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Problems with appraisal

Drug Dependency Unit, Homerton Hospital, Homerton Row, London E9 6SR

Sir: The National Service Framework for Mental Health highlights the need for rigorous performance management in services, and for the support and empowerment of staff. The Health Secretary, in his recent document, Supporting Doctors, Protecting Patients underlined that effective appraisal is an essential part of achieving those aims. However, at a recent Appraisal Training Workshop for Specialist Registrars in Psychiatry, trainees' reflections on their experiences of appraisal showed a wide variation in its quality.

Appraisal can be a positive experience, especially when it is a dialogue that is both respectful and honest. An effective appraiser will provide a structured way to address issues, building on the trainee's previous experience. Concerns need to be acted on as soon as possible and followed up. There should also be an opportunity to explore areas of weakness, without fear that the trainee's reference will be adversely affected.

Trainees have also had negative experiences. At worst, appraisal has been non-existent, or merely 'going through the motions' with an unmotivated appraiser. Trainees may feel reluctant to insist on regular meetings with an already overworked consultant. Meetings can become focused on service needs and used as an opportunity to delegate work, to the detriment of training requirements. Appraisers can also fail to take a balanced approach, either concentrating solely on the appraisee's strengths or by being overly critical.

In order to improve standards in this area, there needs to be appraisal of the appraisers themselves, and the provision of adequate training to facilitate such an improvement.

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