‘I brought that up in my appraisal ... and my consultant said no.’ Structure and agency in specialty and associate specialist (SAS) doctors’ experiences of appraisal

Abstract

Specialty and associate specialist (SAS) doctors comprise a significant proportion of the UK medical workforce.Appraisal has the potential to support professional development, as well as being vital for revalidating a doctor's licence to practise.Early research indicated that SAS doctors experienced difficulties engaging with appraisal. It is not clear if the situation has improved over recent years, and SAS doctors' voices are largely absent from the literature. What are SAS doctors' understanding and experiences of appraisal and how do they make sense of them? Our qualitative, phenomenological case study identified four interrelated themes: development, compliance, recognition and wellbeing. The lived experiences of SAS doctors included compliance with organisational processes (including redundant processes) and structures that diminish agency (including unhelpful hierarchies). Positive experiences included support for development and recognition of unacknowledged work. Our research reveals the importance of enhancing the professional status and agency of SAS doctors. There should be structured support and career guidance for new SAS doctors or those changing specialty and an expectation of support for professional exams. SAS doctors may benefit from explicit discussions around wellbeing. Some of these needs may be better addressed by having SAS doctors as appraisers, but this is likely to be insufficient in itself.