Article

A competency model of general practice: implications for selection, training and development

Department of Psychology, University of Nottingham.
British Journal of General Practice (Impact Factor: 2.36). 04/2000; 50(452):188-93.
Source: PubMed

ABSTRACT The role of the general practitioner (GP) has changed significantly over the past decade. This problem is compounded by growing concern over postgraduate attrition rates from medicine, with current estimates as high as 19%.
To define a comprehensive model of the competencies required for the job role of GP.
Three independent studies were conducted to define GP competencies including (1) critical incidents focus groups with GPs, (2) behavioural coding of GP-patient consultations, and (3) critical incidents interviews with patients. Study 1 was conducted with GPs (n = 35) from the Trent region. Study 2 involved observation of GP-patient consultations (n = 33 consultations), and Study 3 was conducted with patients (n = 21), all from a Midlands-based medical practice.
The data collected from the three studies provided strong evidence for a competency model comprising 11 categories with a summary of the associated behavioural descriptions. Example competencies included empathy and sensitivity, communication skills, clinical knowledge and expertise, conceptual thinking, and coping with pressure.
Triangulation of results was achieved from three independent studies. The competencies derived imply that a greater account of personal attributes needs to be considered in recruitment and training, rather than focusing on academic and clinical competency alone. The model could be employed for future research in design of selection techniques for the role of GP.

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Available from: Fiona Patterson, Aug 28, 2015
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    • "Job analysis research provides supporting evidence for the importance of non-academic attributes for successful performance in various healthcare roles. For example, attributes such as empathy, resilience, team involvement and integrity are necessary for medicine and dental students (Patterson et al. 2012a) and in postgraduate medical training (Patterson et al. 2000, 2008). In terms of selection, this presents a challenge regarding how to reliably assess values, personal qualities and attributes in an effective and efficient way, because many methods that aim to assess non-academic attributes have not been found to be robust (Albanese et al. 2003). "
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    ABSTRACT: Why use SJTs? Traditionally, selection into medical education professions has focused primarily upon academic ability alone. This approach has been questioned more recently, as although academic attainment predicts performance early in training, research shows it has less predictive power for demonstrating competence in postgraduate clinical practice. Such evidence, coupled with an increasing focus on individuals working in healthcare roles displaying the core values of compassionate care, benevolence and respect, illustrates that individuals should be selected on attributes other than academic ability alone. Moreover, there are mounting calls to widen access to medicine, to ensure that selection methods do not unfairly disadvantage individuals from specific groups (e.g. regarding ethnicity or socio-economic status), so that the future workforce adequately represents society as a whole. These drivers necessitate a method of assessment that allows individuals to be selected on important non-academic attributes that are desirable in healthcare professionals, in a fair, reliable and valid way. What are SJTs? Situational judgement tests (SJTs) are tests used to assess individuals’ reactions to a number of hypothetical role-relevant scenarios, which reflect situations candidates are likely to encounter in the target role. These scenarios are based on a detailed analysis of the role and should be developed in collaboration with subject matter experts, in order to accurately assess the key attributes that are associated with competent performance. From a theoretical perspective, SJTs are believed to measure prosocial Implicit Trait Policies (ITPs), which are shaped by socialisation processes that teach the utility of expressing certain traits in different settings such as agreeable expressions (e.g. helping others in need), or disagreeable actions (e.g. advancing ones own interest at others, expense). Are SJTs reliable, valid and fair? Several studies, including good quality meta-analytic and longitudinal research, consistently show that SJTs used in many different occupational groups are reliable and valid. Although there is over 40 years of research evidence available on SJTs, it is only within the past 10 years that SJTs have been used for recruitment into medicine. Specifically, evidence consistently shows that SJTs used in medical selection have good reliability, and predict performance across a range of medical professions, including performance in general practice, in early years (foundation training as a junior doctor) and for medical school admissions. In addition, SJTs have been found to have significant added value (incremental validity) over and above other selection methods such as knowledge tests, measures of cognitive ability, personality tests and application forms. Regarding differential attainment, generally SJTs have been found to have lower adverse impact compared to other selection methods, such as cognitive ability tests. SJTs have the benefit of being appropriate both for use in selection where candidates are novices (i.e. have no prior role experience or knowledge such as in medical school admissions) as well as settings where candidates have substantial job knowledge and specific experience (as in postgraduate recruitment for more senior roles). An SJT specification (e.g. scenario content, response instructions and format) may differ depending on the level of job knowledge required. Research consistently shows that SJTs are usually found to be positively received by candidates compared to other selection tests such as cognitive ability and personality tests. Practically, SJTs are difficult to design effectively, and significant expertise is required to build a reliable and valid SJT. Once designed however, SJTs are cost efficient to administer to large numbers of candidates compared to other tests of non-academic attributes (e.g. personal statements, structured interviews), as they are standardised and can be computer-delivered and machine-marked.
    Medical Teacher 08/2015; DOI:10.3109/0142159X.2015.1072619 · 2.05 Impact Factor
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    • "Having defined these criteria at a level appropriate for the career stage, this information is used to guide choice of selection methods. Role analysis studies conducted in UK healthcare context (Patterson et al. 2000, 2008, 2013) have identified a wide range of attributes and values beyond clinical knowledge and academic achievement that are required for success in healthcare roles. These need to be considered and measured at the point of selection to ensure that healthcare workers learn, train and work within a profession for which they have a particular aptitude (Patterson et al. 2008). "
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    • "Having defined these criteria at a level appropriate for the career stage, this information is used to guide choice of selection methods. Role analysis studies conducted in UK healthcare context (Patterson et al. 2000, 2008, 2013) have identified a wide range of attributes and values beyond clinical knowledge and academic achievement that are required for success in healthcare roles. These need to be considered and measured at the point of selection to ensure that healthcare workers learn, train and work within a profession for which they have a particular aptitude (Patterson et al. 2008). "
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    ABSTRACT: Displaying compassion, benevolence and respect, and preserving the dignity of patients are important for any healthcare professional to ensure the provision of high quality care and patient outcomes. This paper presents a structured search and thematic review of the research evidence relating to values-based recruitment within healthcare. Several different databases, journals and government reports were searched to retrieve studies relating to values-based recruitment published between 1998 and 2013, both in healthcare settings and other occupational contexts. There is limited published research related to values-based recruitment directly, so the available theoretical context of values is explored alongside an analysis of the impact of value congruence. The implications for the design of selection methods to measure values is explored beyond the scope of the initial literature search. Research suggests some selection methods may be appropriate for values-based recruitment, such as situational judgment tests (SJTs), structured interviews and multiple-mini interviews (MMIs). Personality tests were also identified as having the potential to compliment other methods (e.g. structured interviews), as part of a values-based recruitment agenda. Methods including personal statements, references and unstructured/'traditional' interviews were identified as inappropriate for values-based recruitment. Practical implications are discussed in the context of values-based recruitment in the healthcare context. Theoretical implications of our findings imply that prosocial implicit trait policies, which could be measured by selection tools such as SJTs and MMIs, may be linked to individuals' values via the behaviours individuals consider to be effective in given situations. Further research is required to state this conclusively however, and methods for values-based recruitment represent an exciting and relatively unchartered territory for further research.
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