3 Identify the real gap

A useful question before another course

When career progression feels uncertain, it is tempting to do something visible: attend a course, begin an audit or collect another certificate. Any of these can be useful. None is automatically the answer to the problem you face.

Use your scope profile to ask what is missing. Is there an aspect of practice that needs to develop? Is the practice already present but poorly evidenced? Is access to the activity unavailable? Or is substantial responsibility established but insufficiently recognised? These are the four gaps used in this handbook. They are a practical thinking model, not official assessment categories or a validated scoring system.

The distinction matters because each gap calls for a different response. More learning does not by itself create access. Better paperwork does not compensate for unsafe practice. A capable doctor cannot personally authorise a new post. A manager's uncertainty about evidence should not automatically be described as a deficiency in the doctor.

Capability gaps

A capability gap concerns what you can demonstrate in the work itself. It may involve knowledge, judgement, practical skill, communication or another relevant aspect of the role. The useful description is specific enough to guide learning and review.

“Needs more experience” is often too vague. Experience of what? In which activity? What decision is currently difficult? What would an observer need to see? A better statement might identify difficulty prioritising competing problems within a particular activity, then propose supported practice and discussion focused on that decision.

The plan should also recognise what is already established. If one part of the activity needs development, do not label the whole doctor as unready for everything. A precise account allows support to be targeted and avoids unnecessary repetition of work already demonstrated.

Capability develops through opportunities to practise, receive feedback and respond. A course may provide knowledge or a framework, but it needs a relationship to the activity. Ask what you will do differently afterwards and how that change can be reviewed.

Evidence gaps

An evidence gap exists when a claim may be true but the available material does not allow another person to judge it. The answer is often better description or corroboration rather than a new project.

An evidence gap can persist after years of established responsibility. A portfolio may contain a job title and annual appraisal summaries but little account of actual decisions. Colleagues familiar with the service may understand the role without recognising how much an external assessor would have to infer.

Address this by selecting representative evidence, obtaining specific feedback from appropriate observers and explaining how the work relates to the intended capability. Review may reveal a development need in one area. That conclusion should follow examination of practice rather than an assumption based solely on a missing document.

Evidence gaps also arise when documents describe the team but not the doctor's contribution. A successful service change does not show what each person did. A short contribution statement, supported by a relevant colleague or record, can make the difference.

Opportunity gaps

An opportunity gap concerns access, time or support. You may understand what needs to develop but have no chance to undertake the activity. A plan that says “gain experience” without providing access is incomplete.

If the only available development session clashes with existing duties, another course may leave the obstacle unchanged. The next request needs to address the session itself, cover for displaced work and a suitable reviewer. Access requires a service decision as well as a personal development objective.

The opportunity may not be available in exactly the form requested. An alternative could provide the relevant experience, or the service may need to explain why none is currently feasible. The response should be recorded so that the plan does not remain indefinitely on the doctor's list as an uncompleted personal obligation.

Opportunity gaps can affect experienced doctors too. Leadership, teaching or research contribution may be expected but distributed through informal networks. Ask how access is allocated and what a fair opportunity would look like. The book's practical answer is to make the request and decision visible, not assume that persistence alone can overcome structural barriers.

Recognition gaps

A recognition gap concerns the relationship between actual responsibility and how the role is described, supported or graded. It requires careful factual work because recognition is not established merely by feeling that the role is senior.

Start with the scope profile, relevant capability evidence and the current job description and job plan. Identify where they agree and where they diverge. Then establish the applicable route. The same factual account may support a role review, a case for a post or an application under a regrading policy, but those are different processes.

A recognition gap should not be converted automatically into a new training programme. If the service relies on the doctor's established work, ask what evidence is needed to assess it and who has authority to address the discrepancy. Development may still be appropriate in another area, but it should have a defined purpose.

Nor should recognition be assumed to follow merely because additional duties have accumulated. The nature, scope and quality of the work still need examination. The aim is a fair assessment of reality, not an argument based only on workload.

Mixed gaps and changing explanations

Several gaps may coexist. A doctor may need supported experience in one activity and better evidence of another. Recognition of established clinical responsibility may be appropriate while an educational capability still needs a suitable opportunity. Access to a new activity may also reveal a learning need that was not previously apparent.

Record the initial interpretation as a working judgement. Ask what information would change it. If feedback identifies a concrete concern, explore it rather than defend the original label. If a stated capability concern turns out to be lack of access to observation, revise the plan accordingly.

This approach also helps with difficult conversations. Instead of arguing over whether someone is “ready”, ask which claim is not demonstrated and what would resolve it. The answer may be an observation, a clearer document, a period of practice or an organisational decision.

Prioritise the next action

You do not need to solve every gap at once. Choose the next action that will reduce the greatest uncertainty or enable later work. A scope discussion may be more valuable than collecting more evidence against an undefined role. Confirming the applicable route may prevent months of preparing the wrong application.

Write an action with an owner and an intended result. “Discuss leadership” is vague. “Ask the clinical director which service-development activity I can contribute to, what authority it carries and how my contribution can be reviewed” is actionable.

Avoid turning the model into a traffic-light score. A green label can conceal weak evidence, while a red label can make a solvable information gap feel like a judgement of personal worth. Use plain descriptions: evidence available, evidence needing clarification, opportunity required or decision pending.

Test the explanation before committing to the solution

Use the four-gap model to test the proposed action. Suppose a doctor is advised to improve leadership evidence. Relevant learning and a feasible project proposal are already available, but access to the service meeting needed to agree the work has not been arranged. The immediate obstacle is opportunity. Prescribing another course would not resolve it.

The reviewer can test this interpretation by asking what would happen if the doctor had access tomorrow. Would there still be a defined learning need? Would someone be available to review the contribution? Would the doctor have enough authority to carry out the agreed task? These questions may reveal more than one gap, but they make the plan more precise.

For established responsibility, ask a different question: if the job plan accurately described the role, what evidence would still be missing? A specific account of clinical reasoning or teaching contribution may be needed. That justifies a focused evidence action alongside the recognition discussion; it does not necessarily justify postponing recognition until an unrelated new project is completed.

Write the conclusion in ordinary language: “The main obstacle is access to the agreed activity; the learning objective is clear, but the opportunity has not been authorised.” Add what information could change that conclusion. This keeps the model open to correction and prevents a convenient label becoming another assumption.

Separate what you can do from what someone else must decide

Divide the next actions by ownership. You can prepare a factual scope profile, identify existing evidence and make a specific request. A supporting clinician can offer informed review. A manager can decide within their authority how work is allocated. Workforce colleagues can clarify the applicable process. Where a decision belongs elsewhere, record the referral and the person responsible for obtaining it.

This prevents a development plan from holding you responsible for an action you cannot authorise. It also makes your own contribution clear. If the next step is to prepare a short proposal, complete it; if the next step is approval of cover, ask for the decision rather than repeatedly rewriting the proposal. Progress depends on both personal action and organisational response.

What the service needs to arrange

When feedback identifies a capability concern, make it specific and explain how it can be reviewed. When the obstacle is resources, say so. When the route is unclear, identify the person who can clarify it. These are different responsibilities and should lead to different actions.

If no action is agreed, record the unresolved question and the next appropriate discussion. Do not quietly convert a service constraint into a requirement for the doctor to work beyond agreed arrangements. Chapter 10 explains how to obtain a useful record; chapter 18 addresses responses after a formal decision.