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Appraisal for Interventional Radiologists

 

Appraisal was first considered for consultants as part of clinical governance in the consultation document "A First Class Service - Quality in the New NHS" published in 1998.   In 1999 a further consultation document, "Supporting Doctors, Protecting Patients", set out a wide range of proposals to help prevent doctors from developing problems with appraisal at the centre of these.  The aims of appraisal are:

  1. To set out a personal and professional development plan with career paths and goals,
  2. To agree plans for them to be met and regularly review the doctor's performance
  3. To consider the doctor's contribution to quality and improvement of local health services
  4. To optimise the use of skills and resources in achieving the delivery of high quality care
  5. To optimise the use of skills and resources in achieving the delivery of high quality care
  6. To offer an opportunity for doctors to discuss and seek support for their participation in activities
  7. To identify the need for adequate resources so that the service objectives can be met.


The appraisal process was originally laid out in AL(MD)6/00 so that it could become part of the GMC's revalidation process.  However, the precise process of revalidation is still being developed, and new guidance concerning a more robust appraisal process is due form the Department of Health.

If one is to make the most of the opportunity to discuss one's job plan and workload as well as receive support for the job one is doing, it may be helpful for the appraiser to have a full understanding of the interventional radiologist's life.  The appraiser, whatever the specialty, has the responsibility to ensure that they are sufficiently knowledgeable about the consultant's work for the appraisal to be of value.  In addition they should have had training such that they can discuss the radiologist's ability to communicate, team working, teaching and involvement in audit.  The appraiser is usually the Clinical Director; this has the disadvantage that they may not always appreciate the difficulties specific to the interventional radiology.  If this is this case it may be helpful for an interventional radiologist from a different Trust may conduct a separate appraisal beforehand and the conclusions then fed into the Trust-based appraisal.

 

The Appraisal Process

Prior to the appraisal meeting, the appraisee must complete fairly detailed documentation. Information required will include personal details, current practice including job plan, audit, other professional duties, details of CME and CPD, academic activities related both to research and teaching and any evidence of good medical practice.  Giving a detailed description of all of these facets is neither feasible or desirable in an article of this nature.  However, it is worth emphasizing a few points.


Job plans

Appraisal should compare the job plan with the job that is actually being done and discuss the radiologist's satisfaction with this as well as the needs of the Trust.  This should be coupled with assessing the available manpower and looking at the College recommendations for activity.  In 1994-5 the average non-teaching hospital consultant was performing 50% more work than the College recommends; in recent years this has worsened with the increased pressure generated by the target culture.  The shortage of radiologists has continued, and whilst cross-sectional posts are relatively easier to fill, the interventional radiologist shortage shows signs of continuing.  It is likely, however, that once the Academies first cohorts of trainees achieve their CCTs, over the next few years the problems may ease, providing that Trusts fund the necessary posts.  Outside teaching centres, many interventional radiologists are essentially lone practitioners and this can make undertaking any other activity, such as attending courses, teaching and participating in College and Trust management difficult.

The Personal Development Plan and setting objectives

Objectives can be set for each of the areas set out above.  Not all of the areas may be relevant.  Objectives must be SMART (Specific, Measurable, Achievable and Agreed, Realistic and Time limited).  Together with certain other compulsory elements the agreed objective will form the Personal Development Plan.

Resources

All of us working in the NHS are aware of how frequently resources are inadequate for the task.  It is very important when agreeing objectives to be clear that the necessary resources will be available.  It is the Trust's responsibility to provide staff, equipment and other facilities to allow the safe conduct of interventional procedures and many departments do not run an out-of-hours interventional service because of the lack of provision of these resources, even if the radiologist is willing.

The appraisal process is necessarily time-consuming, particularly in its preparation.  The need to participate in appraisal carries the risk that Interventional Radiologists will be diverted away from treating patients or, given the considerable work pressures that exist will more likely mean that for most, appraisal will prove to be an additional unwelcome burden.

Prospective documentation and provision of accurate data require adequate time, IT equipment and staff to input the raw data.  If outcomes for the therapeutic procedures are to be measured then long-term follow-up of the patients is necessary, unlike many other radiological subspecialties, and this also takes time and staff.  The Royal College of Radiologists recommends in its guidance on job plans that activities for interventional radiologists would include outpatient clinics, pre-procedural counselling, post-procedural care, ward visits and follow-up but with present staffing this would be at the expense of other work and the system cannot currently afford this outside specialist centres.  Once outcomes have been determined, they would then have to be compared with agreed standards such as those produced in BIAS for iliac angioplasty and the approved figures for complications following angiography and angioplasty.  Where results lie outside the accepted standards, allowances would have to be made for variables, particularly referral patterns and for sample size.  Agreed standards for non-vascular interventional procedures and for the outcomes of infra-inguinal angioplasty have yet to be produced.  The long-term follow-up required in these patients means that it might be months or years before a practitioner's results are available for comparison.  This would necessarily lead to a delay in identifying a particular practitioner's shortcomings and being able to close the audit loop with retraining.

Conclusion

Appropriately used, appraisal has the potential to improve working lives and patient care by making doctors focus on their practice and their CPD needs, and in identifying shortcomings in a service, be they related to resources or other factors.  Unfortunately whilst appraisal is essential for all doctors, and forms part of the revalidation process, the shortage of interventional radiology colleagues, radiographic and nursing staff combined with pressures of work as well as the inadequacy of IT and lack of necessary funding will make many perceive it as an additional burden for the overworked interventional radiologist.

Mark Charig and Mark Cowling October 2002 (Revised and updated by MC 2009)


References:

  1. Structured Training Curriculum for Clinical Radiology 2007. Education Board of the Faculty of Clinical Radiology, The Royal College of Radiologists.
  2. Care of Patient on the Ward and in Out-patient Clinics in Interventional Radiology Procedures. 2000 [BFCR(00)7]. The Royal College of Radiologists
  3. Risk Management in Clinical Radiology. 2002 [BFCR(02)2]. Board of Faculty of Clinical Radiology, The Royal College of Radiologists
  4. Appraisal and revalidation information: http://www.rcr.ac.uk/content.aspx?PageID=1511
  5. Department of Health. Trust, Assurance and Safety – the Regulation of Health Professionals in the 21st Century. London: The Stationary Office, 2007.

6.      Workload and Manpower in Clinical Radiology. 1999 [BFCR(99)5] Board of Faculty of Clinical Radiology, The Royal College of Radiologists

7.      How many Radiologists do we need? A guide to planning hospital radiology services. Board of the Faculty of Clinical Radiology 2008

 

Mark Cowling Oct 2009