news focus: With appraisals a compulsory part of NHS life, actors are being used to show staff the right and wrong ways of conducting them. Alison Moore reports

Published: 06/12/2001, Volume III, No. 5784 Page 18

Cringe-making Charles is a blustering consultant in general medicine at Greystoke Hospital. He thinks his reserved specialist registrar, Shona, is too slow at taking down what he wants done during ward rounds and he wants to tell her to buck her ideas up.

The trouble is he is going to have to shift her appraisal because it interferes with his trip to a medical conference in Rio de Janeiro, where he is going to present an oh-so-important paper. He calls her into his office and suggests they do the appraisal immediately. So what's wrong with that?

He is a busy consultant, after all, and surely they can knock it on the head in a few minutes.

Meanwhile an audience of consultants from the London Chest Hospital are looking on in horror.

They show their disapproval with cries of 'Appalling!' and 'No way!'

The consultants are watching a role play in which professional actors demonstrate how an effective appraisal works.

Appraisals for medical staff are now a compulsory part of working life in the NHS.

All consultants are meant to be appraised by April - mainly by their clinical directors - and specialist registrars are meant to undergo educational appraisals.

But how can consultants be trained to carry out effective appraisals? A number of hospitals are looking at role play using actors to get key messages across.

Robbie Swales, the actor playing Charles, and colleague Helen Higham are leading a room of consultants through the right way to handle educational appraisals with their juniors.

Charles does everything wrong, continually coming to the audience and asking them how he should handle things better. He dislikes all that 'touchy-feely, American, female stuff ' and has to be convinced to change his approach - and even when he does, he tends to drift back into his unreconstructed self. 'You have to stop playing God, ' says one consultant in a slightly exasperated voice, as Charles puts his foot in it yet again.

As well as Charles and Shona, the consultants meet Lesley, the general surgeon who is new to appraisals, and Peter, the trainee surgeon who can't stitch. Peter, who comes from a family of successful surgeons and has set his heart on it as a career, will not admit there is a major problem. Now Lesley has to find the words to tell him he may not have a future in surgery.

The role play ends with Peter being 'hot seated' - put in front of the audience of consultants and made to answer their most direct questions - still in character, of course. It transpires he is uncertain about his reasons for going into surgery, is suffering from anxiety and badly needs some time out to consider his future.

All these doctors are caricatures, but ones the audience - made up of consultants from across Barts and the London trust - can recognise and laugh about. Robbie and Helen have played various other larger-than-life consultants while visiting other trusts, only to have doctors sidle up to them afterwards to say: 'Everyone says you modelled it on Dr X. ' Just once or twice, they have had doctors who simply can't see that the overbearing consultant character is doing anything wrong.

Graham Coomber, a healthcare management consultant who delivers the more serious side of the morning's training, believes the non-threatening nature of the role play helps get the message across. The consultants do not have to play characters themselves or reveal too much about their own management styles.

Sean Collins, postgraduate training co-ordinator at the trust, agrees: 'The big challenge is to create realistic environments and situations that occur when appraisals take place. There is still that opportunity for people to step in, while the actors play the roles.

'The danger when people are doing their own role play is that it gets flippant and they come out of character. '

The sessions - run by ATM Consulting and drama-based training company Steps - have run in 20 trusts so far this year, as managers gear up for consultant appraisals.

'There are some enormously resistant people - it is about a culture change, ' says Mr Coomber, who was chief executive of Gwent health authority until March.

'The issues and behaviour you establish in the appraisal need to go back into daily life - you can't be nice here and then be a complete bastard the rest of the time. '

Perhaps most revealing of all is the third role play, where Geoff, the clinical director, has to appraise Stella, the upstart anaesthetist.

Stella's aim is to become medical director - all those TV appearances - but she has absolutely no tact and recently compared a patient to Miss Piggy as she slipped under the anaesthetic.

It is clear from the audience's reaction that dealing with colleagues with little or no insight into their failings is likely to be key in consultant appraisals. 'Where people are in denial are some of the most difficult cases, ' Mr Coomber points out.

Remarkably, Geoff ends up with a roomful of consultants telling him he let his colleague off too lightly and her behaviour really was beyond the pale.