the… when you are in the Trust,
more effectively.
You might also want to consider how you can work more smartly, so I can- I’ve got some
suggestions around how you could do that.
F: Okay, I-I (laugh) yes, alright.
What’s working for the appraiser, and what could they consider doing differently?
Think about the point at which we’ve stopped the action.
Who’s doing the work in the conversation?
You might be familiar with the coaching continuum, or push-pull model.
So the push end of the continuum is where the coacher’s solving the other person’s
problems for them, and the pull end is about helping somebody to solve their own problem.
Neither end is good or bad, both can be helpful depending on the coachee.
Here are some of the behaviours you might see from a coach, depending on where they
are on the continuum.
Let’s re-join our appraiser as he attempts a change of tack, using more of a pull style.
INT: Okay, so we’ve discussed the fact that your career’s going really well...
F: Yes, yes.
INT: You’re spending erm a great deal of time away from the Trust.
F: Mmm.
INT: Erm, we’ve talked about the multisource feedback and the fact that your team are reflecting
that erm there’s some strain being placed on them, as a result of your er (pause) absence
from the Trust.
That’s been a surprise to you, and you’ve expressed some desire to do something about
that, and also to look at your post-op complication rates.
F: Yes.
INT: Is that right, is that a fair summary of…?
F: I-I think that’s-that’s fair.
INT: Yeah, okay.
So I suppose the-the question is, you know, it’s the ‘so what’ question.
F: Mmm.
INT: So what are the options in terms of starting to do something about this?
F: Well, funnily enough my PA has been erm badgering me about spending a little bit more
time with her actually.
INT: Oh okay.
F: To help her to manage my-my diary, which we are not staying on top of at the moment.
INT: Right.
F: So I think some difficulties are arising because of that lack of communication between
us, so finding time to… to sit with her I think would be valuable.
INT: Okay.
How-how might that play out, what might be the upside of you erm spending that time with
her?
Because I-I imagine you’re going to need to justify for yourself, the time to sit down
with your PA.
F: Yeah.
INT: So what’s in it for both of you?
F: Well I think (pause) she spends a lot of time trying to get hold of me, and being a
little frustrated when she can’t, erm because I will occasionally insert activities into
my diary that I won’t necessarily erm tell her about.
So (pause) I think we need to talk about the regular items in my-my weekly schedule.
INT: Yes.
F: Make sure we-we’ve timetabled those, and ensure that we have a-a means of-of catching
up throughout the day, so she’s not trying to get hold of me when I’m… when I can’t
pick up the phone.
INT: Okay, great.
So that-that-that’s an option.
F: Mmm.
INT: I’m wondering what else you could do; what other thoughts do you have?
So the appraiser has shifted their approach to what you might recognise as more of a coaching
style.
Discuss your response to this, and decide when you think a pull or coaching style might
be most helpful during an appraisal conversation.
Also consider where you spend most of your time.
Now let’s hear from our doctor, how had this section of the appraisal conversation
landed with them?
F: I’m actually getting a lot from this conversation, erm which I didn’t expect
when I came into the room.
Erm, I have never been challenged in an appraisal before, and actually these questions that
are being posed are making me think, erm probably for the first time er about the levels of
patient care that I’m giving, about how I’m communicating with my colleagues.
Er, and I feel it’s very fair the questions I’m-I’m getting and the comments, and
not judging in any way, so I’m very happy to engage with this.
Er, and I’m (sigh) I’m actually enjoying having the time to talk about the work that
I do, and what matters to me.
Erm so hearing some feedback from colleagues which I don’t generally get, erm and being
challenged on my practices I think is a very healthy place to be.
(Sigh) I mean going back to the feedback I found that quite shocking, if I’m honest,
so I would like to talk to my colleagues about that.
I have no qualms with talking to people directly so, I’d like to get a little bit more information
from them around their thoughts about that.
So I’m-I’m quite happy to call a meeting with my surgical team.
INT: Okay, great.
What erm, I’m wondering what your considerations might be around that.
What we’ve talked about so far is there may have been a reluctance, or maybe even
some…
F: Well I think it’s more a time management issue actually.
INT: Okay.
F: Erm, from-from all of us you know, I’m not the only one that-that’s that’s busy
to be– to be fair to them, so (pause) we will need to timetable something which is
workable.
It-it might mean splitting the team and-and we don’t have one big meeting, but I catch
up with a group, and then a few individuals, possibly, if that’s what I have to do.
INT: Okay, alright.
So (pause) spending some time with the team…
F: Mmm.
INT: … setting some time in your diary to have some conversations with them about how
you can work better together.
Is that…?
F: I think so, and I think my PA will be able to help me timetable that and (pause) and
stick with it.
INT: Okay, very good.
F: Mmm.
INT: Anything else that you (pause) that you think you could do that might make a difference,
might start to remedy this.
F: Erm, you have made me think more about my complication rates, which are- which are
safe and you know I-I understand why they hare the level they are.
INT: Mmm.
F: And yet I think they can be improved upon, and I think that with my increased contact
post-op with patients, that may help to lift those figures so.
Reduce those figures I should say.
INT: Mmm: F: So erm, (pause) it’s looking like I need
to spend more time in the Trust as a general principal, and take less commitments elsewhere,
which although are tempting are (pause) eating away at the time that I do have.
INT: Yeah, okay.
And it might be about finding the balance there because I, you know, I absolutely appreciate
the erm the upside and the temptation to go away and to do that work.
F: And it… and I’m not doing it for, you know, my own glory; I’m doing it because
this field is very young as I’ve said, and there’s a lot of shared practice which is
taking place.
Erm so it’s… it is really important that I’m at the major conferences.
Erm so it-it’s a balancing act, yes.
INT: You mentioned patients a couple of minutes ago.
F: Yeah.
INT: What about your, your erm responsibility to your patients, where does that sit within
what we’ve discussed?
F: Well they are paramount, they-they are paramount so I think (pause) and possibly
I’ve forgotten that, so yes I want to follow up on patient care a little more.
INT: Okay.
F: Erm, have more direct communication with my patients.
Erm, quite a few of my patients know the team better than me, just because of circumstance.
INT: Yeah, yeah.
F: And I think I should work to change that actually.
INT: Okay.
Okay, sounds like we’ve started to generate an interesting list of options there for us.
F: Yes, you’ve given me more work to do thinking about this.
INT: Yeah, I… (laughs) F: (Laugh) So, but no, it’s-it’s good
and erm (pause) I enjoy the challenge of it actually.
Erm, so this is… this is good for me, this is good for me to have a look at my current
practice and-and see what positive changes I can make.
INT: Okay.
F: So no, it’s all good.
INT: Good.
And to be a little bit more provocative for a moment.
F: Okay.
INT: I-I suppose the risk here is that we have this conversation, it feels great and
then you go straight back into the real world and things, events take over and erm before
you know it, you’ve run out of time to-to put into practice some of this stuff.
So, how are you going to make sure (pause) erm that something happens?
F: Well I-I mean I have a PA who is on my back constantly at the moment; so she certainly
won’t let me forget erm a meeting with her.
And-and fairly so, fairly so.
Erm, no I’ll make a commitment to you that I will-I will erm follow up er on this meeting,
and when I say I’m going to do something, I do, do it, so-so rest assured.
INT: Very good, any erm support you need from me around any of this?
F: No, not at all.
I think you’ve made your-your voice very clear, and you’ve helped me to gather my
thoughts.
So-so thank you actually.
INT: Okay, very good.
Shall we move on to start to look at your erm PDP now?
F: Yes, indeed, we’ve probably got a lot of fodder there for it now haven’t we?
INT: I think we probably have.
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?