Ensuring our doctors are trained to provide real-world healthcare

In summary

Applied psychology research by Visiting Professor Fiona Patterson and Dr Lara Zibarras at City St George's Department of Psychology and Neuroscience, has led to the introduction of ground-breaking methodologies and assessment tools for the selection of healthcare professionals in the NHS and internationally.

The Situational Judgement Tests (SJTs) developed assess non-cognitive attributes of candidates for healthcare positions, such as empathy and integrity.

In 2013, they were adopted by the Medical Royal Colleges and Medical Schools Council. Since 2014 around 180,000 UK and 20,000 international medical school applicants have completed SJTs. As candidate performance is less impacted by socio-economic status, this has led to widening of access and diversity benefits.

In the same period, 63,547 junior doctors entering UK Foundation Year Training completed their own SJT saving the NHS around £30 million.

Evidence shows this test is the strongest single predictor of post-graduation performance of doctors, positively impacting the quality of patient care.

Since 2014, further impact includes Prof. Patterson and Dr Zibarras’ research providing evidence for the design of Health Education England’s (HEE) Values Based Recruitment (VBR) Framework.

The VBR Framework has been used in selection for NHS healthcare roles (including across nursing and dentistry) and funded training, bringing care quality and cost benefits to this 1.2 million employee-strong organisation.

The VBR Framework is an approach which aims to attract and select students, trainees or employees on the basis that their individual values and behaviours align with the values of the NHS Constitution.

What did we explore and how?

Starting from 2003 at City St George's, Professor Patterson and Dr Zibarras developed early-stage research into the assessment and selection schemes which have led to the impact described here.

Prior to this work, there had been little validated research investigating selection issues in medical education and training. Most selection entailed a panel interview focusing on academic and clinical competencies, with limited focus on non-cognitive attributes (i.e. communication, empathy, integrity, team-working).

Professor Patterson and Dr Zibarras worked with senior medical stakeholders on a series of research publications in order to identify selection criteria for success in medical specialty training; design and validate selection methods to measure these criteria and evaluate the selection processes.

This research provided evidence to introduce innovative methodologies into medical selection, such as SJTs. Candidates are confronted with authentic workplace scenarios (entailing complex interpersonal dilemmas with colleagues and patients) and are asked to evaluate the most effective course of action, indicating their capacity for professional judgement, dealing with ambiguity and patient care.

Key examples include the first application of SJTs, and assessment centres focusing on non-cognitive attributes for GP selection, which are now being used for all medical specialties.

Benefits and influence of this research

Since March 2015, selection processes for all healthcare roles across 300 NHS organisations in England and all NHS funded training courses have been required to use HEE’s VBR Framework, Approaches to VBR are localised and the NHS Employers organisation provides case studies and resources to show the benefits of the approach.

Nurses are the largest occupational group in the NHS at 332,352 employees (October 2019). As an example of VBR’s reach in England, 133,678 new nurses have joined the Nursing and Midwifery Council Register since March 2015, meaning that VBR has been used in the selection of over 40 per cent of the population.

VBR has also been adopted in the public sector; by local government, and by the College of Policing (England & Wales) and the Fire Service (England).

As part of admissions in Australia and New Zealand, 14,000 applicants have completed the SJT. Singapore, America, Canada, Europe and South Africa have also adopted this process.