Quick Answer
The Quality Improvement (QI) section is where you show that you have looked critically at some aspect of your work, identified whether it could be improved, and reflected on what happened as a result.
Why This Matters
This is an essential section of the appraisal.
Importantly, this is a quality improvement activity section — not necessarily a formal quality improvement project.
You can absolutely include a full audit or QI project, but there are lots of other activities that can also count.
The GMC requirement is that you actively participate in relevant quality improvement activity at least once during each revalidation cycle. So, at least once in the five-year cycle, this section should contain a more formal piece of work such as an audit or quality improvement project.
What Does the Guidance Actually Require?
The GMC requires doctors to actively take part in quality improvement activity relevant to their scope of practice at least once during each revalidation cycle. It does not say that you must complete an audit every year.
In practice, however, the usual appraisal expectation is that you can show some form of quality improvement activity each year. This does not need to be a large formal project — it could be an audit, case review, prescribing review, teaching evaluation or another relevant QI exercise.
What Counts as Quality Improvement?
A large proportion of doctors use 2–3 case-based discussions as their quality improvement activity, usually written up on a structured proforma and discussed with a consultant or senior colleague.
| Type of QI activity | Example |
|---|---|
| Audit | Reviewing current practice against an agreed standard, guideline or target. |
| Re-audit | Repeating an audit after changes have been introduced to see whether practice has improved. |
| Quality Improvement Project | Identifying a problem within a service, introducing changes and measuring whether those changes improve care or efficiency. |
| Teaching and Feedback | Delivering teaching, gathering feedback and using this to improve future teaching sessions or educational programmes. |
| Reflection / Case Review | Reviewing a case, group of cases or an aspect of your own practice to identify learning and changes you could make. |
| Guideline Compliance | Reviewing your clinical practice against local, NICE, Royal College or other recognised guidance and identifying areas for improvement. |
How to Do Quality Improvement Properly
- 01CHOOSE A TOPIC
Pick something relevant to your work
- 02REVIEW IT
Audit, case review, prescribing review,
documentation review, service issue etc
- 03DISCUSS / ANALYSE
What did you find?
What went well?
What could be better?
- 04IDENTIFY LEARNING
What did you learn from the exercise?
- 05MAKE OR CONSIDER A CHANGE
Change practice, improve a process,
or confirm current practice is appropriate
- 06REFLECT
Write up what you did, what you learned
and what happened as a result
See It Done
There is more than one way to demonstrate quality improvement. Choose the route that best reflects your work, then make the evidence and your own learning easy to follow.
Audit / re-audit
Check your practice against a standard and measure it.
- What the audit was about
- Standard or guideline used
- Methodology: who, what, when and how
- Results with data or charts
- What needed improving
- Intervention or change made
- Re-audit results, if completed
- Learning and reflection
- Audit slides or written summary
- Results table or graphs
- Action plan or intervention
- Re-audit results, if completed
A few slides can be enough when they clearly cover the method, results, intervention and re-audit.
Teaching with feedback
Teach others and use feedback to improve your teaching.
- Topic and learning objectives
- Who you taught and when
- Teaching methods used
- Feedback collected
- Summary of key feedback
- What went well
- What you would change next time
- How you will improve future teaching
- Teaching slides or materials
- Feedback forms or results
- Summary of feedback
- Reflection on what you learned and how you will improve
Show both the teaching and the feedback you received.
QI activity / project
Identify a problem and implement changes to improve care or processes.
- What the problem was
- How you identified it
- Aim of the improvement
- What changes you introduced
- How you measured impact
- Results or impact of the change
- Challenges and learning
- What you would do next
- Project summary or short written summary
- Data or before-and-after information
- Meeting notes, action plan or PDSA cycles
- Outcome or impact measures
Make the cycle visible: plan, do, study and act.
Case-based discussion (CBD)
Discuss a clinical case with a consultant or senior colleague to gain learning.
- Brief anonymised case summary
- Why you chose this case
- Key issues or decisions
- Discussion with a consultant or senior colleague
- Feedback received
- Learning points
- What you would do differently or take forward
- Completed CBD proforma
- Evidence of discussion or senior feedback
- Reflection and learning points
Use a structured CBD proforma and include senior feedback.
Structured reflection
Reflect on your practice, experiences and personal learning.
- What the reflection is about
- What happened and the context
- What went well
- What could have been done differently
- What you learned
- How this will change your future practice
- Structured reflection
- Clear learning points
- How you will apply this learning in practice
Focus on what you learned and how it will influence your future practice.
What Good Looks Like
A strong quality improvement entry should make it easy for your appraiser to understand what you did, why you did it, what you found and what you learned from it.
Good evidence usually means:
the activity is relevant to your actual scope of practice
your own involvement is clear
there is something tangible to evidence what you did
the results, feedback or learning are clearly described
you explain what changed or what you would do differently
there is some reflection on how the activity has influenced your practice
It does not need to be a huge project. A well-documented audit, teaching activity with feedback, quality improvement project, case-based discussion or structured reflection can all provide useful evidence when written up properly.
Common Mistakes
A much stronger entry explains:
what the audit was looking at
the standard or guideline used
the methodology
the results
your own involvement
any intervention or change made
what you learned or reflected on.
If your involvement in an audit was minimal, it is often better to present a different activity that demonstrates your own learning more clearly. Case-based discussions are particularly useful if you are close to your appraisal and need to strengthen this section quickly — 3–4 properly structured CBDs can often be completed at relatively short notice, provided they are written up on a proforma and genuinely discussed with a consultant or senior colleague. This is usually much stronger evidence than simply mentioning an audit you barely contributed to.
I would even prefer to see well-chosen clinical cases taken from journals, educational resources or reputable online sources, written up on a structured proforma and then properly discussed during the appraisal, rather than a vague sentence saying you were involved in an audit. For example, as a geriatrician I can discuss relevant geriatric medicine cases with an appraisee and explore their clinical reasoning and learning. This is not as strong as a CBD based on a real case from your own practice and discussed in context with a senior colleague, but it can still provide useful evidence of learning and reflection.
Myth Trap
Myth“Quality improvement means I need to complete a full audit every year.”
No.
The GMC requirement is to actively participate in quality improvement activity relevant to your scope of practice during the revalidation cycle. A formal audit or QI project is one way of doing this, but it is not the only option.
Other useful evidence can include case-based discussions, structured case review, teaching with feedback, prescribing review or reflective review of practice, provided your own involvement and learning are clear.
Bottom line: the aim is not to manufacture an audit for the sake of appraisal. It is to show that you have reviewed your practice, learned something from it and considered what should change or be maintained.
Sources / Last Reviewed
GMC — Quality Improvement ActivitySets out the requirement to participate in QI relevant to your scope of practice and explains the range of activities that may be appropriate.
GMC — Guidance on Supporting Information for RevalidationExplains how quality improvement fits within the wider supporting information discussed at appraisal.
NHS England — Medical Appraisal GuideProvides practical guidance on presenting and discussing quality improvement activity during appraisal.
Last reviewed: August 2026