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How can I meet appraisal requirements if I don't have patient contact?

If you don't have contact with patients as part of your work there are other ways you can meet the requirements expected in your appraisal.

These case studies will help if you:

  • have no direct patient contact
  • work solely in a laboratory setting
  • work in a specialty in which medical care is delivered to patients through other doctors and staff.

Key points to consider

  • You need to collect and reflect on feedback about your performance for revalidation, even if you don’t see patients.
  • If you can’t collect feedback from patients, discuss this with your appraiser and proposed alternatives such as customers or clients or others that you provide services to as a doctor.
  • Think about who you interact with in your day to day practice. If you are laboratory-based, you may work closely with biomedical scientists and laboratory staff. If your role involves delivering clinical practice by advising others, you are likely to regularly communicate with doctors in other specialties.
  • Select those you ask for feedback in a way that avoids bias. For example, by asking consecutive individuals you see, or asking someone else to select who is asked for you.
  • Use an independent survey provider to process your feedback and give you a personalised summary report of your results – don’t collect or collate responses yourself or ask your responsible officer or appraiser to do this.
  • Use the summary report to reflect on what your feedback says about your practice, and discuss this at your appraisal.

Scenario one

Dr Smith is a histopathologist working in a large NHS Trust. Due to the laboratory based nature of his work, Dr Smith does not have any contact with patients or their families or carers. He is therefore unable to collect feedback directly from patients for his revalidation.

How the doctor met our requirements

Dr Smith read our supporting information guidance and discussed his lack of patient contact with his appraiser. He made a list of all the individuals who could provide him with helpful feedback on his work, beyond his direct colleagues. He sent questionnaires to a wide range of individuals and gained a good number of responses on which to reflect at appraisal.

He collected feedback from: 

  • those who receive his histopathology reports
  • hospital consultant colleagues
  • cancer nurse specialists
  • research nurses
  • Bowel Cancer Screening Programme data input staff
  • GPs
  • the coroner and their officers.

He was surprised and pleased to receive very supportive feedback from the cancer nurse specialists and data input staff, who appreciated the clarity of his reports. The coroner was appreciative of the summary paragraph on his autopsy reports, correlating the clinical history with the autopsy findings.

Scenario two

Dr Holditch is a consultant microbiologist and director of a specialist reference laboratory provided by an NHS trust. She provides clinical advice to doctors in various specialties on the investigation and management of infections and also directs the laboratory (managing staff, developing the service etc). She also works on an on-call rota that includes giving clinical advice to doctors and infection prevention and control to nurses and hospital managers.

How the doctor met our requirements

Dr Holditch read our supporting information guidance and noted it advises if you don’t see patients to think broadly about who can give you this sort of feedback on your practice. For example, by collecting the views of people who have a similar role to patients, like patients’ families and carers, students, suppliers or customers.

She made a list of individuals who could provide her with helpful feedback on her work, other than her direct colleagues. Her list included:

  • biomedical scientists
  • medical laboratory assistants
  • clinical scientists
  • clerical and secretarial staff
  • staff in other laboratories
  • ward staff
  • infection prevention and control nurses
  • junior doctors and consultants in her own organisation
  • consultants in other organisations.

Other sources of feedback in this type of role might include:

  • medical laboratory scientific officers
  • anatomical pathology technicians from the mortuary
  • consultant colleagues in a similar specialty
  • medical students or junior doctors, if you are involved in teaching or educational supervision.

She agreed with her line manager and appraiser how many individuals to approach from each group, to get feedback which accurately reflected her practice. She selected colleagues on the basis of who she last interacted with, consecutively and in reverse order, and made sure the questions asked were appropriate for these individuals.

She used appraisal software provided by her employer to collect and collate responses electronically from the staff within her trust.

She supplemented this by asking for feedback from consultants who she had communicated with from outside the trust, acknowledging the limitations of this approach when compared to anonymised feedback at her appraisal.

Dr Holditch analysed her feedback in relation to benchmark data supplied by the survey provider for colleague feedback. She provided appropriate reflections on her feedback at appraisal and identified areas for development.

Useful link

The Royal College of Pathologists has produced a revalidation FAQ.

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