Quick answer
Quality improvement (QI) is about taking a critical look at practice, understanding what is working, identifying what could be better and reflecting on what you learned. The appraisal section is about quality improvement activity — not necessarily a full audit or formal project every year.
In my appraisal practice, I expect doctors to include some meaningful QI activity every year. Across a five-year revalidation cycle, the practical expectation is participation in an audit or substantive QI project at least once. That need not mean a huge, department-wide undertaking.
Why this section matters
It demonstrates that you are not just keeping your knowledge up to date (CPD), but also examining how that knowledge translates into practice. You might review your decisions, look at a recurring problem, use feedback to improve teaching or participate in an audit.
For doctors with varied or limited clinical exposure — including IMGs, FY3/FY4 doctors and locums — it is particularly important not to assume that “no audit” means “nothing for QI”.
What counts? A practical comparison
A simple six-step way to write it up
- 01Choose a topic
Choose a relevant topic from your scope of work.
- 02Review practice
Review the activity or practice — for example a case, pathway, prescribing pattern or teaching session.
- 03Explain your findings
Explain what you found or discussed.
- 04Identify learning
Identify your learning and any feedback received.
- 05Consider a change
Explain what changed, or what you would do differently in future.
- 06Evidence and reflection
Upload evidence and a short reflection.
Worked example: audit and re-audit
An audit compares practice against an agreed standard. Include the topic, standard or guideline, method, numbers reviewed, results and opportunities for improvement. If a change was made and the audit repeated, explain what changed in the results.
Evidence might include a few slides, a short report, a data table, an action plan or re-audit results. You do not need a glossy document if a concise summary clearly demonstrates the work.
Be precise about your role. If you collected data but did not design or lead the audit, say that. Explain whether you understood the audit’s purpose, reviewed the results and identified learning. A truthful description of modest involvement is better than an inflated claim.
Worked example: case-based discussions
Choose relevant, anonymised clinical cases and work through them with a registrar, consultant or other suitable senior colleague. A useful entry includes the case context, key decisions, the discussion, feedback and learning points.
Two or three properly documented CBDs can be a practical approach for doctors without a formal audit in that appraisal year. Avoid merely writing up a case on your own and calling it a CBD; the discussion with an appropriate clinician is central.
A structured proforma makes this easier to evidence and easier for an appraiser to evaluate.
Worked example: teaching and feedback
Describe the session, audience and aims; include slides or other teaching materials if helpful. Collect feedback, summarize what went well and identify something to change next time.
The improvement element is not simply “I delivered teaching”, but the response to feedback and the refinement of your approach.
Worked example: QI project
Outline the problem you identified, your aim, the intervention, how you measured its impact, and what happened. Include any available baseline and follow-up measures, meeting notes, action plans or PDSA cycles.
A project can be small and local. What matters is that your own contribution, thought process, learning and impact are visible.
Worked example: structured reflection or guideline review
For a reflection, describe the event or issue without identifiable patient information, explain what happened, what you learned and how this may influence your practice.
For a guideline review, compare a real element of practice with a relevant standard, identify any difference and consider an improvement. Reading a guideline without reviewing practice is more naturally CPD.
See it done: exactly what to include and upload
These are practical routes into the QI section. Choose the activity that reflects your actual work. An entry should show your involvement and learning, not merely attach a certificate or name a project.
Audit or re-audit
What to describe: the topic and standard or guideline; who or what was reviewed; dates, sample and methodology; findings and results; gaps identified; any change or action plan; re-audit findings if available; and your learning.
Evidence to upload: a short audit report or slides, results table or graph, action plan, and any re-audit findings.
Appraiser tip: clearly state whether you designed the audit, collected data, analysed results or presented findings. Data collection alone can be meaningful if you explain what you learned; do not claim to have led a project you only helped with.
Teaching with feedback
What to describe: topic, audience, date, learning objectives, methods, feedback received, what went well, what could improve and what you will change next time.
Evidence to upload: slides or teaching materials, anonymised feedback forms or a feedback summary, and a brief reflection or improvement plan.
Appraiser tip: delivering teaching by itself does not tell the full QI story. Show how feedback influenced your approach or future sessions.
Quality improvement project
What to describe: the problem, how you identified it, intended improvement, the intervention or changes introduced, how impact was measured, results, limitations and next steps.
Evidence to upload: project summary, before-and-after measures, charts, an action plan, PDSA notes or relevant meeting records.
Appraiser tip: make the improvement cycle clear — plan, do, study, act — even if the project was modest or involved a wider team.
Case-based discussion (CBD)
What to describe: an anonymised case, why you selected it, the key clinical decisions, what you discussed with a registrar, consultant or senior colleague, their feedback, your learning points and how this may affect future care.
Evidence to upload: a structured CBD proforma, senior feedback or documented discussion, and concise reflection.
Appraiser tip: simply writing down a case is not a CBD. Genuine discussion with a suitable senior colleague and the resulting learning are central.
Structured reflection or guideline review
What to describe: the case, issue or guideline reviewed; why it matters to your practice; what you found; what you learned; and what you will change, check or continue doing.
Evidence to upload: a structured reflective account, a short comparison with relevant guidance or reviewed practice, and clear action points.
Appraiser tip: avoid a purely descriptive diary entry or a summary of a guideline. Demonstrate active review of practice and a potential improvement.
Not every activity needs a formal before-and-after dataset. The scale of evidence should match the activity, but your contribution and learning should be transparent.
The difference between CPD and QI
CPD is about maintaining or developing knowledge and skills. QI looks at practice, feedback, outcomes or processes with a view to learning and improvement.
Exam revision or completing a course is CPD. Simply attending an observership is part of scope of work, while specific learning may count as CPD. Neither automatically becomes QI.
An academic dissertation or Masters project could contribute to QI if it genuinely involved identifying a problem, carrying out an intervention or improvement-focused review, evaluating the outcome and reflecting on it. Categorize the evidence according to what you actually did.
What good looks like to an appraiser
I am looking for a real activity that relates to your scope of work, a clear statement of your own involvement, some supporting evidence and a sensible account of what you learned. This is not a requirement to demonstrate a dramatic result from every small annual activity.
A useful formula
- What you did
- What you found
- What you learned
- What you changed or would change
A quick quality check before you submit
- Is the activity relevant to my scope of work?
- Have I said exactly what I personally did (rather than what the whole team did)?
- Can the appraiser see tangible supporting evidence?
- Have I explained findings, feedback or learning rather than only described the event?
- Have I recorded any change made, considered or planned — or why existing practice was appropriate?
- Is there a short reflection showing how this will influence my practice?
The story should be easy to follow: what you did → what you found → what you learned → what changed (or what you plan to change). One well-evidenced, modest activity is often more useful than an ambitious project described in two vague sentences.
Common mistakes — and how to avoid them
Leaving the section blank because you have not completed an audit: use an appropriate case review, CBD, teaching-with-feedback or other meaningful activity.
Claiming an audit without explaining your role: clearly distinguish leadership, analysis, data collection and participation in discussing results.
Uploading slides with no reflection: explain what you learned and what happened next.
Calling an independently written case summary a CBD: document the discussion and feedback from an appropriate senior colleague.
Confusing CPD with QI: coursework and exam revision alone do not demonstrate review or improvement of practice.
Including identifiable patient details: anonymise clinical material and follow information governance requirements.
A practical reminder about the five-year cycle
In day-to-day appraisal practice, some form of QI activity every year is a sensible expectation, with participation in an audit or substantive QI project at least once across the five-year revalidation cycle. The annual entries and the more substantial project can complement each other.
The purpose is to show ongoing engagement with improving practice, not to create a large audit simply to fill a box.
Final takeaway
If you have reviewed your practice, sought feedback, reflected and identified learning, you may already have useful QI material. Document it clearly, show what you contributed and do not leave this section empty just because you have not personally led an audit.