Values-based recruitment in health care

Applicants' success in the ethics entrance exam: A cross-sectional study

BACKGROUND

Student selection is the first step in recruiting future social and healthcare professionals. Ethically competent professionals are needed in social and healthcare. It is important to select applicants who have the best possible abilities to develop their ethical competence in the future. Values-based recruitment has been used to inform the recruitment and selection of higher education applicants. However, objective and valid tests in student selection are needed.

AIM

To assess social and healthcare applicants' success and related factors in the ethics section of the universities of applied sciences digital entrance examination (UAS Exam) to undergraduate degree programmes.

RESEARCH DESIGN

A cross-sectional design was used.

PARTICIPANTS AND RESEARCH CONTEXT

Social and healthcare applicants needed to identify ethical situations in the ethics section of a national digital entrance examination (UAS Exam) in autumn 2019 (between 29 October and 1 November) in 20 Finnish universities of applied sciences.

ETHICAL CONSIDERATIONS

The process for the responsible conduct of research was followed in the study. Ethics committee approval was obtained from the Human Sciences Ethics Committee in the Satakunta region (27 September 2019). Approval to undertake the study was obtained from the participating universities of applied sciences. Participation to the study was voluntary and based on informed consent.

RESULTS

The applicants' (n = 8971) mean scores were 7.1/20 (standard deviation 6.5), and 22.7% of the applicants failed the ethics section. Age, previous education, and place of birth (own/parent) explained the applicants' success in the ethics section (total score and failed exam results).

CONCLUSION(S)

Applicants' success in the ethics section varied indicating that future students may have a different basis to develop their ethical competence. This may impact on (new) students' learning, especially in practical studies.

Conceptualisation and Development of a values-based scale of emergency physicians' professional identities

BACKGROUND

Physicians' values about what constitute their professional identities are integral in understanding how they ascribe meaning to their practice. However, there is no general consensus on the conceptualization and measurement of physicians' professional identities. This study developed and validated a values-based scale for measuring physicians' professional identities.

METHODS

A hybrid research method was used to gather both qualitative and quantitative data. We employed literature review, semi-structured interview, Q-sorting exercise to examine the conceptualization of emergency physicians' professional identities and to initially develop a 40-item scale. A panel of five experts assessed the scale's content validity. Using 150 emergency physicians as our sample, we conducted Confirmatory Factor Analyses (CFA) to test the fit of our hypothesised four-factor model based on our preliminary findings.

RESULTS

Initial CFA suggested revisions to the model. Following theoretical assumptions and modification indices, the model was revised and adjusted to a four-factor 20 item Emergency Physicians Professional Identities Value Scale (EPPIVS) with acceptable fit statistics χ2 = 389.38, df = 164, Normed χ2 = 2.374, GFI = 0.788, CFI = 0.862, RMSEA = 0.096. The Cronbach's alpha, McDonald's Omega reliability and composite reliability of the subscales ranged from α: 0.748 to 0.868, Omega: 0.759 to 0.868 and CR: 0.748 to 0.851, respectively.

CONCLUSION

The results indicate that the EPPIVS is a valid and reliable scale for measuring physicians' professional identities. Further research on the sensitivity of this instrument to important changes over career progression in emergency medicine is warranted.

Codesigned framework for organisational culture reform in South Australian older persons' mental health services after the Oakden Report

The Oakden Report documented failures in governance, clinical practice and organisational culture occurring at the Oakden Older Persons’ Mental Health Service and drew national attention to the care of older people with complex clinical needs. Responding to the recommendations of the Report, a working group brought together stakeholders to engage in a codesign process involving literature review, gallery walks and focus groups, under the governance of the Oakden Response Oversight Committee. The working group developed a framework as a blueprint for organisational culture reform built around a central philosophy of compassionate relationship-centred care, supported by four priorities: developing a values-based workforce, cultivating psychological safety, facilitating excellence in care and providing transparent accountability. The purpose of the framework was to provide a way forward for South Australian older persons’ mental health services after The Oakden Report, and it may provide insight into similar processes of codesign and culture change in other service contexts. What is known about the topic? Changes to healthcare systems, requiring improved efficiencies and lower costs, are contributing to increasing challenges with staff satisfaction and wellbeing, and consistent delivery of dignified, meaningful care to people and their families. The need to nurture and lead healthcare organisations characterised by compassionate cultures is an increasingly prominent theme in global healthcare literature. The engagement of people with lived experience at all levels of system design supports effective and ethical service development. What does this paper add? This paper illustrates an approach to positive, compassion-focused organisational culture change, developed through codesign, occurring as a reform process following a crisis in service delivery. The paper applies key concepts in a framework that may be applied in a range of services to achieve positive organisational transformation. What are the implications for practitioners? Committed action to develop positive organisational culture characterised by compassionate relationship-centred care will have benefit for healthcare providers and the people who receive care. Keeping people with lived experience at the centre of design and development will support optimal outcomes for all stakeholders.

Predicting fitness to practise events in international medical graduates who registered as UK doctors via the Professional and Linguistic Assessments Board (PLAB) system: a national cohort study

BACKGROUND

International medical graduates working in the UK are more likely to be censured in relation to fitness to practise compared to home graduates. Performance on the General Medical Council's (GMC's) Professional and Linguistic Assessments Board (PLAB) tests and English fluency have previously been shown to predict later educational performance in this group of doctors. It is unknown whether the PLAB system is also a valid predictor of unprofessional behaviour and malpractice. The findings would have implications for regulatory policy.

METHODS

This was an observational study linking data relating to fitness to practise events (referral or censure), PLAB performance, demographic variables and English language competence, as evaluated via the International English Language Test System (IELTS). Data from 27,330 international medical graduates registered with the GMC were analysed, including 210 doctors who had been sanctioned in relation to at least one fitness to practise issue. The main outcome was risk of eventual censure (including a warning).

RESULTS

The significant univariable educational predictors of eventual censure (versus no censures or referrals) were lower PLAB part 1 (hazard ratio [HR], 0.99; 95% confidence interval, 0.98 to 1.00) and part 2 scores (HR, 0.94; 0.91 to 0.97) at first sitting, multiple attempts at both parts of the PLAB, lower IELTS reading (HR, 0.79; 0.65 to 0.94) and listening scores (HR, 0.76; 0.62 to 0.93) and higher IELTS speaking scores (HR, 1.28; 1.04 to 1.57). Multiple resits at either part of the PLAB and higher IELTS speaking score (HR, 1.49; 1.20 to 1.84) were also independent predictors of censure. We estimated that the proposed limit of four attempts at both parts of the PLAB would reduce the risk in this entire group by only approximately two censures per 5 years in this group of doctors.

CONCLUSIONS

Making the PLAB, or any replacement assessment, more stringent and raising the required standards of English reading and listening may result in fewer fitness to practice events in international medical graduates. However, the number of PLAB resits permitted would have to be further capped to meaningfully impact the risk of sanctions in this group of doctors.

Student nurse selection and predictability of academic success: The Multiple Mini Interview project

BACKGROUND

With recent reports of public enquiries into failure to care, universities are under pressure to ensure that candidates selected for undergraduate nursing programmes demonstrate academic potential as well as characteristics and values such as compassion, empathy and integrity. The Multiple Mini Interview (MMI) was used in one university as a way of ensuring that candidates had the appropriate numeracy and literacy skills as well as a range of communication, empathy, decision-making and problem-solving skills as well as ethical insights and integrity, initiative and team-work.

OBJECTIVES

To ascertain whether there is evidence of bias in MMIs (gender, age, nationality and location of secondary education) and to determine the extent to which the MMI is predictive of academic success in nursing.

DESIGN

A longitudinal retrospective analysis of student demographics, MMI data and the assessment marks for years 1, 2 and 3.

SETTINGS

One university in southwest London.

PARTICIPANTS

One cohort of students who commenced their programme in September 2011, including students in all four fields of nursing (adult, child, mental health and learning disability).

METHODS

Inferential statistics and a Bayesian Multilevel Model.

RESULTS

MMI in conjunction with MMI numeracy test and MMI literacy test shows little or no bias in terms of ages, gender, nationality or location of secondary school education. Although MMI in conjunction with numeracy and literacy testing is predictive of academic success, it is only weakly predictive.

CONCLUSIONS

The MMI used in conjunction with literacy and numeracy testing appears to be a successful technique for selecting candidates for nursing. However, other selection methods such as psychological profiling or testing of emotional intelligence may add to the extent to which selection methods are predictive of academic success on nursing.