Chapter 3 – Personal development planning for SAS anaesthetists
By: Dr Imran Sharieff
In this chapter, we will highlight the importance of personal development planning for SAS doctors. Personal development is a process by which an individual becomes more self-aware, hence allowing them to improve performance and equip themselves with new skills. A personal development plan (PDP) is essential to identify your needs, set objectives and monitor progress. A PDP is an essential component of appraisal and revalidation.
What is appraisal and revalidation?
Revalidation is a mandatory process for every licensed doctor on the General Medical Council (GMC) register and the requirements for SAS doctors are no different than for consultants. One revalidation cycle is 5 years. Appraisal is an annual process of facilitated self-review. A responsible officer, usually the medical director in your Trust, will make recommendations to the GMC regarding your revalidation. Outputs from your annual medical appraisals, over a 5-year period, will help your responsible officer make these revalidation recommendations.
How difficult are appraisal and revalidation?
It may sound intimidating, particularly to colleagues who are new to the NHS. Indeed, failure to engage and participate in the appraisal and revalidation processes may put your medical licence at risk; however, the overwhelming majority of SAS doctors do not have difficulty. The standard to comply with appraisal and revalidation is not high. Appraisal should be developmental, and assurance focused, and it is not a pass or fail exercise.
Isn’t appraisal and revalidation just a tick box exercise for SAS doctors?
If approached with this attitude, then appraisal and revalidation can be just an exercise in doing the bare minimum. This can be true for doctors of all grades. However, in these circumstances, it is unlikely that an SAS doctor will get much out of the process. On the contrary, many SAS doctors find it valuable to take the time to reflect and discuss their professional development and practice as a doctor. If done well, appraisal can prevent stagnation and spur an SAS doctor to improve their career and wellbeing. It can give focus, direction, and recognition to your professional development as an SAS doctor.
Other than appraisal and revalidation, why do I need professional development as an SAS anaesthetist?
Regardless of background or grade within the medical profession, all doctors should have the opportunity to develop themselves. When SAS doctors are allowed to reach their full potential, there are huge personal benefits. In addition, there are inevitably, benefits for patients and organisations. A fulfilling and satisfising SAS career is one where there is access to and engagement with development opportunities.
For individuals aspiring to become a Specialist they need to demonstrate that they can critically assess their own learning needs and have a PDP to enable them to lead and develop services.
Do I have access to an educational supervisor?
SAS doctors are by nature a very diverse group. Some are early in their SAS career and may only have a few years in the specialty, whereas others are more senior, with extensive experience. Some colleagues will have been in formal postgraduate training within the UK and many others will have been in training or completed training from abroad.
There is no obligation for Trusts to provide SAS doctors with an educational supervisor; however, some Trusts are leading the way and providing early career SAS with a dedicated educational supervisor and funding the role. You should ask your department if this is something they have or aspire to introduce.
Of course, many senior SAS doctors are themselves educational supervisors to undergraduate and postgraduate doctors. Medical education is itself a worthwhile and gratifying professional development activity. There are no educational roles that are off-limits to SAS doctors, as long as they can demonstrate they meet the specification required of the position.
How can I get time for professional development?
All SAS doctors have the contractual right to supporting professional activities (SPA) time. A common myth is that SAS doctors are only afforded one programmed activity (PA) of SPA per week. This would equate to 4 hours. However, this is an absolute minimum and not a target. The Academy of Royal Medical Colleges recommend a minimum of 1.5 PAs of SPA for all SAS doctors. The British Medical Association recommends a minimum of two PAs of SPA for the majority of SAS doctors over threshold two of their specialty doctor contract or for all Associate Specialists and Specialists. The appropriate SPA time for you should be agreed through job planning.
What should I do in my SPA time?
SPA time should not be used for direct clinical care or any admin related to direct clinical care. SPA time is an opportunity for you to do the non-clinical work necessary to fulfil your appraisal and revalidation requirements. In addition, you might want to undertake additional teaching, research, clinical management or medical education roles. All of these might well require additional SPA time. You are not expected to do professional development activities, including appraisal preparation, unpaid in your own time.
What if I am unable to use my SPA time?
You cannot be forced to give up your SPA time in order to do direct clinical care. If, due to extenuating circumstances and mutual agreement, you are unable to utilise your SPA time, then you should have this SPA time returned. If you find that you are regularly unable to take your SPA, then this is a contractual breach, and it should be raised urgently with your clinical director.
How much study leave do I get and what should I do with it?
SAS doctors also have a right to take up to 30 paid days for professional or study leave, with expenses, within a 3-year period. Some employers will interpret this as 10 days per year. Whatever the local circumstances, please try to utilise your full quota of professional and study leave. Some examples of things that you might consider doing with this leave include:
- Study, usually but not exclusively or necessarily on a course or programme
- Research
- Teaching
- Examining or taking examinations
- Visiting clinics and attending professional conferences
- Training
Who else will support my professional development?
Across England and the devolved nations there are colleagues appointed to support SAS professional development within each Trust or health board. In England and Wales, they are called SAS tutors, in Scotland they are SAS education advisors, and in Northern Ireland they are the SAS leads. These individuals are responsible for providing local support and guidance for SAS professional development. They are likely to work closely with your Director for Medical Education (DME), may arrange local SAS educational courses or webinars, and may organise an annual SAS professional development day. In England and Wales, the SAS tutors also work collaboratively with a regional Associate Dean for SAS doctors.
If you have a question, concern or any other issue with your professional development as an SAS doctor, your SAS tutor, SAS educational advisor, or SAS lead, can be approached to help you.
What funding is available to support my development as an SAS doctor?
Trusts will have a local policy on a study budget for consultants and SAS. The annual study budget allowance will vary from Trust to Trust but is in the range of £500–£1000 per year. This money can be spent on relevant courses, seminars and conferences, as well as any reasonable associated costs (travel, subsistence and accommodation). It is really important to keep receipts of all of these expenses and any certificates awarded, as these will be needed in order to claim reimbursement. It is not possible to use your study budget to pay for membership or examination fees.
What about other sources of funding available to SAS?
Additional to the individual SAS study budget, there is also central funding for SAS development. For example, in England, Associate Deans will administer a regional fund that will be allocated to Trusts and spent under the direction of SAS tutors. This SAS specific professional development funding is often used to create a programme of free SAS educational events within Trusts. Money from the fund might also be spent on SAS away days, SAS professional development days and in some cases, to fund the SAS tutor post.
If you have an additional professional development expense that cannot be met by your individual study budget, your SAS tutor (or equivalent) might consider an application to help cover these costs. An example might be funding to help cover the cost of a Postgraduate Certificate in Education (PGCE), Master of Business Administration, or other academic qualification. Your Trust may also have funding streams, separate to the SAS professional development fund, for such qualifications.
Do I have to have a specific consultant as my appraiser?
Appraisal should not be a hierarchical process and there is no reason why your appraiser could not, for example, be an SAS doctor. You should have the ability to have some choice in who appraises you. If you perceive that there is a conflict of interest in a particular person, then you have the right to ask for an alternative appraiser; this should not cause offence.
Can SAS doctors become appraisers?
Absolutely they can. In fact, more SAS appraisers are needed and encouraged. There are several benefits to becoming an SAS appraiser.
- You should receive remuneration (within your job plan) for work as an appraiser.
- Many SAS colleagues (and some consultants) will prefer to have you as their appraiser.
- An increased understanding of the appraisal process will benefit you in your own appraisal.
- Training is provided on communication and listening skills. These are applicable in other areas of your practice, e.g. in educational and clinical supervision.
What are the important components of appraisal?
The annual appraisal has three components:
1. Appraisal inputs
This will include the preparation of an appraisal portfolio with supporting information. In most Trusts this will be on an electronic platform. It can take time to get familiar with these systems. It is recommended that you start your preparation early and submit in good time.
2. Appraisal meeting
This is a confidential meeting with your appraiser. It is protected time for you to focus on the work that you have done over the past year. You should think about your achievements, challenges, aspirations, and personal development plan (PDP) for the next year.
3. Appraisal outputs
This will include your agreed PDP objectives and an appraisal summary written by your appraiser.
How should I prepare for my appraisal?
You do need to provide supporting information on the following:
- Continuing professional development (CPD)
- Quality-improvement (QI) activity
- Significant events
- Feedback from patients
- Feedback from colleagues
- Compliments and complaints
You do not need to submit every possible certificate or piece of evidence that you have collected during the year. To do so may be hugely time consuming and is unnecessary. For example, if you have provided evidence of a skill or activity once, there is no need to provide multiple examples of the same skill or activity.
What is reflection?
An important aspect of appraisal is that it is a reflective process, and this should be demonstrated throughout. For instance, you might have extensive amounts of supporting information, demonstrating much time spent in CPD and QI activities, but without reflection it will be a poor-quality appraisal.
To reflect means to give serious and careful thought to one’s own medical practice and to consider the learning from each piece of supporting information. Reflection is relevant for both positive and negative experiences and there is no one set way to reflect. It is important that there is evidence of this reflection both in the submitted appraisal and during your appraisal meeting.
Will my own reflection be used as evidence against me?
You should not include any identifiable patient information in your appraisal. In fact, your reflection does not need to include the full details of any particular event. It should however capture your learning outcomes. Everything discussed at an appraisal is confidential between the appraiser and the appraisee unless issues arise that may indicate a patient safety risk.
What are good CPD activities for an SAS anaesthetist?
Anything that materially contributes to your knowledge, skills, attitudes and behaviours as an SAS anaesthetist may be considered CPD. This might be formal and informal, internal or external learning activities. CPD is individual to you and should be relevant to your learning requirements. There is no single form of CPD and in fact doing a mix of different activities is likely to be more effective. Learn@ is an extremely valuable CPD resource exclusively available to members, containing more than 1000 videos of talks from Association events. These are categorised and searchable by date, speaker, event, title, keyword or any combination of those. The system will allow you to create and store a CPD record of your reflections on these videos, and to record any other CPD activities you undertake.
You should strongly consider joining the SAS professional development events at your local and regional level. You may also want to consider attending regional, national, and international meetings, webinars and conferences. As a member of the Association of Anaesthetists you will have discounted access to a full range of such professional events that are relevant to your practice.
How many annual CPD hours should I complete?
Again, appraisals are not pass or fail. Every college has different rules on what constitutes a CPD ‘point’ and how much one should accumulate each year. The Royal College of Anaesthetists (RCoA) recommends that every anaesthetist should complete a minimum of 50 hours of CPD per year. This includes a minimum of 20 hours of internal and 20 hours of external CPD. The GMC simply requires you to have enough CPD to remain up-to-date and fit to practise.
How often do I need to collect feedback?
You are required to collect patient feedback, using a formal feedback exercise, at least once in every revalidation cycle, i.e. once every 5 years. Similarly, you are required to collect formal colleague feedback, once every 5 years. You can include informal feedback as part of your appraisal at any point of the revalidation cycle.
What QI activity should I do as an SAS doctor?
You are required to demonstrate that you have participated in QI activity at least once in your revalidation cycle. This QI activity might be one of many forms:
- Clinical audit
- Audit of prescribing activity
- Review of performance/morbidity and mortality statistics
- Case review or discussion
- Learning event analysis
- Audit of effectiveness of teaching
- Evaluating effectiveness of health policy or management practice
- National audit projects, e.g. National Emergency Laparotomy Audit
There is no QI role that is outside the scope of an SAS anaesthetist. SAS doctors are ideally situated, as permanent members of staff, to identify issues where improvements can be made and to lead on such projects. Improving quality is about making healthcare safe, effective, patient-centred, timely, efficient and equitable. The best QI work involves patients and uses collaborative team-working within teams. Many SAS doctors have been locally and nationally recognised for their contributions to QI.
The RCoA has a QI compendium with useful recipes for audit and QI projects. In departments working towards gaining or maintaining Anaesthesia Clinical Services Accreditation (ACSA), all anaesthetists, of all grades, will be needed to contribute to the required QI. Many of the ACSA standards are reflected in the RCoA QI compendium.
What are appropriate PDP objectives for an SAS anaesthetist?
Your PDP objectives are entirely related to your learning and development needs as an individual. They are essentially an outcome-based learning plan for the next year of your practice. Appraisers will help and advise you on constructing PDP goals during your appraisal process. Your objectives should be SMART (specific, measurable, achievable, relevant and time-bound). There is no set minimum or maximum number of PDP objectives required by the GMC.
Although you should commit to completing all of your PDP objectives, it is recognised that circumstances and priorities may change during the year. At PDP review, some objectives may need to be discarded, revised or included again in the following year.
Summary
Every doctor is obliged to have an annual PDP that is reviewed at appraisal and discussed at job planning. SAS anaesthetists have access to paid time, reimbursement for expenses and other funding, and support from SAS tutors (or equivalent) for a range of generic and specific professional development activities. Your job satisfaction, career progression and own wellbeing can all be enhanced by embracing personal and professional development opportunities.