The aim of appraisal is to provide an opportunity for individuals to reflect on their work to facilitate learning and development. Appraisal for GPs has been a contractual requirement since 2004 in Scotland, and is seen as an integral part of revalidation. AimTo investigate the outcomes of GP appraisal in terms of whether it has prompted change in medical practice, education and learning, career development, attitudes to health and probity, how GPs organise their work, and their perception of the overall value of the process. Design of studyA cross-sectional postal questionnaire. SettingGP performers in Scotland who had undertaken appraisal. MethodThe questionnaire was based on the seven principles outlined in Good Medical Practice, a literature review, and previous local research. The survey was conducted on a strictly anonymous basis with a random, representative sample of GPs. ResultsFifty-three per cent (671/1278) responded. Forty-seven per cent (308/661) thought that appraisal had altered their educational activity, 33% (217/660) reported undertaking further education or training as a result of appraisal, and 13% (89/660) felt that appraisal had influenced their career development. Opinion was evenly split on the overall value of appraisal. ConclusionAppraisal can have a significant impact on all aspects of a GP's professional life, and those who value the process report continuing benefit in how they manage their education and professional development. However, many perceive limited or no benefit. The renewed emphasis on appraisal requires examination of these findings and discussion of how appraisal can become more relevant.

Introduction: Reflective practice has become the cornerstone of continuing professional development for doctors, with the expectation that it helps to develop and sustain the workforce for patient benefit. Annual appraisal is mandatory for all practising doctors in the UK as part of medical revalidation. Doctors submit a portfolio of supporting information forming the basis of their appraisal discussion where reflection on the information is mandated and evaluated by a colleague, acting as an appraiser. Methods: Using an in-depth case study approach, eighteen online portfolios in Scotland were examined with a template developed to record the types of supporting information submitted and how far these showed reflection and/or changes to practice. Data from semi-structured interviews with the doctors (n=17) and their appraisers (n=9) were used to contextualise and broaden our understanding of the portfolios. Results: Portfolios generally showed little written reflection and most doctors were unenthusiastic about documenting reflective practice. Appraisals provided a forum for 2 2 verbal reflection, which was often detailed in the appraisal summary. Portfolio examples showed that reflecting on continued professional development, audits, significant events and colleague multi-source feedback were all felt to be useful. Reflecting on patient feedback was seen as less valuable because feedback tended to be uncritical. Conclusion: The written reflection element of educational portfolios needs to be carefully considered, since it is clear that many doctors do not find it a helpful exercise. Instead, using the portfolio to record topics covered by a reflective discussion with a facilitator would not only prove more amenable to many doctors, but would also allay fears of documentary evidence being used in litigation.

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This paper describes a qualitative study which explored the possible impact of enhanced appraisal and the requirements of revalidation upon GP appraisers in Scotland. So far there has been little research examining the impact 'enhanced' appraisal may have on the appraisee or appraiser population. Key objectives were to identify potential benefits and problems with the introduction of enhanced appraisal for the appraiser population and to explore what they perceive its impact will be on the GP workforce more generally. Three focus groups were held with a purposive sample of 17 highly experienced GP appraisers from across Scotland between February and April 2010. The results showed that this group of appraisers perceived that they would need to become more prescriptive about the standard of basic paperwork and evidence that is submitted by an appraisee. This created some anxieties about taking on a more judgemental role. They were concerned about a possible need to inform a high-achieving GP that their evidence was insufficient. Concerns were also raised about appraisees becoming less open and candid during appraisal once the links to revalidation are in place. Uncertainty was expressed about the relationship between the appraiser and responsible officer (RO) and how appraisers should decide which appraisees ought to be flagged up to the RO. The need for clear, standardised summary forms (known as GP Scot 4 in Scotland) to be passed to the RO was highlighted. Some of the appraisers were unsure about the value of new types of evidence which will be required--notably MSF and continuing professional development (CPD) credits. However, a few appraisers noted that some early adopters of CPD credits liked this way of recording their learning whilst MSF could be valuable and was seldom controversial. Potential benefits of 'enhanced appraisal' were highlighted--particularly increased engagement from some GPs who have hitherto been reluctant appraisees. The appraisers in this study wanted further training for their role, particularly training and calibration in delivering MSF feedback and in verifying CPD credits. They were frustrated by delays to revalidation and concerned that enhanced appraisal might be implemented without sufficient support (remediation and IT systems) being in place. However, they remained cautiously optimistic that some of the formative elements of appraisal can be maintained and were content to continue as appraisers provided they receive appropriate training and support and provided adequate remediation systems are in place for those GPs requiring help.

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Abstract. In this paper we present the design, implementation, and evaluation of Jiminy: a framework for explicitly rewarding users who participate in reputation management systems by submitting ratings. To defend against participants who submit random or malicious ratings in order to accumulate rewards, Jiminy facilitates a probabilistic mechanism to detect dishonesty and halt rewards accordingly.Jiminy's reward model and honesty detection algorithm are presented and its cluster-based implementation is described. The proposed framework is evaluated using a large sample of real-world user ratings in order to demonstrate its effectiveness. Jiminy's performance and scalability are analysed through experimental evaluation. The system is shown to scale linearly with the on-demand addition of slave machines to the Jiminy cluster, allowing it to successfully process large problem spaces.

We found important issues regarding the arrangements for revalidation which have not previously been described which may impact on the effectiveness of prospective responsible officers.