Appraisals and Revalidation (02 October 2025)

SPEAKER_02 0:14

So, hello, and welcome to Consultant Conversations, which is brought to you by the recently appointed Consultants Committee at the Royal College of Physicians of Edinburgh. My name is Ayla Schnimo, and I'm a member of the recently appointed consultants committee, and I'm a kidney consultant working in Bristol. This podcast series has been developed to try and support early career consultants, and today we're going to be discussing appraisal and revalidation. I'm joined by one of my colleagues, Dr. Alex Hodsman, who's also a kidney consultant here in Bristol and is an appraiser for our trust. From my perspective, I hadn't really considered what the appraisal process would involve before I started working as a consultant, and we hope that we'll be able to cover the essential information about this process and our experiences with it over the next 20 to 30 minutes. So thank you so much for joining us today, Alex.

SPEAKER_01 0:58

Thanks for having me. Just give you a little bit of my background, Ailish. So yeah, I've been a kidney consultant for 10 years now, and I took on the role of an appraiser pretty much as I started as a new consultant. There was an appetite in the department to have a third appraiser. We had two already in the department, and so took it on when I started. So it's something that I very much enjoy, and I guess I probably do somewhere between about 50 and 20 consultant appraisals a year now with a variety of different colleagues, both within specialty and from other specialties in the trust as well. That's great.

SPEAKER_02 1:34

So you've had some experience now over the course of your career. I thought first of all, it might be helpful just to clarify what we mean by appraisal and revalidation and what the difference between these two processes is.

SPEAKER_01 1:45

Yeah, so both sort of come into the appraisal process. So I guess I always see appraisal as being the two bits, the revalidation bit and the regulatory bit for the GMC. So when I complete an appraisal, there's a checklist that we have to go through that's provided by the GMC sort of good medical practice framework. And I look based through the conversation that I have with the appraisee and their documentation that they provide me with to make sure that they're fulfilling those requirements and that I can document some evidence, those bits have been completed. So revalidation is the process that checks that doctors' licenses will continue and that they're fit to practice. And so, as I say, there are various aspects of good medical practice that we have to show evidence for every five years to make sure that we remain fit to practice. And the revalidation process itself involves appraisal. So to be revalidated, you're required to have between four and five appraisals in that five-year cycle. So I know for our trust, they expect four appraisals in the five-year cycle. I think it's a bit variable from trust to trust. We're expected in our trust to have an appraisal every year, every 12 months. But I understand from my appraiser training that in some trusts, that time scale has been expanded a bit. So hence the reason for some variation in the number of appraisals that's needed. As well as the appraisal, there are other bits that are necessary for revalidation, for example, consultant and colleague feedback and patient feedback as well, as well as probity and health declarations. So I think that probably covers most of the bits that are needed for the revalidation. And then the appraisal process is a bit more about reflecting on your practice in the previous 12 or 18 months. And for that bit, an individual needs to look at their sort of whole scope of practice and make sure that they have appropriate things like CPD and evidence of reflection, which I guess most of us are used to having done throughout training now as well. But the appraisal process must cover your whole scope of practice. So, for example, if you're an academic or you do private practice or medical-league or work, it needs to include reflections on all of that and appropriate CPD and things to cover all of that.

SPEAKER_02 4:02

So you've covered that the appraisal is generally an annual process and that's done in person with an appraiser at the trust that you work. Is revalidation something that you attend in person?

SPEAKER_01 4:14

So, no, revalidation, most trusts will have a designated officer or body within the trust who'll be responsible for making sure that all their consultants are revalidated. So, as an appraiser, I undertake the annual appraisals and they then go through the evidence, including the completed paperwork from the appraisal, to make sure that each consultant has completed everything they need to do to be revalidated. So that will include, as we mentioned, four to five appraisals usually, evidence of colleague and patient feedback, and the probity and health declarations, and they'll have that all collated and then put it through the GNC once they're satisfied, they've got everything they need to revalidate an individual doctor.

SPEAKER_02 4:57

Thank you. And you mentioned at the beginning that you've done appraisal for people within the department that you work, but also consultant colleagues in other areas of the hospital. Who does our appraisals?

SPEAKER_01 5:09

So certainly in our trust, there are, I'm not quite sure how many appraisers actually there are within the trust, but I think anyone can become an appraiser should they wish to. There's obviously a training process. So there's a bit like being an educational supervisor, there's an initial training course. There is an annual appraiser review that we undertake. I think it's a day or half a day a year for training. And then I'm also an educational supervisor. So I find that the two and a half days every five years that you need for educational supervisor training often cross-pollinates with the kind of training that's useful for being an appraiser as well. So, for example, I think I've done a mentoring course and I think I'm doing a coaching course this year. So those kind of skills are very useful for being an appraiser as well.

SPEAKER_02 5:55

And just following on from that, can we choose who our appraisers are?

SPEAKER_01 6:00

We do. So in Bristol, yes, we're able to select our own appraisers. I understand from my training that in some trusts that's not the case, and appraisals are sort of allocated. So as appraisers, they've set their expectations much more clearly, actually, in the last couple of years from the revalidation trust bit. So I think we're expected to undertake at least eight appraisals a year, which I guess is reasonable to keep your skills and like any bit of medicine, keep your skills up. I tend to do about 15 to 20 a year. I tend to do most within departments. So within our department, we were quite keen to have the availability of enough appraisers to be able to undertake in-house departmental appraisal. And really that means having three appraisers because you can only do three appraisals with one person, and then you have to have someone else, which again, I guess, is a sensible thing because you get something different from each appraiser. Obviously, some departments are much smaller and don't have that capacity. So within the trust, the other people that I've tended to appraise have been are transplant surgical colleagues and my subspecialty areas, renal sportive care as well. So I've also undertaken appraisal from palliative care colleagues who, again, I have something clinically in common with, and that's been quite helpful. It's useful to have an appreciation of someone else's job and how they work. I think it would be not impossible, and maybe I should give it a go, but I think it would be more difficult to undertake appraisal for someone whose job was very, very different from my own, maybe for a psychiatrist or a surgeon. But maybe I should challenge myself. It would be interesting to see what you can see when you're possibly a little bit more objective from someone else's work.

SPEAKER_02 7:45

Yes, and I'm sure that goes both ways as the appraiser, but also as the appraisee, and that you might get different things out of appraisals with different colleagues. I know that you've touched on this already, but there's obviously a lot of different components that you look at within an appraisal. So you've talked about people's CPD record, considering feedback, complaints and compliments, their health declaration and probity statement, and also considering PDP. There's a lot of information there to gather. Do you have any suggestions or recommendations on how best to collate all of that information? And also thinking about what kind of evidence is required. So, for example, for things like complaints or compliments, what do you expect to be put in if we're needing to address those components?

SPEAKER_01 8:28

So, I guess as to say, the biggest things that I always take from my training and what always sort of sits as the most important central tenet to it all is making sure that the evidence you collect reflects your scope of practice, whatever that may be. We've talked about private practice and academia, and also making sure that you've provided evidence that you're a reflective doctor. I think those would be the key things that I would ask people to do. When you fill in the paperwork, and I think all different trusts have slightly different paperwork, but obviously most of the electronic paperwork now will bring up the GMC domains and the expectation. So providing evidence through your CPD or through your quality improvement or through your audit often is good to have the evidence. So there's four main areas. So there's now I've got to remember it, there's trust and professionalism, communication, quality improvement and knowledge and skills. So I guess thinking about those four areas and making sure that you've provided evidence and evidence of reflection as well in those four areas is good. For a PDP, I'd usually suggest, I guess, again, most people are quite familiar with PDPs in training. For appraisal, I would say they can be a little bit more aspirational because you're going to be in your job for probably the next 20 years, and therefore you can think a bit further ahead rather than just the next year, which tends to be how things work in training. However, I would suggest that it's helpful to have maybe three or four PDP items, no more than that. One that you will almost certainly achieve. So sometimes, particularly in first year of appraisals, it's useful just to put things like achieve my CPD or do my mandatory training, something that you're guaranteed to do, something that you're involved in, so maybe an audit project or a QI project. And then the third one, something slightly more aspirational that you might not achieve in a year, and might be something that's more of a kind of five-year goal. And that gives three good talking points and also is useful to do. Of course, your PDP doesn't necessarily have to be to do with your work goals as well. For some people, it might be a sort of more personal goal as well. So it is about the well-being of the whole doctor, not just work sometimes.

SPEAKER_02 10:41

Yeah, that's a really nice way of thinking about it as a much more holistic process, thinking for the longevity of your career, isn't it?

SPEAKER_01 10:48

Yeah, and I would say that new consultants often come into appraisal, worrying that it's very like the ARCP process and the training process. And I always try and reassure people and make people feel that this is, you know, the rest of your career and it is a much more aspirational experience and less of a checklist that you've completed all the curriculum points. I think it should be a much more enjoyable experience than sometimes all the sort of educational processes through training. But obviously, there is that regulation that you still need to go through and make sure that that's all in place.

SPEAKER_02 11:22

And this might be a silly question, but thinking of our RCP where it's a very much kind of pass-fail process, do you have such a scheme when you're completing an appraisal?

SPEAKER_01 11:31

So I look through all the points of a GMC framework and I like to make sure that I can provide some evidence, either of reflection or something that that doctor's achieved, to make sure that I'm doing my job as an appraiser and that I'm sure that they've completed all those regulatory processes. We may come on to this a little bit later, but I guess if there's concerns, then I feel like the training I'm provided with would give me the skills to know where to go in the same way that I would as an educational supervisor as well, and how to help that consultant get some additional support or when and have concerns what to do next.

SPEAKER_02 12:08

Yeah. And I guess that leads on to the next question, which was just thinking that in this process, you know, when it is considering people's kind of whole scope of practice and maybe kind of personal aims as well. I imagine at times some sensitive information has potential to come up during a person's appraisal. And I was wondering if you had any kind of guidance on how kind of confidentiality is dealt with in that situation or how you as an appraiser might deal with information that is brought to light during an appraisal.

SPEAKER_01 12:35

I mean, it's a very privileged position. It's nice to have a confidential conversation with colleagues, and mostly that's a really positive experience, and it is hearing about people's longer-term personal and professional goals, and that is a real, real privilege. Obviously, we have a duty, if there's anything shared that is of potential patient safety risk, and I would then discuss that, I guess, with my senior colleagues in the revalidation process, if I had any significant concerns. I've never had to do that, so I've not got a great deal of experience to share in that way. Often, I think if people are struggling and having problems at work, then one thing I think the trust would see is that people then often don't engage in the appraisal process. So I guess that raises alarm bells in itself if there are specific doctors who aren't engaging in the process. So often that sort of triggers concerns and worries from there, I suppose. But yes, it is a confidential conversation. I guess the training is similar around the educational supervisor process. It's knowing the right way to go. So, you know, asking someone to see their GP if you're concerned, or referring them to occupational health, or going through some of the well-being avenues in the trust if there are specific things that people need help with. But yes, obviously, if there's something very concerning from a patient safety point of view, that'd have to braid confidentiality at that point. That would be the only reason for doing it, I think.

SPEAKER_02 14:04

You mentioned that there's variation between the different trusts in terms of how many appraisals people have to have before their revalidation process. And I was just thinking for some people, there may be periods of extended leave, so perhaps sick leave or parental leave during their time as a consultant. Does that have an impact on the appraisal process or CPD requirements?

SPEAKER_01 14:24

So I think people worry about that a lot. So I've definitely had colleagues who've had maternity leave and things. And I think I meant when I have maternity leave, feeling the same, thinking, oh my goodness, how am I going to revalidate because I've missed an appraisal or one or two appraisals because maternity leave can be a little bit over a year sometimes, sort of 14 or 15 months sometimes. Our trusts certainly are very helpful and supportive around that. So there is allowance made for the fact that you've had a period of time off work and your appraisal for that revalidation period should reflect that scope of practice during that time. And so certainly our trusts are very supportive. I think the timing between appraisals often reflects resource in each trust, and I guess that varies from trust to trust. In terms of CPD, again, I think obviously there are raw colleges set requirements for points for external and internal CPD. I tend to say I don't count points when I look at my appraisees. I tend to look more about whether their CPD reflects their scope of practice. And I think the general view nationally and from the colleges is more to that sort of end now, rather than having to have specific numbers of points. Generally, most doctors are actually very good at their CPD, and people tend to have more rather than their CPD. I would say we're quite good at keeping up with that. And also there's lots of stuff that you just do in your job that counts as CPD as well, certainly the internal stuff. So the MDTs you go to. So for us, I certainly usually put things like our biopsy meetings in our CPD because it's a learning experience, and obviously all the self-directed learning as well. So podcasts, things like this, all that sort of stuff counts towards your CPD. And we all do quite a lot of that, I think.

SPEAKER_02 16:06

Yeah, definitely just keeping a track of it, isn't it? Provides the evidence of it at the end.

SPEAKER_01 16:12

So I guess that's a good tip, actually, just making sure you put some little reflections down or just the things you got out of a bit of CPD is quite good every so often, just keeping that sort of record through the year.

SPEAKER_02 16:25

No, we talked a little bit about PDP, and she said sometimes it's good to have something that's a bit more aspirational that you might try and work towards over a longer period of time over the course of your career. I wondered, in terms of your appraisal training, you've obviously gained a lot of skills in kind of coaching and mentoring alongside it. But I guess at times the PDP will fall out with your scope as an appraisal. So if people want to develop a certain aspect of their job, the appraisal process is completely separate from the job planning process. Do you feel that you're able to kind of help provide people with some support and advice about what are sort of sensible or realistic goals during the process?

SPEAKER_01 17:02

Yeah, I think so. I think sometimes changing your job plan can be part of your longer term goal. So I've certainly had that, I think, within my own PDP and in appraise as well. So I guess that's not actually uncommon. I guess the role is slightly different in that you're not acting as the clinical lead's role to actually do the mechanics of the job plan, but it can be something more aspirational, like you want to do more research or you want to do some more educational stuff. So I guess it's more the kind of overall goal rather than the mechanics of actually physically changing your job plan. But it's actually quite a common thing, I think, that people have, particularly maybe once you get sort of three or four years into your new consultant role and it's a bit more clear where you want your career to go. It's not surprising that that may form part of a job plan. I guess it gives people that real space to explore how they might go about that or how they might achieve that change that they want in how their job works. And then I guess that helps leading onto conversations with clinical leads and things to actually change the mechanics of your job plan. So, yeah, absolutely. I think that's quite a common thing. Obviously, some things, sometimes it's research goals, sometimes it's educational goals, is all sorts of things I think that people put in their PDPs. That's the best bit of the appraisal process is the PDP and the discussion of the more sort of aspirational aspects of things. Yeah, it's lovely.

SPEAKER_02 18:27

And obviously, through the appraisal process, you're going to be collating evidence and reflections over the kind of five-year period. Do you have any specific advice about preparing for a revalidation as opposed to appraisal beyond what you might have included in that annual appraisal process?

SPEAKER_01 18:44

Um, so I guess the main bit is the colleague feedback and the patient feedback. It's quite specialty dependent, I think. So obviously, I appraise quite a lot of nephrologists and kidney doctors. For us, because we do lots of outpatient work, it's quite easy to hand out a patient feedback questionnaire around a dialysis unit or in an outpatient clinic. I've also, as I mentioned, appraised my palliative care colleagues, and getting feedback from patients is really hard if you're a palliative care doctor. And I guess it might be similar for surgical colleagues. I haven't done quite so much with surgical colleagues. I know my palliative care colleagues that I've appraised start their patient feedback two or three years into the cycle, because obviously when you're looking after people at the end of life, it's quite hard to ask their relatives or ask them for feedback. So I suppose it's quite specialty dependent. Whereas in kidney medicine, a couple of clinics, and you've probably asked 15 people for feedback quite easily. And even with a normal questionnaire response rate, which isn't always perfect, you can probably get the numbers you need. Generally, patients are ever so nice about people, they always write nice things. And if they write critical things, they're often really a bit unusual things that they've found difficult rather than the actual sort of medicines. But 360 colleague feedback, as I guess most people have found in training, is often really sharp on what you might improve on. It's usually really positive as well. But I think colleagues are really good at giving very positive but critically positive feedback. It's useful actually to have that before your final appraisal going into revalidation. From an appraiser's point of view, the patient and colleague feedback also provides really good evidence for almost all the GMC domains. So I always find those slightly easier appraisals to do because actually the feedback kind of covers most of the domains that the GMC wants for regulation. So that is really good for good evidence. But having that done well in that last year, I guess, so that you can discuss it with your appraiser going into that sort of final appraisal is quite helpful.

SPEAKER_02 20:46

Great. So be prepared if you can.

SPEAKER_01 20:49

Yeah. As ever, you don't want to be rushing to do your patient feedback when you've got two months before your revalidation date. It's good to sort of start it at the beginning of that sort of final year. And that's certainly what our trust recommends. Again, I don't know whether other trusts suggest that you do it midpoint in a revalidation cycle. Ours suggest you do it sort of the beginning of the year before you revalidate, which seems kind of a sensible pattern.

SPEAKER_02 21:13

And I think I was just hoping to close now with a question about kind of how your experience is as an appraiser. You obviously talk about it really passionately, but is this a process that you enjoy? Can you tell us a little bit about how you became an appraiser? And finally, is this something that's kind of job planned as part of your job?

SPEAKER_01 21:29

So, yes, as I said at the beginning, I became an appraiser because the department would be keen to have another appraiser. It is job planned. As I say, we're expected to do at least eight appraisals a year, and for that, I think we get 0.25 PAs for appraisals. Yeah, it absolutely is job planned. So I found it really hard for the first three or four years. We had a very experienced senior colleague who's now retired who was one of our other appraisers and supported me a lot through the first few years. It's really hard when you're a year one or year two consultant talking to people who have 10 years of experience and expecting to help them with their careers. But I feel like it is something that I've really settled into. I guess I think I really began to love it during COVID. So it was really lovely to be able to sit down with colleagues and have a really normal conversation about something that wasn't work when we were all very focused on COVID. So that was the point where I sort of felt that it was a really interesting and a really nice part of the job that wasn't that sort of intense focus on patients and clinical medicine. And I guess it's kind of gone from there. And I think that's probably the point where it really switched for me into being something that I really enjoyed doing. It's a nice thing to do. I really like being an educational supervisor as well, and that's obviously quite aspirational with trainees. But I find being an appraiser is a bit more interesting than being an educational supervisor because having more senior colleagues who have great plans for their careers. And it's just fascinating to hear what people want to do with their lives and their careers. And usually what I tend to do with my appraisals is sit down with a coffee and do the regulatory bit first and then have a nice conversation about the more interesting bits of appraisal. So it's a really nice hour to sit down with a colleague and just find out what's going on in their lives and their careers.

SPEAKER_02 23:16

That's brilliant. Well, thank you so much for joining us today, Alex. And thank you for listening in to this podcast. Great. Nice to be here.

SPEAKER_00 23:44

Remember how many hours of CPD you need, or plan your first education supervision meeting. Even if you're not, sometimes it can be difficult adjusting to a new role. The great news is that you're not alone. You probably have a colleague in your hospital who did all of this just last year, or maybe even the year before. Go and ask them about it. Buy them a coffee. Go on. Either way, the recently appointed consultants committee at the RCPE have compiled a top tips guide for recently appointed consultants. This is a compilation of all of the advice we wish that we'd had when we started. You can find the top tips for recently appointed consultants at rcp.ac.uk slash top tips rac. We hope it helps. Okay, the next coffee is definitely on you.