• The ability of the appraisee to ‘cherry-pick’ favourable SI • The subjective and inconsistent interpretation of SI by appraisers • The subjective and inconsistent interpretation by appraisees • Access to SI, for example patient feedback, which may not be ready available for some medical professionals • Some SI may be important to certain medical professionals, for example outcome data for surgical specialties, currently not mandatory • The administration of MSF • ‘Assessing’ the quality of reflection |