Examples of Challenging Scenarios for Appraisers
As an appraiser, you may occasionally encounter sensitive or complex situations during the appraisal process. Below are examples of challenging scenarios, along with practical guidance on how to respond effectively, professionally, and in line with appraisal principles.
SCENARIO 1 - Disengaged and Disorganised Appraisee
An appraisee is consistently difficult to engage in the appraisal process. It takes multiple compromises on date, time and venue to schedule the meeting. When the meeting finally happens, they turn up late, and the session is frequently interrupted by calls from their receptionist. During these interruptions, they advise their receptionist that patients should either wait until the appraisal is finished or attend A&E.
Despite previous guidance on the importance of reflection, their documentation is mostly just a list of meetings (many of which are drug-sponsored) and brief notes on BMJ articles. There’s no real evidence of reflective commentary or learning.
Recommendations:
- Acknowledge that the appraisee may be under pressure but remind them of the importance of engaging meaningfully in the process.
- Remind them that appraisal is a professional responsibility and is also a chance to reflect, learn, and think about how they want to develop.
- Ask the appraisee to limit interruptions where possible. If the meeting is continually disrupted, consider rescheduling or relocating to ensure a more productive conversation.
SCENARIO 2 - Use of AI in Appraisal
You are appraising an international medical graduate who is in their first job in the UK. On reading their appraisal material it becomes evident that the language used is unnatural and scholastic, the words and grammar used is not something you would usually encounter in appraisal material. You suspect they have used AI to prepare their appraisal information and reflection.
Recommendations:
- Avoid making direct accusations and open a dialogue to understand their approach to preparing their appraisal material
- Explore their understanding of reflection and its purpose in appraisal.
- Explore the appraisee’s understanding of the material and elicit any learning, changes, or reflections on the topic, bearing in mind they may have used AI to overcome a written language barrier
- Offer guidance on the UK appraisal process or signpost them to relevant resources.
SCENARIO 3 - Concerning Patient Feedback
An appraisee brings their patient feedback (360 exercise) to appraisal. The scores under professionalism and courtesy are significantly below benchmark, and only 50% of respondents indicate they would wish to see the doctor again. Free-text comments include:
- “This doctor is rude”
- “I felt I had no time to discuss my problems”
- “Ignored me”
- “Raised his voice”
In their written reflection, the appraisee states:
“I undertook this 360 exercise while we were changing computer systems and as such had no access to patient records. During this time, I regularly ran 30-45 minutes late and despite knowing that I was working under pressure, many patients were rude and demanding. I am therefore not concerned that the feedback is negative.”
Recommendations:
- Explore how they feel about the feedback and encourage them to be open and curious about what they might learn from it.
- Identify patterns or recurring themes in the feedback to help them understand how they’re coming across to patients.
- Encourage reflection on how patients might have felt and what could be done differently next time.
- If it becomes apparent there are deeper issues going on such as burnout or communication difficulties, signpost them to wellbeing services or communication skills training.
SCENARIO 4 - Distress Related to Colleague Behaviour
During the appraisal meeting, the appraisee becomes visibly distressed when discussing their working relationships. They disclose that they find it very difficult working with Dr X, and that this is negatively affecting their mental health and attitude to work.
When asked to elaborate, the appraisee explains that Dr X is often “touchy-feely,” which makes them uncomfortable. They describe repeated physical contact, including:
- Putting an arm around them or patting them on the back.
- Placing a hand on their leg during a recent meeting,
- Giving them an unwelcome hug when alone, during which they felt there may have been “wandering hands.”
The appraisee is clearly upset. When asked if they’ve sought support, they say they’ve only confided in a friend outside of work. They express reluctance to raise the issue formally, citing Dr X’s influence in the department and fear of repercussions. They also mention considering going off sick just to get a break.
Recommendations:
- Be supportive and reassure them that their wellbeing is a priority.
- Explore whether they would consider speaking to someone confidentially (e.g., HR, occupational health or a professional support service).
- Signpost to wellbeing and support resources
SCENARIO 5 - Allegation of Bullying
At the start of the appraisal meeting, you ask the appraisee what they would like to discuss first. They appear visibly distressed and share that, since their appraisal folder was closed, they have been informed that a colleague has made an accusation of bullying against them.
They speculate that the complaint may have come from “an unprepared medical student who recently left a teaching session in tears,” or “possibly a nurse who couldn’t take a joke about her appearance.”
Recommendations:
- Avoid engaging in speculation about who made the complaint or whether it’s valid.
- Encourage them to think about how their behaviour may be perceived by others and how they might adapt their approach going forward.
- Advise them to seek advice from HR or professional services on how to respond to the allegations constructively