Lewis Malcolm, Elwyn Glyn, Wood Fiona
Department of Postgraduate Education for General Practice, University of Wales College of Medicine, Heath Park, Cardiff, CF14 4XN.
Br J Gen Pract. 2003 Jun;53(491):454-60.
Appraisal has evolved to become a key component of workforce management. However, it is not clear from existing proposals for appraisal of doctors whether employers, health authorities or primary care organisations should take responsibility for appraisal processes.
To evaluate the introduction of a pilot peer appraisal system in general practice and to gain insight into the reactions of appraisers and doctors.
Semi-structured telephone interviews combined with participant surveys and documentary analysis.
Five health authorities in Wales.
General practitioners (GPs) appointed as appraisers and volunteer practitioners (doctors).
Twenty-six appraisers were appointed and given training in the appraisal process, each appraising an average of eight individuals. Appraisers and appraised doctors participated in semi-structured telephone interviews and completed separate participant questionnaires.
GPs willingly undertook peer appraisal in a volunteer-based pilot study where participation was recompensed. The majority of participating clinicians were positive, with appraisers reporting the most gain. Appraisers were enthusiastic, provided the process remained non-judgemental and did not threaten or burden their colleagues. Appraised doctors were less enthusiastic but the most significant perceived benefit was the opportunity to reflect on individual performance with a supportive colleague. There were, however, repeated concerns about time, confusion with revalidation and personal development plans, worries about including health and probity queries, and an opinion that the process would be entirely different if conducted with non-volunteers or by representatives of 'management'.
This study illustrated three fundamental problems for appraisal systems in general practice. First, there is as yet no organisational hierarchy in general practice. Perhaps the aggregation of practices into primary care organisations will generate a hierarchy. Second, the question of who conducts appraisals then becomes pertinent; this study illustrates a professionally-led peer appraisal model. Third, the spectre of summative assessment causes problems in appraisal schemes. Typically, only mutually agreed summaries are kept for future use in appraisal systems (for example, for promotion or discipline). So the proposal to use GP annual appraisal documentation as the basis of a summative 'revalidation' exercise is at odds with orthodox personnel practice, which regards appraisal as a formative process.
评估已逐渐成为劳动力管理的关键组成部分。然而，从现有的医生评估提案中尚不清楚雇主、卫生当局或基层医疗组织是否应对评估过程负责。
评估在基层医疗中引入试点同行评估系统，并深入了解评估者和医生的反应。
半结构化电话访谈结合参与者调查和文献分析。
威尔士的五个卫生当局。
被任命为评估者的全科医生（GPs）和志愿从业者（医生）。
任命了26名评估者，并对其进行评估过程培训，每位评估者平均评估8个人。评估者和被评估医生参与半结构化电话访谈并分别完成参与者问卷。
在一项基于志愿者的试点研究中，全科医生自愿进行同行评估，参与有报酬。大多数参与的临床医生持积极态度，评估者收获最大。评估者很热情，前提是该过程保持无评判性，且不会威胁或给同事带来负担。被评估医生热情稍低，但最显著的感知益处是有机会与支持自己的同事一起反思个人表现。然而，人们反复担心时间问题、与重新认证及个人发展计划的混淆、对纳入健康和正直性问题的担忧，以及认为如果由非志愿者或“管理层”代表进行该过程会完全不同的看法。
本研究揭示了基层医疗评估系统的三个基本问题。首先，基层医疗中尚无组织层级。或许将诊所整合为基层医疗组织会产生层级。其次，谁来进行评估的问题就变得相关了；本研究说明了一种由专业主导的同行评估模式。第三，总结性评估的幽灵在评估方案中引发问题。通常，只有双方商定的总结会被保留以供评估系统未来使用（例如用于晋升或纪律处分）。因此，将全科医生年度评估文件用作总结性“重新认证”活动基础的提议与正统人事做法相悖，正统做法将评估视为一个形成性过程。
