After a decade-long gestation period, revalidation is finally here. Responsible officers (ROs) will make the recommendation for revalidation based on quality-assured appraisals, including the personal development plan (PDP). ROs will therefore take a keen interest in the standard of PDPs.
The case for change
Currently, PDPs vary widely. Some are too detailed, others too brief, often vague and written to a poor educational standard.
There may be no link to learning needs, focusing only on 'wants' or items unrelated to work. These may not be congruent with the commentary and context of the appraisee.
Signing off the previous year's PDP is also done inconsistently. This matters because perfunctory PDPs will not lead to better patient care or better support for GPs.
Standards and approach
Attention and energy need to be devoted to building a good PDP.
The PDP is not a learning log. It is a strategic and deliberate approach that sets a direction for the GP.
The PDP is a formal agreement and a key output of the appraisal.
Although appraisees are responsible educationally for their PDP, the appraiser is responsible in terms of governance. A poorly formulated PDP could expose the appraiser.
Ideally, appraisees should put forward their own PDP. It should then be discussed by reference to individual learning needs. The appraiser's role is to 'hold up a mirror' to the appraisee.
Standards exist that define a good PDP. I set these out in four areas: identification of learning needs, fit for purpose learning methods to meet those needs, writing SMART (specific, measurable, achievable, relevant and time bound) objectives, and documenting proof of learning and change.
In an appraisal, many matters are identified from the discussion and the supporting information. This generates a list of learning needs.
These can consist of personal, practice, local and national needs.
At least three learning needs should be included.
Priorities will need to be decided. However, this can lead to conflict.
For example, a GP may want to undertake development in a particular interest, such as cardiology. But the doctor may have an unresolved complaint about a missed diagnosis of ectopic pregnancy. The PDP should therefore ensure these gynaecological learning needs are addressed.
A skilled appraiser will recognise conflict and agree outcomes linked to motivation for change. All significant matters, including complaints and extended roles, should be included in the list of needs.
Valid learning methods
Although learning is focused on acquiring knowledge, only a small proportion of this knowledge is actually put into practice.
The strategic aim of appraisal is to move doctors from knowing to doing - improving performance.
For each topic, drill down to discover the desired outcome in terms of knowledge, skills or attitude.
This also makes clear the evidence that needs to be kept. For example, learning about AF could involve reading a guideline, whereas a plan to do minor surgery requires a course to develop skills.
An educational framework such as Miller's pyramid can help in setting goals and driving behaviour change.
Writing SMART objectives
The PDP should be written up in educational language: why a goal was chosen, the objectives, the learning method to be used and why, the outcomes specified and the information required for verification. This is the minimum dataset for a PDP.
A useful approach is to link goals to the NHS outcomes framework and the GMC's four domains. Unfortunately, current documentation templates do not all lend themselves to writing the minimum dataset.
Learning and change
The supporting information to be provided for each goal should be specified at the outset and must include an element of measurement. This will assist in signing off the achievement.
GPs should expect a detailed discussion of their progress. For example, 'attended course on diabetes' would invite discussion about the impact of the course. If the PDP is not achieved without a cogent explanation, the appraiser should tick the 'disagree' box in the medical appraisal guide documentation.
Appraisal is key to the future of general practice and can improve support for GPs. A revalidation-ready PDP is an essential step towards improving practice.
- Professor Lakhani is a GP and appraiser in Leicestershire and past chairman of the RCGP
- RCGP. Personal Development Plan (PDP): guidance for appraisers. www.rcgp.org.uk/revalid ation-and-cpd/ cpd-credits-and-appraisal.aspx
- Khan A, Charlton R, Rughani A et al. Appraisal - reflecting learning and becoming even better. www.essentialgptrainingbook.com/resources/web_chapter_09/09%20appraisal.pdf
- Rughani A. The GP's Guide to Personal Development Plans. Milton Keynes, Radcliffe Publishing, 2001.