If you're preparing for your annual medical appraisal, you're probably aware that participation in quality improvement activity (QIA) is one of the six types of supporting information required by the GMC. But what exactly counts as a QIA—and how much is enough?
In this blog, we’ll explore the wide range of activities that can meet this requirement and share practical tips to help you reflect on your impact.
What Is a Quality Improvement Activity?
A QIA is any structured activity that helps improve the quality, safety, or effectiveness of care in your clinical setting. It doesn’t have to be large-scale or formal. The GMC defines it broadly to encourage participation from doctors across all specialties and settings.
At its core, a QIA should demonstrate that:
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You’re measuring something that matters (e.g. safety, outcomes, efficiency).
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You’ve made changes based on what you learned.
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You’ve reflected on the process and its impact.
Examples of Acceptable QIAs
Here are some activities that can be used as QIA evidence:
🔹 Clinical Audit
A classic form of QIA. Ideally, this is a full audit cycle (data collection, intervention, re-audit), but even a single-cycle audit can be acceptable if accompanied by meaningful reflection.
🔹 Case Reviews or Mortality & Morbidity Meetings
Regular participation in structured case reviews or M&M meetings, particularly where you contribute actively or initiate changes, can provide strong QIA evidence.
🔹 Significant Event Analysis (SEA)
Analyzing significant clinical incidents, near misses, or positive events, especially when they result in practice change, is a valuable form of QIA.
🔹 Clinical Outcome Data
Reflecting on your own outcome data, such as complication rates, prescribing trends, or admission patterns, shows a commitment to improving practice.
🔹 Quality Improvement Projects (QIPs)
These often follow the Plan-Do-Study-Act (PDSA) model and may focus on improving patient pathways, reducing delays, or enhancing communication. Many QIPs are done in teams—this is fine, as long as your individual role is clear.
🔹 Contribution to Service Development
Have you led or contributed to changes in clinic processes, pathways, or policies? Even informal improvement work can count, especially if you evaluate its impact.
🔹 Participation in National or Local QI Schemes
Involvement in national audits, Royal College QI programs, or NHS improvement initiatives can be very relevant—again, be sure to reflect on your role and learning.
Tips for Presenting QIA at Appraisal
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Describe the context – What was the problem or area of focus?
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Summarise your activity – What did you do, and who was involved?
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Reflect on outcomes – What changed? What did you learn?
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Highlight personal impact – What was your role, and how did it affect your practice?
You don’t need to submit reams of data. A short written reflection, supported by evidence (e.g. slides, reports, emails), is usually sufficient.
Final Thoughts
The GMC does not prescribe a specific number or format for QIAs. The emphasis is on meaningful participation and reflection. Even small, locally relevant improvements—when well thought-out—can be just as impactful as large-scale projects.
So whether you’re auditing antibiotic prescribing, streamlining discharge processes, or reflecting on a complex case, don’t underestimate the value of your everyday efforts to improve patient care. Your appraiser will want to hear about them.
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