Selecting competent and compassionate healthcare workers is an increasingly important issue internationally. There is over a century’s worth of research literature exploring how best to select a person for a given role, but historically less attention has centred on selection into the healthcare professions . This picture is changing rapidly however, and here we present the research evidence with a view to supporting recruiters, researchers, educators and students in understanding the design and evaluation issues to further inform selection policy and practices in future.
In this opening chapter, the context of healthcare is explored and the implications for how to approach the design of selection methods and processes. The key principles in designing selection processes are presented and various evaluation criteria used to judge the quality of selection practices are offered. From here, the key topics addressed in this book are introduced, categorized into three parts including (i) the effectiveness of different selection methods , (ii) designing selection systems and (iii) issues in recruitment . In each part, there is a collection of chapters authored by leading researchers in their field. They present the research evidence, alongside international case material to showcase the practical application of these findings.
Context of Selection and Recruitment in Healthcare
Selection into the healthcare professions remains highly competitive for some professions such as medicine and dentistry, whereas other healthcare professions struggle to recruit, such as in nursing in the UK. Furthermore, within professions, the picture can look very different; for example, recruitment into medical school is highly competitive internationally, yet there are recruitment shortages into postgraduate training in specialties such as psychiatry and general practice (family physicians). In this book, we explore designing selection methods and systems in both highly competitive settings and in settings where there are workforce shortages which tend to focus more on recruitment and attraction issues. It must also be acknowledged that most of the previous research has focused on medical education , although the learning from this evidence base has strong relevance for many other healthcare professions .
Traditionally, most research on selection in healthcare has focused on exploring the quality of different selection methods using largely student populations (those entering education programmes in healthcare such as medical school admissions; see Hecker & Norman, 2017). In the past five years, the field has progressed to potentially more complex topics, including selection policies and systems design , methodological concerns (beyond psychometric issues), diversity and fairness issues, new evaluation frameworks, and developments in theory (Patterson et al., 2018).
Practically, selection and recruitment are often resource-intensive, so a key consideration is efficiency. Where there are a high-volume number of applicants, a key consideration is how to ‘manage the numbers’; for example, how one constructs short-listing procedures and interview processes are important real-world problems. Drawing upon international case material, we also explore the increasing use of technology to deliver selection tests and interviews which we review in detail in our closing chapter (Chapter 13).
Key Principles in Selection Research and Evaluation
Two main principles underlie the role that selection procedures play in healthcare settings. The first principle is that there are individual differences between people in aptitudes, values , skills and other personal qualities. This simple principle leads to the very important conclusion that people are not equally suited to a career in healthcare and suggests that procedures for selecting healthcare workers have important implications for patient safety and good-quality patient care. Historically, research has tended to focus mainly on academic capability as the main criterion for selection in healthcare, but more recently, the field has progressed to focus more on how best to select for various non-academic attributes and values (see Chapter 3 on personality assessment , Chapter 4 on situational judgement tests (SJTs), Chapter 5 on interviews, Chapter 11 on values -based recruitment and Chapter 12 focusing on altruism and pro-sociality in selection).
The second principle is that future behavior is, at least partly, predictable. The goal of selection activities is to match people to roles and ensure the best possible levels of future performance (both as a trainee and a practicing clinician). The belief that future performance can be estimated is an important facet of the second principle mentioned above. The essential function of selection methods and processes is to provide means of estimating the likely future performance of candidates and wherever possible, linked to health outcomes.
In evaluating professional exams, the reliability of the assessments is viewed as the ‘gold standard ’; to ensure that a trainee is safe for subsequent independent practice. In selection, the predictive validity of the assessments has traditionally been the gold standard , as students and trainees enter supervised education, and recruiters wish to appoint those most likely to succeed in training . Selection research in healthcare has largely focused on reliability issues (e.g. how many stations are required for a multiple mini-interview to be reliable), and here, we remind readers that it is quite possible to be reliably wrong , such that greater attention should be paid to establishing the predictive and construct validity of selection systems . Furthermore, the field is moving beyond relatively simple linear and regression-based approaches to judging the validity of selection practices to acknowledge that selection is a complex, multi-level, dynamic phenomenon and as such has recently been characterised as a ‘wicked problem’ (see Cleland, Patterson, & Hanson, 2018).
This shift in emphasis beyond psychometric issues is reflected in a new international consensus statement on selection and recruitment to the healthcare professions (developed at the 2018 Ottawa-ICME Joint Conference on the Assessment of Competence in Medicine and the Healthcare Professions and reviewed in more detail in Chapter 13). The statement was developed by a specially convened group of international researchers with expertise in selection and recruitment , assessment, curriculum and educational theory to critically appraise the literature and develop a consensus statement (see Patterson et al., 2018). In addition to dealing with the latest evidence on selection methods , the...