Appraiser: Quality Assured by: Date 1 2 3 PROGRESS QA tool Comments Score from 0-2 or 0-4 0=absent , Quality assurance and development of Explain low scores and how the appraiser 1(or 1-3)=room for post appraisal documentation can improve the appraisal documentation improvement 2 (or 4)=well done Appraisal identifier (Dr 1 2 3 initials) Professional (2) 1 is typewritten, – objective, free from bias or prejudice, describes a professional appraisal: venue, 2 time taken, good information governance, and confirms no identifiable third party 3 information is included Reflects a good appraisal 1 discussion (4) – demonstrates support, 2 challenge and focus on the reflection and needs of the doctor 3 Overview (2) 1 includes a description of – the whole scope of work and context for 2 the doctor, the appraisal and the revalidation cycle 3 Gaps (1) 1 identifies in the PDP any gaps – in requirements for revalidation, mandatory 2 training or scope of work and specifies how they will be addressed (or states if no 3 gaps) Reviews supporting information (SI) 1 and lessons learned (4) reviews SI – in relation to Good Medical Practice; 2 comments on SI not supplied electronically and any information the doctor was asked to bring. Reflects on lessons learned, 3 changes made and actions agreed. Encourages excellence (2) 1 – affirms good practice, celebrates achievements and actions accomplished, gives examples 2 of good practice and records aspirations (some of which may have a timescale over one year) 3 Sign Offs & Statements (1) 1 – ensures the input and output statements, including health and probity, have been completed, 2 commented on and, where appropriate, explanation made to the RO 3
Appraiser: Quality Assured by: Date 1 2 3 PROGRESS QA tool Quality assurance and development of post appraisal documentation Score from 0-2 or 0-4 0=absent , 1(or 1-3)=room for improvement 2 (or 4)=well done Comments Explain low scores and how the appraiser can improve the appraisal documentation Appraisal identifier (Dr initials) 1 2 3 Professional (2) – is typewritten, objective, free from bias or prejudice, describes a professional appraisal: venue, time taken, good information governance, and confirms no identifiable third party information is included 1 2 3 Reflects a good appraisal discussion (4) – demonstrates support, challenge and focus on the reflection and needs of the doctor 1 2 3 Overview (2) – includes a description of the whole scope of work and context for the doctor, the appraisal and the revalidation cycle 1 2 3 Gaps (1) – identifies in the PDP any gaps in requirements for revalidation, mandatory training or scope of work and specifies how they will be addressed (or states if no gaps) 1 2 3 Reviews supporting information (SI) and lessons learned (4) – reviews SI in relation to Good Medical Practice; comments on SI not supplied electronically and any information the doctor was asked to bring. Reflects on lessons learned, changes made and actions agreed. 1 2 3 Encourages excellence (2) – affirms good practice, celebrates achievements and actions accomplished, gives examples of good practice and records aspirations (some of which may have a timescale over one year) 1 2 3 Sign Offs & Statements (1) – ensures the input and output statements, including health and probity, have been completed, commented on and, where appropriate, explanation made to the RO 1 2 3
appraiser_review_form_-_non_clinical_appraisers.docx