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| # | Scottish Medical Appraisers Conference sessions |
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| 01 |
Journey of a Form 4 Many appraisers have told us they don’t know what happens to the Form 4s they draft once the appraisal has been signed off. Who looks at them? How does it inform the ROs’ revalidation decision making? What do they look for in the Form 4s? For this session, we invited guests from the GMC and AoMRC to share with us a brief history behind medical revalidation, and we also invited a few ROs to share with us what they look for in a Form 4, their processes for revalidating colleagues and the role appraisers play. This was followed by a large group open Q&A. Speakers:
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Is it possible to put too much information in the Form 4?
The focus of the Form 4 should be an objective formative summary, not a transcript of the appraisal meeting. The summary needs to cover reflections on learning and performance. It should demonstrate that the individual is up-to-date, and that the reflection on the supporting information covers clinical and non-clinical work as well as health and wellbeing. There should be actionable outcomes such as PDP (Personal Development Plan) and reflection of any changes to the doctor’s practice.
Appraisees often worry about documentation about complaints in Form 4, can you reassure us that "less is more" in that we should really document actions/ outcomes and reflections rather than anything specific to the actual complaint?
It’s about reflection of the event and not about the details or content of the event itself.
What if any dr doesn't see patients? What about questions regarding prescribing where drs don't prescribe?
Doctors who do not see patients do not need to carry out a Patient Satisfaction Questionnaire (PSQ).
Most of the doctors are working fine, so why would they change their practice every year?
It should be part of the discussions around a doctor’s continuous learning and development, quality improvement, and impact on patient care. The requirement isn’t to change one's practice, it's to reflect on past practice and consider whether changes should be made.
Along the same line, in relation to MSF, considering that so many GPs are portfolio or undertake non medical/ more management roles, is it really only WASP that we can use or are there other 360 MSF tools that might be better suited and appraisees could use instead? Or could this be an area for development?
The College of Psychiatrists’ MSF tool – called ACP360 – is very good in my opinion; it allows very simple electronic collection of colleague and patient feedback with quite helpful analysis compared with one’s peers (though it costs about £125+VAT per doctor). Is there no similar tool available from other Colleges for their own specialties?
The focus should be about the multi-source feedback as opposed to the tool. As long as the RO is happy for the appraisee to use a particular tool (instead of WASP) and they are prepared to fund it themselves, you can use alternative MSF tools. Provision of WASP is funded by the Scottish Government (same as SOAR), therefore free for those working in Scotland to use.
Why have the GMC removed the minimum number of patients to acquire feedback from in GMP2024? Makes it difficult to ensure that an adequate amount of information is obtained
There are some rules of thumb, such as 20 responses but for some doctors that isn’t actually possible. As it is so variable the GMC removed the specific requirement.
How would a good reflection look for a complaint which is unjust and inappropriate. Not all complaints are reasonable
Be objective and keep it factual – as appraisers you are not asked to make a judgement on the complaint itself (nor any of the supporting information), but to help reflect on educational or QIA opportunities.
Hmmmmm. So as the appraiser are we there to report that the individual has reflected (could be a brief statement "they have reflected on the complaint") or summarising their reflection so the RO can determine whether they have reflected sufficiently?
It is neither of these things. The appraiser is to create an environment where in the course of the conversation and through coaching type questions they can tease out from the appraisee their reflections on the complaint and then capture that (or not) in the Form 4 in a way that the appraisee is comfortable with. RO’s are not expected to determine whether an individual has reflected sufficiently.
It is not uncommon to find the same significant event occurring in multiple practices and sharing with consent might help to prevent other practices making the same mistake
I agree re the SEA comment. I guess it's not an appraisal issue per say, but appraising people you often do see the same SEA come up and it would be good to have a mechanism to feed these in/ collect these more widely, not as appraisers but as a more general observation of improving safety.
Can the data be analysed to get pulse of our community as a whole and other aspects can be analysed too
I think the mechanism for learning from adverse events is important but sits in clinical governance processes and outside appraisal other than for the individual involved
As pointed out in the last comment, because this sits outside of appraisal, careful consideration will need to be factored in with regards to confidentiality but in principle this is similar to M&M meetings with the goal of fostering a system of continuously learning and quality improvement.
On the Medical Appraisal Scotland website there is a QIA library with anonymised examples for appraisees to consider so they can reflect on their own work and appraisal submission. QIA case studies submissions are always welcomed.
Before revalidation came along, primary care appraisal did include a section for collating possible collective learning needs. My understanding was that it was to inform educational provision but didn't really work and quietly vanished.
The learning needs function previously existed for primary care users on SOAR has evolved into the CPD log function that is on SOAR today.
Evaluating equivalence for locums, part-time doctors, and doctors in different organisations involves gathering supporting information, which is often more complex.
As appraisers, how can we ascertain sufficient information to cover all aspects of their work?
Appraisers should ensure that the supporting information covers the whole scope of work and that it meets the minimum requirement for revalidation set by the GMC. For a more detailed description please consider reviewing the “Supporting Information” module from the revamped New Appraiser training courses.
I would just highlight that some doctors have very limited capacity to reflect! Like pulling teeth
Have the doctors been trained how to reflect {diverse workforce}?
where doctors are new to reflecting they are invariably great to work with. It's when people ought to know it can be exhausting
This can be challenging but there are different approaches you can try. You may wish to review the “Coaching approach in appraisals” module from the revamped New Appraiser training for ideas. Or attend one of the Improving Appraisal Conversation workshops for a hands-on experience. You may also find the Appraiser Agility session from the conference of interest too.
Journey of a Form 4 (slides)
Date updated: 05/09/2025
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Type: pdf
This page was last updated on: 10/09/2025
