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Part 1 Literature & Documentation Review

The literature review is reported in two sections. Section 1 comprises a review of the research literature relating to best practice selection in general. Specifically, implications for consultant recruitment are discussed. Section 2 reviews existing documentation and reports, relevant to consultant recruitment in Scotland. An executive summary of both reviews is presented here and the full detail is available in the Appendices 1 and 2.

Section 1. Literature Review of Best Practice Selection

The recruitment and retention of consultants in medicine has become a critical issue. The implications of making the wrong selection decision are serious both in human and in financial terms. Hence, developing and implementing recruitment and selection methods that are accurate and fair is crucially important.

The aims of the literature review are to:

• Briefly outline the principles behind best practice recruitment and selection, with an emphasis on implications for senior level selection.
• Establish sound principles on which consultant appointments can be made.
• Provide practical recommendations to design and implement a valid recruitment and selection system for consultants.

The key implications for consultant recruitment are as follows ( See Appendix 1):

The selection process

The design and implementation of valid assessment methods starts with a thorough job analysis which defines the selection criteria required for the post. The existence of selection criteria has implications for issues of fairness and equal opportunities legislation. In order for the selection process to be fair and objective, candidates should be assessed against the same agreed standards or criteria. When choosing a selection method, issues of reliability, validity, feasibility, fairness and equity must be taken into account. Selection methods should be developed carefully through piloting and candidates' reactions should be taken into account. It is important to conduct validation studies in order to monitor the quality of the selection process and update the process.

Implications for consultant recruitment
When a post arises a carefully prepared Person Specification will enable the recruiter to define the desired candidate skills sets and attributes in an objective and fair manner. A job analysis is needed to define the skills and attributes. This also ensures the selection process operates within the legal framework. Attracting an eligible pool of candidates to select from may be a major challenge in consultant recruitment for some areas.

Organisational Attractiveness

Attracting an adequate number of suitable candidates is the first stage of recruitment and selection. Potential employees do not select organisations on the basis of job and organisational characteristics alone (e.g. location, and organisational structure). Studies show that the organisation's image/reputation/identity plays a vital part in attracting suitable talented applicants (Cable & Turban, 2001; Slaughter, Zickar, Highhouse, & Mohr, 2004; Lievens & Highhouse, 2003). Hence the importance of monitoring and promoting the corporate brand to be more successful at attracting suitable candidates.

Implications for consultant recruitment
The first step in any selection process is attracting an adequate number of appropriate candidates. Job and organisational characteristics such as pay, career progression, location, and opportunities for advancement, are all related to organisational attractiveness. Less tangible factors, such the image/ identity/reputation that candidates ascribe to an organisation, are just as important in making an employer attractive.

Selection methods

The most popular selection procedures used at senior or executive level are: interviews, job-related exercises, and personality measures. These methods are not all equally useful or appropriate in some selection processes:

• Interviews are used widely for selection purposes at senior or executive level (Campion, Palmer, & Campion, 1997; Garman, 2005). Research shows that to increase their reliability, validity and feasibility, interviews should be based on a thorough job analysis and selection criteria, they should be semi-structured and scored according to a behaviourally anchored rating scale. Multiple interviews are often favoured over panel interviews, the modality of the interview should be standardised across all candidates, and assessors should be trained (Blackman, 2002; Chapman, & Rowe 2001; McDaniel, Whetzel, Schmidt, & Maurer 1994; Schmidt, & Hunter, 1998).
• Job-related exercises can be valid predictors of job performance when designed and conducted according to best practice (Damitz, Manzey, Kleinmann, & Severin, 2003; Lievens, Van Keer, & De Witte, 2005). In order to obtain valid ratings of performance the exercises should be based on competencies identified by job analysis, and scored by trained assessors using pre-defined anchored rating scales. Presentations and written tests are two of the most frequently used exercises for executive or senior level selection. Confidentiality issues often warrant the use of individual exercises.
• Personality measures can be used to enhance the decision making process at senior/executive level; to comply with best practice they should always be used in conjunction with other selection methods and never as the sole determinant of a selection outcome.

Implications for consultant recruitment
Selection methods should follow a thorough job analysis and selection criteria to increase their reliability and validity. Interviews can be effective when designed and implemented appropriately. Job related exercises are widely used in other occupational groups and there is evidence of their use within specialty selection. medicine. Other selection tools such as personality measures can be used to enhance the decision making process in selection but evidence for use at consultants level is required. Use of personality measures within selection must be carried out by appropriately trained individuals.

Summary and Conclusions

The principles and issues behind best practice recruitment and selection are summarised in the full literature review with a view to provide evidence that can be used in guiding any future strategy on the selection of consultants. Specific issues around the recruitment and selection of consultants have not been addressed directly as there was little reference in the literature to this. However, the lessons learned from best practice recruitment and selection research in general, and from the assessment of executives more specifically, are transferable to the context of consultants' assessment.

In summary, the following recommendations are made:

• The design and implementation of valid assessment methods starts with a thorough job analysis which defines the selection criteria required for the post.
• When choosing a selection method, issues of reliability, validity, feasibility, fairness and equity should be taken into account.
• It is important that the process is seen to be fair by all candidates. Research shows that candidates favour selection methods which are job relevant and less personally intrusive. Applicants also value the opportunity to meet personally with recruiters and have a preference for multiple opportunities to demonstrate their skills. They also tend to prefer selection systems which are administered consistently for all applicants.
• The selection methods should be developed carefully through piloting with diverse populations.
• The selection process must be evaluated and reviewed by monitoring candidates with respect to diversity and subsequent job performance.
• The evaluation of the selection process should lead to improvements aimed at enhancing validity and reducing adverse impact.
• All individuals involved in assessing candidates during the selection process should have received appropriate training (for example in interview skills) and have been adequately briefed about the selection criteria. Assessors should also be aware of unfair discrimination and equal opportunity legislation, two aspects which have a serious impact on the diversity of the organisation. Best practice recommends that feedback should always be provided as part of the selection process.

Section 2. Review of Existing Documentation on Consultant Recruitment in Scotland

Recent changes in postgraduate education and legislation in the UK, such as changes in doctors' training, the need for better accountability and improved continued medical education, have increased the demands on senior doctors. Within this context and in view of the shortage of senior doctors in Scotland (Temple, 2004), the recruitment and retention of consultants has become a critical issue. In 2005, the Scottish Executive allocated NHS Boards with new funding to help develop and implement recruitment strategies aimed at consultants. The selection process for consultant posts in Scotland is undergoing a review.

The aim is to briefly outline articles relevant to the appointment of Consultants which have been gathered by the Scottish Government. The articles (See Appendix 2 for a full list) can be categorised under three key headings, as follows;

1. Background & Legislation
2. Fairness & bias
3. HR best practice recruitment advice

Background & Legislation

Several articles review the statutory framework surrounding the appointment of Consultants in Scotland. NHS Scotland has undergone a series of structural changes since the 1999 Health Act.

• The single-system reform, with the creation of 15 single-system NHS boards and the abolition of NHS trusts, is intended to improve service organisation and delivery in NHS Scotland with devolution of decision making to the front-line (Jones, 2003).

Various reports provide recommendations for improving the recruitment/retention.

• In a NES report, McGregor et al (2005) suggest improving the communication and information flow between NES and NHS boards in order that consultant posts can be designed and their advertisement timed to match the output of training schemes. They also recommend the electronic canvassing of trainees' views to take into account their career intentions and a mentoring system that facilitates the transition from trainee to consultant (McGregor, Wakeling, French, & Bagnall, 2005).
• The above recommendations have led to the introduction of an advance appointment scheme (Scottish Executive HD 2006), designed to retain a higher number of SpRs in Scotland as they move to consultant grade. The scheme involves aspiration interviews with current SpRs and funding to assist NHS boards in running with two post holders for a maximum period of 6 months.

Fairness & Bias

The literature review also identified a number of articles on career choice and potential discrimination against women and doctors of ethnic minority origin (see Scottish Executive Workforce Statistics, 2006; RCP 2004; Mavromaras, & Scott 2006; Esmail, 2004; McManus, & Sproston, 2000):

• The majority of consultants (September 2006) are male of white ethnic origin.
• The proportion of women medical students has increased steadily over the years, exceeding 50% in 1991 and reaching 60.8%by 2002.
• The proportion of female doctors and of doctors of ethnic minority origin drops as the seniority level increases.
• There is evidence in some cases of disproportionate promotion that may be interpreted as direct or indirect discrimination. Doctors who graduated in Scotland are more likely to be promoted than doctors who graduated from the rest of the UK or overseas. Female doctors and doctors who work part time are less likely to be promoted to a consultant post. ¹

Best practice recruitment ( HR perspective)

Best practice recruitment guidelines are available from an HR perspective from the Department of Health (2006). The guidelines outline best practice at each stage of the recruitment process with the aim of ensuring that the process is unbiased and feasible. Some recommendations include:

• Providing realistic job previews & inductions;
• Using valid selection methods such as structured interviews;
• Training the recruiters.

Summary of documentation review

The reports identified by the Scottish Executive on the recruitment and retention of consultants were reviewed. The context and legal framework surrounding the selection of consultants in Scotland is outlined. Articles relevant to the fairness of the current consultant selection process and the related issues of diversity are included. This review also outlines HR advice on best practice recruitment.

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