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FY1 Job Analysis Appendix D

Improving Selection to the Foundation Programme Appendix D FY1 Job Analysis

ISFP Final Report Page 125

FY1JobAnalysisReportImprovingSelectiontotheFoundationProgramme

WorkPsychologyGroupandtheUniversityofCambridge

ProfessorFionaPattersonVickiArcherDrMaireKerrinVictoriaCarrLouiseFaulkesPhillipaCoanDrDavidGood

FinalReportJuly2010



FY1JobAnalysisReportInconfidencetoMedicalSchoolsCouncil

AcknowledgementsThisprojectwasconductedby theWorkPsychologyGroup incollaborationwith theUniversityofCambridgeonbehalfof the ImprovingSelection to theFoundationProgrammeProjectGroup.TheISFP Project Group, Chaired by Professor Paul ONeill, includes representatives from fifteenorganisations: the Academy ofMedical Royal Colleges (AoMRC), the BritishMedical Association(BMA)MedicalStudentsCommittee,theConferenceofPostgraduateMedicalDeans(CoPMED),thefourUKDepartmentsofHealth, theGeneralMedicalCouncil (GMC), theMedicalSchoolsCouncil,theNorthern IrelandMedical andDental TrainingAgency (NIMDTA),NHS Education for Scotland(NES), NHS Employers (NHSE), the Scottish Board for Academic Medicine, the UK FoundationProgrammeOffice (UKFPO) and clinical tutors. The ISFP Project is funded by theDepartment ofHealth.

TheCodirectorsoftheprojecttodevelopaSituationalJudgementTestforISFPareProfessorFionaPattersonandDrDavidGood.Thecoreproject teamconsistedofProfessorFionaPatterson,VickiArcher, DrMaire Kerrin, Victoria Carr, Louise Faulkes and Phillipa Coan in conjunctionwith theMedicalSchoolsCouncilprojectteamincludingProfessorPaulONeill,ProfessorTonyWeetman,DrKatiePettySaphon,DrDenisShaughnessy,SiobhanFitzpatrickandAmyStringer.

TheprojectteamswouldliketothanktheCambridgeUniversityHospitalsNHSFoundationTrust,UniversityHospitalofSouthManchesterNHSFoundationTrustandNHSHighlandinScotlandforenablinginsightfulshadowingofFoundationdoctors.WeareespeciallygratefultostaffattheUKFPO,AoMRCandUKmedicalschoolsforfacilitatingtheresearch,andtotheindividualFoundationSchoolDirectorsandManagers,FoundationProgrammeDirectors,Foundationdoctors,MedicalSchoolEducationDeans,Consultantclinicaltutorsandpatientrepresentativeswhosharedtheirtimeandexpertise.WewouldliketoaddapersonalthankyoutoDrAlysBurns,EastofEnglandDeanery;DrIanCurran,LondonDeanery;LynneHobbs,Methods;ProfessorStephenPowis,RoyalFreeHampsteadNHSTrust;andDrKimWalker,NHSEducationforScotland,fortheircontributionstothisresearch.




Contents1. ExecutiveSummary.........................................................................................................................1

2 Introduction....................................................................................................................................3

2.1 Purposeofthejobanalysis.....................................................................................................3

2.2 Structureofthisreport...........................................................................................................3

3 JobAnalysis.....................................................................................................................................4

3.1 Introduction............................................................................................................................4

3.2 Jobanalysisapproach.............................................................................................................4

3.3 Literaturereview.....................................................................................................................6

3.4 Semistructuredinterviews.....................................................................................................8

3.5 Observations(Shadowing)....................................................................................................11

3.6 Validationquestionnaire.......................................................................................................12

4 AnalysisoftheData......................................................................................................................14

4.1 Analysisstrategyfortheinterviews......................................................................................14

4.2 Creationofthetemplate......................................................................................................15

4.3 Analysisstrategyfortheobservations..................................................................................15

4.4 ValidationofProfessionalAttributesFramework.................................................................15

5. ResultsofJobAnalysis..................................................................................................................18

5.1 ProfessionalAttributesFramework......................................................................................18

5.2 Findingsfromtheliteraturereview......................................................................................18

5.3 Findingsfromtheinterviews................................................................................................29

5.4 Findingsfromobservations...................................................................................................32

5.5 Findingsfromvalidationquestionnaire................................................................................33

5.6 Summaryoffindings.............................................................................................................36

5.7 Mappingontoexistingmaterial...........................................................................................37

6.SituationalJudgementTestDesignSpecification..........................................................................41

6.1 SJTliteraturereview.............................................................................................................41

6.2 Purposeofthetest................................................................................................................42

6.3 TargetattributedomainsfortheSJT....................................................................................43

6.4 Context..................................................................................................................................47

6.5 Itemselectionmethodology.................................................................................................47

6.6 Responseformats.................................................................................................................48

6.7 Testlength............................................................................................................................49

6.8 Teststructure.......................................................................................................................49

6.9 Scoringkey...........................................................................................................................49




6.10 Multipleforms......................................................................................................................50

7. SummaryandConclusions............................................................................................................51

8. References....................................................................................................................................52

Appendix1:LiteratureReviewSpecification&SearchStrategy..........................................................55

Appendix2:JobAnalysisParticipantBriefing.......................................................................................59

Appendix3:FY1DoctorJobAnalysisQuestions...................................................................................61

Appendix4:PatientRepresentativeBriefing........................................................................................63

Appendix5:ObservationObserveandRecordSheet..........................................................................65

Appendix6:FoundationYearOneDoctorProfessionalAttributesQuestionnaire..............................66

Appendix7:FoundationProgrammeCommencingAugust2010........................................................69

Appendix8:FY1LiteratureReviewTable.............................................................................................71

Appendix9:SituationalJudgementTestLiteratureReviewTable.....................................................83

Appendix10:ProjectTeamBiographies.............................................................................................104



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1. ExecutiveSummary1.1 Thepurposeofthejobanalysiswastodefinetheprofessionalattributes(asopposedto

clinicalknowledgeandskills)thatareexpectedintheroleofaFoundationYearOne(FY1)doctor.Theresultswillbeusedtodeterminethetargetdomains(andtestspecification)fortheSJTwhichwillbeusedalongsideameasureofeducationalattainment(EducationalPerformanceMeasurement)forselectiontotheFoundationProgramme.

1.2 Asystematic,multimethodjobanalysis,whichincorporatedaliteraturereview,semistructuredcriticalincidentinterviewsandobservations,wascarriedout.Thistriangulationapproachwasusedtoincreasethecredibilityandvalidityoftheresults.

1.3 Theliteraturereview,whichcoveredallexistingpolicydocumentationandrelevantpublications,wasconductedintwoparts.ThefirstpartaimedtoidentifythekeyskillsandprofessionalattributesofaFY1doctor.

1.4 ParttwooftheliteraturereviewfocussedonSituationalJudgementTests(SJTs)andtheiruseinhighstakesselection.TheresultshelptoputthepurposeofthejobanalysisincontextandaidanunderstandingofthemethodologythatwillbeundertakenwhendevelopingtheSJT.

1.5 Inall,51semistructuredinterviewswerecarriedoutwithFoundationdoctors,clinical/educationalsupervisors,Directors/Deans/HeadsofMedicalEducationatMedicalSchools,TrustMedicalDirectors,FoundationSchoolandProgrammeDirectorsandpatientrepresentatives.Theinterviewswereconductedfacetofaceorbytelephoneandlastedbetween3045minutes.IntervieweeswereaskedforexamplesofspecificincidentsfromtheFY1jobthatwerecharacteristicofeffectiveornoneffectiveperformance,andthustoidentifythekeyskillsandattributesneededtoperformasaFY1doctor.

1.6 Observations(shadowing)ofFY1doctorswerecarriedoutatfourlocationsthroughouttheUK.13FY1doctorswereobserved.Atotalof29hoursofobservationswereundertakenbytworesearchers.ThepurposeofobservingFY1doctorswastogainagreaterinsightandunderstandingintothetasksandresponsibilitiesofaFY1doctor,aswellastheprofessionalattributesrequiredtoperformtherolesuccessfully.Theresearchersrecordedthetasks,responsibilities,behavioursandattributesoftheFY1doctor.Arecordwaskeptofthetimingsofactionsandbehaviourstogainanunderstandingofthetemporalnatureoftherole.

1.7 Asurveywasconductedtovalidatetheoutcomesofthejobanalysiswithalargernumberofindividuals.Thevalidationsurveywassenttoanumberofdifferentorganisations(witharequestforittobecascaded)andindividuals,including;theBMAJuniorDoctorsCommittee,theUKFPOFoundationDoctorsAdvisoryBoardandtheUKFPOFoundationSchoolDirectorsandManagers.230individualsresponded.



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1.8 Theinterviewtranscriptswereanalysedusingtemplateanalysis11toidentifythekeythemeswithinthedata.All51transcriptswerecodedaccordingtoaninitialtemplate.Thetemplateunderwentanumberofiterations,andqualitycheckswerecarriedoutatafterhalfofthetranscriptshadbeencoded.

1.9 Theobservationswereanalysedandthebehavioursclassifiedaccordingtothetemplate.Wherebehaviourscouldnotbeassociatedwithexistingclassificationsinthetemplate,newclassificationswereintroduced.

1.10 Analysisofthedatafromtheinterviewsandobservationsresultedinnineprofessionalattributesbeingdefined,namely:(1)CommitmenttoProfessionalism,(2)CopingwithPressure,(3)EffectiveCommunication,(4)LearningandProfessionalDevelopment,(5)OrganisationandPlanning,(6)PatientFocus,(7)ProblemSolvingandDecisionMaking,(8)SelfAwarenessandInsightand(9)WorkingEffectivelyasPartofaTeam.TheseweresetoutinaProfessionalAttributeFrameworkwhichliststhebehaviouraldescriptorsthatarerepresentativeofeachattribute.

1.11 The contentsof theProfessionalAttributesFrameworkwere checkedagainst the findingsfrom the first part of the literature review. This confirmed that all of the professionalattributes identifiedthroughthereviewhadalreadybeen identifiedthroughtheothertwojobanalysismethods (i.e. interviewsandobservations), thusconfirming thevalidityof theFramework.

1.12 TheresultsfromthevalidationsurveyindicatedthatallnineProfessionalAttributeswereratedasimportantforaFY1doctorandimportanttoevaluateatselection.

1.13 TheProfessionalAttributesFrameworkwasmappedagainstexistingdata,includingtheFY1PersonSpecificationandtheFY1Curriculum.ThemappingdemonstratedthatthejobanalysisresultsandtheresultantProfessionalAttributesFrameworkshowedgoodconcordancewiththeUKFPOFY1PersonSpecification,althoughtheProfessionalAttributesFrameworkidentifiedoneattribute;LearningandProfessionalDevelopmentthatisnotpresentintheFY1PersonSpecification.ThemappingalsodemonstratedgoodconcordancebetweentheProfessionalAttributesFrameworkandtheFY1Curriculum.

1.14 ThisreportoutlinesthedesignspecificationfortheSJT.Section6detailstheSJTtargetattributedomains,thelengthofthetest,responseformatsandtheteststructure.

1.15 Inconclusion,thejobanalysishasresultedinaProfessionalAttributesFrameworkwhichidentifiestheprofessionalattributesthatareimportantforaFY1doctor,andprovidestargetattributedomainsfortheSJT.ItisrecommendedthatthedetailprovidedwithintheProfessionalAttributesFrameworkisusedgoingforwardtoassistinthedevelopmentoftheexistingFY1PersonSpecification.



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2 Introduction2.1 Purposeofthejobanalysis

2.1.1 ThisreportoutlinesthemethodologyandresultsofajobanalysiscarriedouttosupportthedevelopmentofaSituationalJudgementTest(SJT)fortheselectionoftraineedoctorsontotheFoundationProgramme.Thepurposeofthejobanalysiswastodefinetheprofessionalattributes(asopposedtoclinicalknowledgeandskills)thatarerequiredbytheroleoftheFoundationYearOne(FY1)doctor.TheresultsareusedtodeterminethetargetdomainsfortheSJTandwillbeusedtoinformthetestspecification.

2.1.2 TheoutcomesofthisanalysisaredescribedinbehaviouraltermsintheformofaProfessionalAttributesFramework,whichsetsoutthekeydimensionsandexampledescriptorsofeffectiveperformanceintherole.

2.1.3 TheSJTwillbeusedalongsideameasureofeducationalattainment(EducationalPerformanceMeasurement,orEPM)whichwillmeasureclinicalskillsandknowledge.TheEPMisnotwithintheremitofthisreport.

2.2 Structureofthisreport

Thisreporthasfourmainsections:

Section3describesthejobanalysismethodologyandresearchconductedtoidentifytheprofessionalattributesthatarejudgedasimportantbyarangeofstakeholdersforaFY1doctor.

Section4providesanoutlineofthedataanalysismethodologyemployed.

Section5describesthefindingsfromthejobanalysis,andprovidesaframeworkofthekeyprofessionalattributes(withassociatedbehaviouraldescriptors)fortheFY1doctor(ProfessionalAttributesFramework).Thecontentvalidityofthisframeworkisillustratedbyshowinghowtheseattributesmapontoexistingpolicydocumentation,includingtheFoundationProgrammecurriculum.

Section6presentsindetailthedesignspecificationfortheSituationalJudgementTestandprovidesamatrixofthetargetdomainsandexamplescenarios.

AsummaryandconclusionsareprovidedinSection7.FurthermaterialsrelevanttosectionsofthereportareprovidedintheAppendices.



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3 JobAnalysis3.1 Introduction

3.1.1 Thecornerstoneofaneffectiveselectionsystemisathoroughanalysisoftherelevantknowledge,skills,attitudesandotherpersonalqualitiesassociatedwithsuccessfulperformanceinagivenrole,asthisenablesaccurateidentificationofdomainstobetargetedatselection.

3.1.2 Jobanalysisisasystematicprocessforcollectingandanalysinginformationaboutjobs.Whenproperlyconducted,ajobanalysisprovidesobjectiveevidenceoftheskillsandabilitiesneededforeffectivejobperformanceandthusprovidessupportfortheuseofselectionproceduresmeasuringthoseskillsandabilities.Assuch,acomprehensivejobanalysisistypicallyregardedasbestpracticeasafirststepindesigninganyselectionsystem.Researchevidencealsoshowsthatconductingajobanalysisisimportantforanorganizationtodefenditshumanresourcemanagementpracticesagainstlegalchallenge1.

3.1.3 Asthenamesuggests,ajobanalysisshouldbeanalytical,meaningthatthejobanalysisprocessshouldbreakdownthejobintoitsmaincomponentpartsratherthandescribingthejobasawhole.Theendresultofthejobanalysisshouldbeadocumented,structured,andthoroughreportwhichoutlinestheessentialrequirementsofthejob2.

3.1.4 Forpurposesofinclusion,diversity,andbuyinfromstakeholders,itisimportanttogatherinformationfromarangeofindividuals.Bygatheringadiversityofopinionsandviews,anaccurateandrepresentativedescriptionofthejobismorelikelytobereached2.

3.1.5 Thereisnogivenruleforthenumberofindividualswhoshouldparticipateinajobanalysis,howeverguidanceisprovidedontheacceptablenumberofparticipantsneededtoobtainreliableandaccurateinformationaboutajob3.Forajobthathasapopulationofaround8000(asdoestheF1roleintheUK),40individualsshouldbeinvolvedintheprocesstoobtain80%confidenceintheresults.Toobtain90%confidenceintheresults,100individualsshouldbeinvolvedintheentirejobanalysisprocess,includinginterviews,observationsandrespondentstosurveys.

3.1.6 Jobanalysisisaprocessandnotasinglemethodology.Therearemultiplewaystogatherandanalysejobinformation.Bestpracticeadvisesamultimethodapproachtojobanalysis,whichgathersinformationfrommultiplesourcesusingmultiplemeans,asthisallowsidentificationofaspectsofajobthatmaynotbeaccessiblethroughasinglemethodology4.Datacollectedfrommultiplesourcesalsopreventspotentialbiasesfromasinglesource5andusingmultiplemethodsallowsforconvergenceofresultstomakethejobanalysismorecomprehensive6.

3.2 Jobanalysisapproach

3.2.1 Inthisstudy,apreviouslyvalidatedmultimethodjobanalysisapproachwasfollowed7,8.Thejobanalysismethodsusedincluded:



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afullliteraturereviewofexistingresearchandrelevantpolicydocumentation

Semistructuredcritical incident interviewswith individualsfamiliarwiththeroleofaFY1doctor,includingFoundationSchoolDirectorsandEducationalSupervisors,aswellasFoundationDoctorsandpatientrepresentatives

Direct observations (shadowing) of FY1 doctors in the workplace, using structuredchecklists

A validation questionnairebased survey that asked respondents (a range ofstakeholders)toratetherelativeimportanceofeachoftheprofessionalattributesandtheimportanceofassessing/evaluatingeachattributeatthepointofselection

3.2.2 Figure1belowdepictsthemultimethodapproachusedanddemonstrateshowtheresultsfromtheindividualmethodsaretobetriangulated.Triangulationisatechniquethatreferstotheapplicationandcombinationofseveralresearchmethodologies.Thepurposeoftriangulationinqualitativeresearchistoincreasethecredibilityandvalidityoftheresults.

Figure1:TriangulationApproachtoJobAnalysis

3.2.3 Whendecidingwhichmethodtoemployaspartofthemultimethodapproachtojobanalysis,theprojectteamtookseveralconsiderationsintoaccount.Theoverridingconsiderationwastherequirementforathoroughandindepthapproachthatfollowedbestpracticebygatheringinformationfrommultiplesourcesusingmultiplemeans.Otherconsiderationsincluded;availabilityofindividualsfromwhomtocollectdata,utility,theavailabilityofinformation,andtheneedtoforminimalinterference.

3.2.4 Whenundertakingthejobanalysis,evaluationcriteriafortheoutcomesofthejobanalysiswereagreedattheoutset.Theevaluationcriteriaforthisjobanalysisareasfollows:

Facevaliditythisiswhenamodelorprocedurelooksrighttotheapplicant/incumbentorotherse.g.doestheProfessionalAttributesFrameworkappearrelevantandrealisticandreflecttheprofessionalattributesrequiredforsuccessfulperformanceintheFY1role?



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ThiswasestablishedthroughensuringjobanalysisinterviewswereconductedwithFY1doctorsandotherrelevantpartiesthatwerefamiliarwiththeprofessionalattributesrequiredforsuccessfulperformance.ThevalidationquestionnairealsoassistedinestablishingfacevaliditybyaskingwhethertheprofessionalattributesidentifiedwereimportanttotheFY1role.

Contentvaliditythisiswhenamodelorprocedureappearstocoverarepresentativesampleofthedimensionsbeingtargetede.g.doestheframeworkaccuratelyreflecttheprofessionalattributesrequiredforsuccessfulperformancewithintherole?

Thiswasestablishedthroughconductinginterviewswithindividualsfamiliarwiththerole,observingFY1doctorsintheworkplaceandtheuseofavalidationquestionnairetoensurethattheprofessionalattributesthatarerequiredfortheFY1rolewereidentifiedandagreedbyacrosssectionofindividualswhohadspecificknowledgeandexperienceoftheFY1role.TheoutcomesofthejobanalysisarethenmappedontotheexistingFY1PersonSpecificationandtheFY1curriculumtoensurethattheoutcomesofthejobanalysisrelatetowhatisalreadyknownabouttherole.

Criterionrelatedvaliditythisiswhetheroutcomesof,orscoreson,aselectiontestorprocedurepredictfuturejobperformanceand/orpredictmeasuresofperformancethatarealreadyaccessiblee.g.dotheoutcomesofthejobanalysisrelatetosuccessfulperformance?ThiswillbeestablishedaspartoftheimplementationoftheSituationalJudgementTest(moredetailsareprovidedintheSJTdesignsection6)andwillcontinuetobeaddressedaspartoftheongoingprocess.

Politicalvalidity9selectionmodels,proceduresordecisionsmustaccountforawidevarietyofperspectivesbetweendifferentstakeholdergroups(beyondthecandidateandemployingorganization)whoholdpotentiallydiverseviews.Itisimportantthatamodelorprocedureforselectionhasbuyinandacceptancefromallkeystakeholders.Politicalvaliditywasestablishedthroughtheuseofthevalidationquestionnaireandwillcontinuetobeaddressedthroughoutthedevelopmentandevaluationprocess.

Constructvaliditythisisestablishingthatthemethodorprocedureissamplingdistinctconstructs(orattributes/skills/proficiencies)thatreflectwhattheyclaimtosamplee.g.doestheProfessionalAttributesFrameworkidentifydiscreteandindependentattributesthatreflectsuccessfulperformanceintheFY1role?

Constructvaliditywasestablishedthroughtheevaluationofthetheoreticalframeworkbyoccupationalpsychologistandresearchersexperiencedinjobanalysisandcompetencydesign(seesection4.4).Furthervalidationoftheframeworkwillbecarriedoutfollowingtheautumn2010pilotoftheSituationalJudgementTest.

3.3 Literaturereview

3.3.1 Theliteraturereviewwasconductedintwoparts,bothofwhicharepresentedwithinthisreport.



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3.3.2 Partoneoftheliteraturereviewfocusesonexistingpolicydocumentationandrelevantpublicationsintheliteraturetoassistinidentifyingthekeyskills,abilitiesandprofessionalattributesofaFY1doctor.

3.3.3 ThisaspectoftheliteraturereviewformspartofthetriangulationapproachtothejobanalysisoftheFY1roleandallowsfortheidentificationofspecificskills,abilitiesandprofessionalattributesthataredocumentedintheliteraturewhichmaybeincorporatedintotheproposedframework.

3.3.4 ParttwooftheliteraturereviewfocusesonSituationalJudgementTestsandtheiruseinhighstakesselection.TheresultsassistinplacingthepurposeofthejobanalysisincontextandunderstandingthemethodologythatwillbeundertakenwhendevelopingtheSituationalJudgementTest.

3.3.5 Thefollowingisabriefsummaryofthesearchstrategyusedfortheliteraturereviews.ThiswasapprovedinadvancebyrepresentativemembersoftheISFPProjectGroup.Thefullsearchstrategycanbefoundintheappendices(Appendix1).

3.3.6 A comprehensive literature search was conducted across the most relevant databasesincluding:Medline,ERIC,CINAHL,Psycinfo,PubMedandBioMedCentral.Inordertoidentifythekeyskills,abilitiesandprofessionalattributesoftheFoundationProgrammedoctorthefollowingsearchtermswereused:

JuniordoctorPreregistrationdoctorPGY1PreregistrationhousingofficerPRHOHouseOfficerFoundationdoctorFoundationyearMedicalstudentMedicalundergraduateInternF1

AND SkillsKnowledgeAbilitiesAttitudesCompetenciesCapabilitiesInterpersonalProfessionalattributesNoncognitiveattributesProfessionalcompetence

3.3.7 Thesearchstrategiescreatedweredesignedformaximumsensitivity(recall)toensurethatnopapersof significancewereoverlooked.The searchescovered the last twentyyearsofresearch(1990presentday).Thesearchmethodologyinvolvedthreemainstages:

i) The above search strategy was conducted along with reviews of relevant reportsincludingGoodMedicalPractice (2006), theNewDoctor (2009),TomorrowsDoctors(2009),TheFoundationProgrammeCurriculum(2010),RoughGuidetotheFoundationProgramme(2010),andtheFoundationProgrammePersonSpecification(2010).



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ii) Alldocumentswerescannedforrelevanceonthebasisoftheirtitleandabstract.Nonrelevant papers were rejected at this stage on the basis of the following inclusioncriteria:

Relevanttoidentifiedtopic Adequatemethodology Informedopinionwhichaddstothepictureofthetopic Peerreviewed(researchpublicationsonly) Englishlanguage

iii) A detailed review of the relevant papers was undertaken including checking allreferencelistsforadditionalarticlesofrelevance.

3.4 Semistructuredinterviews

3.4.1 Jobincumbentandsupervisor/stakeholdersemistructuredinterviewsareadvantageousastheyallowtheinputfromarelativelylargenumberofindividualstobeincludedaspartoftheanalysisandalsoenableafuturefocused/orientatedapproachtobeemployed.Itispossiblethatjobincumbentsmaypresentanexaggeratedrepresentationoftheirjob,buttheycanprovideinsightsintothejobthatareunavailablethroughothermethods.

3.4.2 Semistructuredinterviewswerecarriedoutwithindividuals(representingvariousstakeholdergroups)familiarwiththeroleofaFY1doctor.StakeholderswereidentifiedafterdiscussionwiththeProjectBoardandincludedFoundationSchoolDirectors,HeadsofUndergraduateMedicalEducation,FoundationDoctors,nursingstaffandpatientrepresentatives.ThejobrolesoftheintervieweesaredescribedinTable1andtheprimaryspecialitiesoftheintervieweesoutlinedinTable2.

3.4.3 InvitationswerecascadedthroughtheUKFPOFoundationDoctorAdvisoryBoard,FoundationSchoolDirectorsandManagers,andtheMedicalSchoolsCouncilAssessmentAlliance.PatientrepresentativeswereidentifiedthroughAoMRC,RoyalCollegeofAnaesthetists(RCoA),andRoyalCollegeofGeneralPractitioners(RCGP)patient/laygroups.

3.4.4 Allintervieweesweresentabriefingdocument(Appendix2)whichprovidedtheintervieweewithsomebackgroundinformationabouttheproject,andanoutlineofwhattheinterviewwouldinvolve.Thisinformationwasimportanttoprepareindividualsfortheinterviewandgainconsent.Followingalltheinterviews,thankyoulettersweresenttoallinterviewees.

3.4.5 Atotalof51participantswereinterviewed(ofwhom8werepatientrepresentatives).TherelativelylargenumberofinterviewsconductedwastoensurethattheinformationgainedwasrepresentativeandtoensurethatalltherelevantareasoftheFY1jobrolewerecovered.Informationabouthegender,ageandethnicityoftheintervieweesispresentedinTable3.

3.4.6 Thesemistructuredinterviewslastedapproximately30to45minutesandwereconductedeitherfacetofaceorbytelephone.TheinterviewsincorporatedtheCriticalIncidentTechniquemethodology10.Usingthispreviouslyvalidatedmethodology6,intervieweeswereaskedforexamplesorspecificincidentsfromtheFY1jobthatwerecharacteristicofeffective



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ornoneffectiveperformance,andthustoidentifythekeyskillsandattributesneededtoperformasaFY1doctor.ThisalsoprovidedcontextualinformationthatwasusedtoassistwiththedevelopmentofsomeofthescenariosfortheSJT(fulldetailsofinterviewquestionscanbefoundinAppendix3).Theinterviewswereaudiorecordedandthentranscribedpriortoanalysis.

3.4.7 Interviewingarangeofindividualswithdifferentjobrolesanddifferentexperiences/knowledgeofFY1doctorshelpedtoensurethattheinformationgatheredcoveredthebreadthoftheFY1jobroleandenableddifferentperspectivestobeconsidered.Theinvolvementofthepatientrepresentativeswasimportanttoensureapatientfocusedperspective.However,alimitationofusingpatientrepresentativesistheirpossibleunfamiliaritywiththeroleoftheFY1anddifficultywithdifferentiatingtheFY1rolewiththeroleofotherdoctorsthattheymayhaveencountered.Withthisinmind,thepatientrepresentativeswereprovidedwithanoutlineoftheFY1jobroleandexamplesofwhereandhowtheymayhaveencounteredaFY1doctor(Appendix4).IntheabsenceoffamiliaritywithFY1sspecifically,intervieweeswereaskedtoconsidertheroleofadoctoringeneral.

Table1:IntervieweesRoles

JobRole N

FoundationYearOne/TwoDoctor 6

ClinicalTutor/Clinical/EducationalSupervisor 16

FoundationProgramme/SchoolDirector 10

Director/Head/DeanofUndergraduateMedicalEducation

10

Patientrepresentative 8

Nursingstaff 1Table2:IntervieweesPrimarySpeciality



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PrimarySpeciality N

Endocrinology 1

Gastroenterology 2

EarNoseandThroat 2

Geriatrics 2

ClinicalOncology 1

Paediatrics 1

Medicine 1

Physiology 1

Anaesthetics 2

GeneralPractice 1

GeneralSurgery 1

Haematology 1

ObstetricsandGynaecology 1

Mixed(FY1/2) 6

NotStated 28

Table3:DemographicsofJobAnalysisParticipants

Interviews(includingpatientreps)

Observations(FY1s)

ValidationQuestionnaire

(rangeofstakeholders)

Gender Male 27 3 105

Female 24 10 121

NotStated 0 0 4

Agerange 25andunder 2 9 16

2635 3 4 31

3645 12 0 75

4655 12 0 74

5665 7 0 31

66andover 0 0 0

Notstated 15 0 3

Ethnicity White 35 10 191

Black 0 0 3

Asian 3 2 23

Mixed 0 0 5

Chinese 0 1 2

NotStated 13 0 6



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3.5 Observations(Shadowing)

3.5.1 Directobservationcanprovideinsightsthatothermethodscannot.However,carehastobetakenthatthebehaviouroftheindividualbeingobservedisnotalteredbythepresenceoftheresearcher.

3.5.2 ThepurposeofobservingFY1doctorswastogainagreaterinsightandunderstandingintothetasksandresponsibilitiesofaFY1doctor,aswellastheprofessionalattributesrequiredtoperformtherolesuccessfully.Additionally,adirectbehaviouralobservationofdoctorsintheworkplacegivesagreaterunderstandingofthetemporaldynamicsoftheroleandhowthejobisactuallyperformedthroughouttheday.Inaddition,theobservationstudyprovidedanopportunitytoobserveinteractionsbetweentheFY1doctorsandotherhealthcareprofessionals(nurses,pharmacists).

3.5.3 ObservationswerecarriedoutatfourlocationsthroughouttheUK.ShadowingFY1doctorsinfourdifferentlocationsprovidedagreaterunderstandingofthebreadthoftherole,andhowtherolemaydifferindifferentrotationsandlocalities.Forexample,observationsintheWesternIslesprovidedusefulinformationwithregardstotheroleofaFY1doctorinamorerurallocation,comparedtoacityhospital,suchasinManchester.

3.5.4 Fourlocationswereidentifiedbytheprojectteamassuitableforshadowing;WythenshaweHospital,UniversityHospitalofSouthManchesterNHSFoundationTrust;AddenbrookesHospital,CambridgeUniversityHospitalsNHSFoundationTrust;RaigmoreHospital,Inverness;andWesternIsleGeneralHospital,Stornaway.

3.5.5 Thehospitalswereaskediftheresearcherscouldsamplethethreecoregroupingsofspecialities;acute,family/communitybasedandinterventionistspecialties;recognisingthatfamilybasedspecialitiesarelessfrequentlyundertakenbyFY1s.ThiswastotryandensurethatshadowingcoveredthebreadthoftheFY1role.Themajorityofshadowingtookplaceintheacuteandinterventionistspecialities;howeverthefamily/communitybasedspecialitiesweresampledinthesemistructuredinterviews.

3.5.6 Intotal,13FY1doctorswereshadowedforperiodsbetweenonehourandfiveandahalfhours,withatotalof29hoursofobservationtakingplace.DemographicdetailsofthedoctorsshadowedareoutlinedinTable3.Shadowingtookplaceduringdayandnightshifts.DetailsofthespecialitieswherethedoctorsworkedandthehospitalsinwhichtheywerepostedaredetailedinTable4.

3.5.7 Twoexperiencedoccupationalpsychologistresearchers,whohadreceivedtheappropriateclearancetoshadowtheFY1s,wereinvolvedintheobservations.Aspartoftheshadowing,theresearchersprovidedanintroductionandashortbriefingaboutthebackgroundoftheprojectandtheaimsfortheshadowingtothenecessaryindividuals,includingtheFY1doctor(s)tobeshadowed.Itwasimportantthatthepurposeoftheshadowingandhowtheinformationwouldbeusedwasexplainedtoensurethedoctorsdidnotfearevaluationofthempersonally.ItwasmadeclearthatthestudywasdesignedtoevaluatetheFY1rolein



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generalaspartofabroaderjobanalysisstudy.Theresearchersthenshadowedthespecifieddoctor,ensuringthattheydidnotinterferewiththeirroleorcareofthepatients.

3.5.8 Theresearcherrecordedthetasks,responsibilities,behavioursandattributesoftheFY1doctor,usingtheobserveandrecordelementsofObserve,Record,ClassifyandEvaluate(ORCE),apreviouslyvalidatedmethodology4.TheresearchersobservedtheFY1doctorsandrecordedallbehaviourandinteractionswithotherindividuals.Whereconversationstookplace,verbatimcommentswererecorded.Arecordwaskeptofthetimingsofactionsandbehaviourstogainanunderstandingofthetemporalnatureoftherole.Appendix5showsthedocumentationusedtoobserveandrecordthebehaviour.

Table4:DetailsofObservations

Hospital Speciality

WythenshaweHospital,Manchester Gastroenterology

TraumaandOrthopaedicSurgery

AddensbrookeHospital,Cambridge HPBSurgery

Cardiology

RespiratoryMedicine

InfectiousDiseases

RaigmoreHospital,Inverness TraumaandOrthopaedicSurgery

RespiratoryMedicine

GeneralMedicine

WesternIsleGeneralHospital,Stornoway GeneralMedicine

GeneralSurgery

3.6 Validationquestionnaire

3.6.1 Thepurposeofthevalidationquestionnairewastovalidatetheoutcomesofthejobanalysiswithalargernumberofindividuals.TheaimwasnottoranktheprofessionalattributesinorderofimportancebutrathertoratetheirimportancebothintermsofimportancetotheroleofaFY1andimportanceforevaluatingatselection.

3.6.2 Thevalidationquestionnairewhichwasproducedasanonlinesurveyaskedtherespondenttwoquestions;toratetheimportanceofeachprofessionalattribute(asidentifiedthroughthejobanalysis)foraFY1doctoronascaleof16(1=littleimportance,6=extremelyimportant),andtoratetheimportanceofevaluatingeachprofessionalattributeatselection,againonascaleof16(1=notatall,6=essential).ThequestionnaireisshowninAppendix6.

3.6.3 Aninvitationtoparticipateinthesurvey(accessiblethroughaweblink)wassentouttoanumberofdifferentindividualsandorganisations(witharequestforittobecascadedwiththeaimthatitwouldbeseenbyalargenumberofpeople),including;BMAJuniorDoctorsCommittee,theUKFPOFoundationDoctorsAdvisoryBoard,UKFPOFoundationSchool



13

DirectorsandManagers,AssociationofUKUniversityHospitals(AUKUH)MedicalDirectors,NationalAssociationofClinicalTutors(NACT),LondonDeanery,AoMRCPatientLiaisonGroup,MedicalSchoolsCouncilAssessmentAlliance,plusalljobanalysisinterviewparticipantsanditemwritingworkshop1attendees,includingthosewhoexpressedaninterestbutwereunabletotakepart.ThelinkwasalsopostedontheMedicalSchoolsCouncilwebsiteandincludedintheUKFPObulletin.Individualsweregiventhreeweekstocompletethesurvey.

3.6.4 Thetotalnumberofrespondentstothesurveywas230.Duetothewaythesurveywascascaded,itisnotpossibletocalculatearesponserate;howeverfollowingbestpracticeregardingacceptablenumberofresponsestosurveys7,thenumbersareseenassufficient.Table3outlinesthedemographicdetailsoftheindividualswhorespondedtothesurvey.Table5outlinesthejobrolesofthosewhorespondedtothesurvey.

3.6.5 Thedatawasthencollatedandanalysed.

Table5:Jobrolesofsurveyrespondents

JobRole N

FoundationYearOne/TwoDoctor 46

ClinicalTutor/Clinical/EducationalSupervisor 78

FoundationProgramme/SchoolDirector/Manager

52

Director/Head/DeanofUndergraduateMedicalEducation

10

Patientrepresentative 6

Other 38

1FiveSJTitemwritingworkshopswerecarriedoutbetweenAprilandMay2010.IndividualsfamiliarwiththeFY1role

(excludingFoundationDoctors)andthosewhoworkcloselywithFY1swereinvitedtoattend.ThepurposeoftheseworkshopswastogenerateSJTitemsfortheSJTpilotinautumn2010.



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4 AnalysisoftheData4.1 Analysisstrategyfortheinterviews

4.1.1 51 interview transcriptswereavailable foranalysis. Templateanalysiswasused,as it isasystematicandwellstructuredapproachtohandlingtextualdata11.

4.1.2 Template analysis is awellestablished technique in job analysis research, and allows theresearcher to thematically analyse relatively large amounts of qualitative data12. Thetemplate is createdasa listof codes that represent themes (or in this casebehaviouraldescriptorswhichrepresenttheprofessionalattributesrequired foraFY1toperformtheirrole) within textual data (in this case, interview transcripts). The codes are typicallyorganisedhierarchicallyallowingaclear(andtransparent)representationoftheassociationsbetween themes. For example there are broad themes (or domains that representprofessionalattributes)withinwhichsubsidiarythemes(orbehaviouraldescriptors)willfall.It should be noted that codes are specified not only for themes found inmost of thetranscripts but also for those that appear in only aminority of transcripts in linewithestablishedtemplateanalysismethodology13.

4.1.3 Intemplateanalysis,aninitialtemplateiscreatedandusedtocodethetextualdata.Whensomerelevanttextisfoundthatdoesnotfitlogicallywiththeexistingcodes,achangetothetemplate isrequired.Where therequiredchange in thecodingstructure issignificant, theresearchermayneedtoadjusttheearliercodingoftranscriptstofitthenewversionofthetemplate.Theworkmayrequireiterationsofsuchchangestothetemplate14.

4.1.4 Oneofthemainadvantagesoftemplateanalysis isthat itallowsthereadertogainaclearoverviewofthethemes identified intheanalysisandtherefore lends itselfappropriateforjob analysis research. It also enables the researcher to reduce large amounts ofunstructured text into a structured format which is relevant and manageable for theevaluation15.

4.1.5 Oneof thedisadvantageswith templateanalysis is the time taken to reviewand codealldata16.Anotherpossible limitationof templateanalysis is the researchers involvement inthe research process, and how this may shape its outcomes. Reflexivity2 is thereforerequired to ensure the researcher is aware of how their own assumptions about thephenomenon under investigation may influence the formulation of the model12.Involvement of other researchers throughout the process to quality check progress isrecommended13.

2Reflexivityreferstoanawarenessoftheresearcher'scontributiontotheconstructionofmeaningsthroughoutthe

researchprocess,andanacknowledgmentoftheimpossibilityofremaining'outsideof'one'ssubjectmatterwhileconductingresearch



15

4.2 Creationofthetemplate

4.2.1 TheinterviewswerecodedaccordingtothefollowingdefinitionbehavioursidentifiedtoexplaineffectiveFY1performancethatrepresentprofessionalattributes(asopposedtoclinicalknowledgeandskills).

4.2.2 Aninitialtemplatewasdevisedbasedonthemesemergingfromanalysisofasubsetoftheinterview transcripts. Three experienced occupational psychologist researchersindependently analysed three transcripts and produced their own initial template.A onehourmeetingwas then held between the three researchers to agree an initial template.Duringthemeeting,thethreeindependentlycreatedtemplateswerecompared,contrastedanddiscusseduntilaconsensuswasreachedastoaninitialtemplate.

4.2.3 Theinitialtemplatewasmodifiedafterfiveinterviewshadbeencoded,andthenagainafter16interviewsandafourthversionofthetemplatewascreatedafter28interviews.Ateachmodification, previous transcripts were reviewed and updatesmade based on the newcoding.

4.2.4 Atthisstage,after28transcriptshadbeencoded,thetworesearcherswhohadpreviouslybeeninvolvedincreatingtheinitialtemplatewereprovidedwithtwotranscriptsandaskedto code them independently using themost recent (fourth) template. Thiswas done toprovideaqualitycheckoftheanalysistoensureitwasnotbeingsystematicallydistortedinsomemannerbytheresearchersownpreconceptionsandassumptions.Thesimilaritiesanddifferenceswerediscussedtoagreerevisionstothethemes.

4.2.5 Thefifthiterationofthetemplatewascreatedbyanalysingthefinal23interviews,reviewingthe first three transcripts used for creating the initial template and through successivereadingsofallthetranscripts.

4.3 Analysisstrategyfortheobservations

4.3.1 From the29hoursofobservationsa totalof470behaviourswereobserved.Of these470behaviours, analysis showed that there were 61 unique behaviours observed and theremainingbehaviourswerereplicated.

4.3.2 Thebehavioursobserved and recorded from theobservationswere classified against thefifthiterationofthetemplate.Itwasfoundthatthemajorityofthebehaviourswerealreadyrepresented in template, thus confirming its validity.A sixth versionof the templatewascreatedtotakeintoaccountthefewremainingbehavioursthatwerenotpresentinthefifthversion.

4.4 ValidationofProfessionalAttributesFramework

4.4.1 Thesixthtemplategroupedthebehaviouraldescriptorsintoninebroadthemes.Toensurethat thebehaviouraldescriptorsweregroupedunder the correctbroad theme,andwererepresentativeofthattheme,furtheranalysiswascarriedout.Eachbehaviouraldescriptorfrom the templateanalysiswasrecordedonaseparatecardwith theaimofgrouping the



16

descriptors intosimilar themes.This technique isknownascardsorting,whereagroupofsubjectexpertsareguidedtogenerateacategorytreeorgroupings17.Toperformthecardsort, twoexperiencedoccupationalpsychology researchers (whohadpreviouslynotbeeninvolved in the job analysis interviews/observations or subsequent analysis) workedtogetherfortwohourstogroupthebehavioursrecordedonthecards intosimilarthemes.Thisresultedineightbroadthemes.

4.4.2 Thetworesearcherswhohadcarriedoutthecardsortandthe leadresearcherheldaonehourmeeting todiscuss theoutcomesof thecardsortand finalise thebroad themesandinclusion of the behavioural descriptors within these themes. The eight broad themeselicited from the card sortwere comparedwith theninebroad themeselicited from thetemplate analysis. The themes and the behavioural descriptors were discussed andjustificationforinclusionconsidereduntilconsensuswasreachedregardingthefinalnumberofbroad themes and groupingof thebehaviouraldescriptorswithineachof thesebroadthemes.

4.4.3 The final template,or framework,consistsofninebroad themes.Thesebroad themesarefrom here on in referred to as professional attributes. The framework is termed theProfessionalAttributesFrameworkandprovidesa fulldescriptionof thedataandoutlinesthe behavioural descriptors grouped under the nine professional attributes that areexpectedintheroleofaFY1doctor.

4.4.4 Eachprofessionalattributecanbedefinedasasetofspecificbehaviourpatterns,includingknowledge,skillsandabilities,apersonisexpectedtohavetoperformeffectivelyasaFY1.Professionalattributeheadingswere thendefinedandshortdescriptionsof theattributeswere developed, based on the elements ofwhich they consisted, thus using a posthocapproachtolabellingthem4.

4.4.5 In order to further validate the framework, the headings and descriptions wereindependently reviewedby two senioroccupationalpsychologistswhohadnotpreviouslyhadaccesstothedata.

4.4.6 Anexpertpanelof researchersandoccupationalpsychologistsexperienced in jobanalysisand competency design (N=7) then reviewed the content and the constructswithin theframework for twohours. Thisprocesswas intended to confirm the results and that theprofessionalattributesarerepresentativeoftheattributedefined,thushelpingtoestablishthecontentvalidity(andtosomeextentconstructvalidity)oftheframework.

4.4.7 Figure2providesanillustrationofthejobanalysismethodologyandanalysisstrategy.



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Figure2:JobAnalysisMethodologyandAnalysisStrategy

Qualitychecksoftemplatebytworesearchers

Cardsortbytwoindependentresearchers

Expertpanel(n=7)confirmedbehaviours

representativeofdomain

Expertpanel(n=2)revieweddescriptionsandtitles



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5. ResultsofJobAnalysis

5.1 ProfessionalAttributesFramework

5.1.1 The Professional Attributes Framework (Table 6) consists of nine professional attributes(that represent the professional attributes important for the role of a FY1 doctor) andprovidesadefinitionofeachoftheprofessionalattributesandthebehaviouraldescriptorsthatrepresenttheprofessionalattribute.

5.1.2 Thenineprofessional attributes are: (1)Commitment to Professionalism, (2)CopingwithPressure, (3) Effective Communication, (4) Learning and Professional Development, (5)OrganisationandPlanning, (6)PatientFocus, (7)ProblemSolvingandDecisionMaking, (8)SelfAwarenessandInsightand(9)WorkingEffectivelyasPartofaTeam.

5.1.3 Eachof theseprofessionalattributes isrepresentedbyarangeofbehaviouraldescriptors.The behavioural descriptors describe the detail of the professional attribute and arethereforecoretowhattheprofessionalattributerepresents.

5.1.4 Within the professional attribute Effective Communication, further categories emerged.Theseare:

Generalcommunication Communicationwithpatients Communicationwithcolleagues Writtencommunication

5.1.5 Thecontentvalidityof this framework is illustratedbyshowinghow theseattributesmap

ontoexistingpolicydocumentation,includingtheFoundationProgrammecurriculum.Thisisdescribedinmoredetailinsection5.7.

5.2 Findingsfromtheliteraturereview

5.2.1 The main findings from the literature review were compared with the ProfessionalAttributes Framework to identify if therewere anyprofessional attributes thathadbeenidentifiedwithintheliteraturereviewthathadnotbeenidentifiedduringtheinterviewsorobservations. Table 7 outlines the main findings of the literature review and how thefindingsmapontotheframework.

5.2.2 ThereviewindicatedthatallfindingsfromtheliteraturereviewhadbeenidentifiedthroughtheothertwojobanalysismethodsthusconfirmingthevalidityoftheProfessionalAttributesFramework.

5.2.3 ThefullFY1literaturereviewispresentedindetailinAppendix8.

5.2.4 AsummaryoftheSituationalJudgementTestliteraturereviewfindingscanbefoundinsection6.



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Table6:ProfessionalAttributesFrameworkandBehaviouralDescriptors

ProfessionalAttribute ProfessionalAttributeDefinition BehaviouralDescriptors

*I=behaviourfromInterviewO=behaviourfromObservation

1.CommitmenttoProfessionalism

Displayshonesty,integrityandawarenessofconfidentiality&ethicalissues.Istrustworthyandreliable.Demonstratescommitmentandenthusiasmforrole.Willingtochallengeunacceptablebehaviourorbehaviourthatthreatenspatientsafety,whenappropriate.Takesresponsibilityfor

ownactions.

1. Ispunctual(I)2. Takesresponsibilityforownactions/work(I&O)3. Ownsuptomistakes(I)4. Takesresponsibilityforownhealthandwellbeing(I)5. Demonstratescommitmenttoandenthusiasm/motivationforrole(I)6. Understands/isawareoftheresponsibilityoftheroleofbeingadoctor(I)7. Isreliable(I)8. Displayshonestytowardsothers(colleaguesandpatients)(I)9. Trustworthy(I)10. Identifies/challengesunacceptable/unsafebehaviour/situationswhen

appropriate(colleague/organisationalissues)(I)11. Challengesothersknowledgewhereappropriate(I)12. Understands/demonstratesawarenessofethicalissues,including

confidentiality(I)

2.CopingwithPressure Capabilitytoworkunderpressureandremainresilient.Demonstratesabilitytoadapttochangingcircumstancesandmanageuncertainty.Remainscalmwhenfacedwithconfrontation.Developsandemploysappropriatecopingstrategiesanddemonstratesjudgementunderpressure.

1. Remainscalmandincontrolofsituations(I&O)2. Managesuncertainty/ambiguity(I)3. Effectivelydealswithoutcomesofmistakes/decisions(I)4. Exhibitsflexibility/adaptabilitywhendealingwithchangingcircumstanceor

issues(I&O)5. Employseffectivecopingmechanismsfordealingwithstress/emotions

(I&O)6. Demonstratesgoodjudgementunderpressure(I)



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7. Doesnotgiveupeasily(I)8. Dealsappropriatelywithconfrontational/difficultsituations

(colleagues/patients)(I&O)9. Seekssupportwhenfacedwithstress/pressure(I&O)

3.EffectiveCommunication

Activelyandclearlyengagespatientsandcolleaguesinequal/opendialogue.Demonstratesactivelistening.Communicatesverbalandwritteninformationconciselyandwithclarity.Adaptsstyleofcommunicationaccordingtoindividualneedsandcontext.Abletonegotiatewithcolleagues&patientseffectively.

General 1.Listenseffectively(I&O)2.Ensuressurroundingsareappropriatewhencommunicating(I)3.Understands/respondstononverbalcues(I)4.Usesnonverbalcommunicationeffectively(I)

WithPatients

1. Useslanguagethatisunderstoodbypatients/relativesandfreefrommedicaljargon(I&O)

2. Demonstratessensitiveuseoflanguage(I&O)3. Communicatesinformationtopatientsclearlyandconcisely(I&O)4. Adjustsstyleofcommunicationaccordingtopatients/relativesneeds

(I&O)5. Adjustshowmuchinformationtoprovideaccordingtopatients/relatives

needs(I)6. Providesinformationtopatientsandkeepsthemupdated(I&O)7. Readilyanswerspatientsandrelativesquestions(I&O)8. Ensureshasalltherelevantinformationbeforecommunicatingto

patients/colleagues(I&O)9. Asksquestions/seeksclarificationtogainmoreinformation/understanding

aboutthepatient(I&O)10. Findsoutpatients/relativeslevelofknowledge/understanding(I)11. Allowspatients/relativestoaskquestions/usessilenceeffectively(I&O)12. Checkspatients/relativesunderstanding(I&O)13. Summarisesinformation/reflectsbacktopatientstoclarifytheirown

understanding(I&O)



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Withcolleagues

1. Asksquestionsofcolleaguestogainmoreinformation(I&O)2. Provides/summarisesinformationaccuratelyandconciselytocolleagues

(I&O)3. Providesonlyrelevantinformationtocolleagues(I&O)4. Keepscolleaguesinformed/updated(aboutpatientsandaboutwherethey

willbe)(I&O)5. Isabletonegotiate/usediplomacy(I&O)6. Knowsexactlywhatareaskingforandwhy(I)7. Isassertivewherenecessary(I)8. Adaptsstyleofcommunicationaccordingtoneedandsituation(I)9. Clarifiesinformationtochecktheirownunderstanding(O)

Written 1. Displayshighstandardsofwrittencommunication(I)2. Usesconciseandclearwrittencommunication(I)3. Haslegiblehandwriting(I)

4.LearningandProfessionalDevelopment

Demonstratesdesireandenthusiasmforcontinuedlearning,takesresponsibilityforowndevelopment.Willingtolearnfromothersandfromexperience.Isopenandacceptingoffeedback.Demonstratesadesireandwillingnesstoteachothers.

1. Demonstratesadesireandenthusiasmtolearnandimprove(I)2. Iswillingtolearnfromothers(I&O)3. Keepsuptodatewithknowledge(I)4. Iswillingtolearnoutsideofworkthroughreadingaroundsubject/accessto

internet(I)5. Learnsfrompreviousexperiences(I&O)6. Learnsfrommistakes(I)7. Takesresponsibilityforownlearning(I&O)8. Isopentoandacceptsoffeedback(I&O)9. Iswillingtoteachothers(I&O)



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5.OrganisationandPlanning

Managesandplansworkloadeffectively,displayingefficienttimemanagementanddeliveringtasksontime.Abletoprioritiseeffectivelyandreprioritisewhereappropriate.Isconscientiousandmaintainsaccuraterecords.

1. Demonstrateseffectivetimemanagement(I&O)2. Prioritisestaskseffectively(I&O)3. Managesandplansworkload/tasks(I&O)4. Checkstasksarecomplete/followsuptasks(I&O)5. Maintainsaccuraterecords(I&O)

6.PatientFocus Ensurespatientisthefocusofcare.Demonstratesunderstandingandappreciationoftheneedsofallpatients,showingrespectatalltimes.Takestimetobuildrelationshipswithpatients,demonstratingcourtesy,empathyandcompassion.Worksinpartnershipwithpatientsabouttheircare.

1. Abletogaintrustfrompatients/instilconfidence(I)2. Isempathetictowardspatients(I&O)3. Isabletomaintainappropriatedistancefrompatients/relatives(I)4. Iswillingtomakeselfavailabletopatients(forsupport/provide

continuity/gettoknowthem)(I)5. Understands/considersthedifferingneedsofpatients(I&O)6. Recognisesthatpatientshavedifferentbackgrounds/values/beliefs(I)7. Showsrespectforpatients(I&O)8. Worksjointlywiththepatientabouttheircare(I)9. Recognisesthepatientasthecentreofcare(I&O)10. Showsagenuineinterestinpatients(I&O)11. Showscompassiontowardspatients/relatives(I&O)12. Iswillingtospendtimewithrelatives(I)13. Buildsrapportwithpatients(I&O)14. Ispolite,courteousandpresentsanopenmannerwhendealingwith

patients(I&O)15. Providesreassurancetopatients(I&O)16. Considerspatientssafetyatalltimes(I)



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7.ProblemSolvingandDecisionMaking

Demonstratesanabilitytoassimilatearangeofinformationandidentifykeyissues.Engageswiththewiderissuesandthinkscreativelytosolveproblemsandreachappropriatedecisions.Isproactiveanddemonstratesinitiative.Isabletoattendtodetail.

1. Makesappropriatedecisionsbasedonalltherelevantinformation(I)2. Demonstratesabilitytouseowninitiative(I&O)3. Abletoassimilateandintegrateinformationeffectively(I)4. Understandsproblemsfromawiderperspective/takesintoaccountwhole

picture(I)5. Demonstratesgoodattentiontodetail(I)6. Isproactive;takeschargeofasituationandmakesthingshappen(I&O)

8.SelfAwarenessandInsight

Demonstratesawarenessoftheboundariesoftheirowncompetenceandwillingtoseekhelpwhenrequired,recognisingthatthisisnotaweakness.Exhibitsappropriatelevelofconfidenceandacceptschallengestoown

knowledge.

1. Iswillingtoseekhelpwhenneeded(I)2. Abletosaynowhenfacedwithasituation/tasktheyarenotcomfortable

with/admitthattheydontknow(I)3. Acceptsthataskingforhelpisnotaweakness(I)4. Recognisesboundaries/limitationsofowncompetence(I)5. Displaysappropriatelevelofconfidenceinself/ownability(I&O)6. Acceptschallengestoownknowledge(I)7. Acceptsmistakeswillbemade(I)

9.WorkingEffectivelyasPartofaTeam

Capability&willingnesstoworkeffectivelyinpartnershipwithothersandinmultidisciplinaryteams.Demonstratesafacilitative,collaborativeapproach,respectingothersviews.Offerssupportandadvice,sharingtasksappropriately.Demonstratesanunderstandingofownandothersroleswithintheteamandconsultswithotherswhereappropriate.

1. Demonstratesanunderstandingofothersroleswithintheteam,includingarecognitionofothersknowledge/skills/abilities/roles/responsibilities(I&O)

2. Abletoidentifyandutilisethemostappropriatepersonforatask/situation(I&O)

3. Awareofownrole/responsibilitieswithinteam(I&O)4. Buildsrapportandestablishesrelationshipswithotherteammembers

(I&O)5. Supportsothers(inanontaskrelatedway)(I)6. Iswillingtoofferassistancewithtasks/workload(I&O)7. Iswillingtooffer/provideadvice(I&O)8. Valuesotherpeoplesopinionsandcontributions(I&O)



24

9. Showsrespectforcolleagues(I&O)10. Delegatesandsharestaskseffectively(I&O)11. Maintainsharmonywithintheteam(I&O)12. Identifieswhenothersareindifficulty/arestruggling(I)13. Abletotakeonboardteammembersperspectives(I&O)14. Abletoadaptrolewithinteamwherenecessaryi.e.takeonroleofleader

(I)15. Sharesknowledgeandexpertisewithcolleagues(I&O)16. Iswillingtotakedirectionfromothers(O)17. Consultswithothersandasksforadvice(I&O)18. Makesothersawareofownworkload(I&O)



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Table7:ProfessionalAttributesMappedagainstFindingsfromFY1LiteratureReview

3Reportsrefertothefollowingdocuments:GoodMedicalPractice(2006),theNewDoctor(2009),TomorrowsDoctors(2009),TheFoundationProgrammeCurriculum(2010),RoughGuidetotheFoundationProgramme(2010),andtheFoundationProgrammePersonSpecification(2011).

ProfessionalAttribute Definition FindingsfromLiteratureReview

CommitmenttoProfessionalism

Displayshonesty,integrityandawarenessofconfidentiality&ethicalissues.Istrustworthyandreliable.Demonstratescommitmentandenthusiasmforrole.Willingtochallengeunacceptablebehaviourorbehaviourthatthreatenspatientsafety,whenappropriate.

Takesresponsibilityforownactions.

Reports3 F1doctorsmust: Be honest in their relationships with patients, colleagues and employers; Act with integrity (e.g. act without delay if they have good reason to believe they or a colleague may be putting a patient at risk; never abuse a patients trust); Demonstrate that they are able to take appropriate action if their own health, performance or conduct or that of a colleague puts patients, colleagues or the public at risk; Know how errors can happen and how to manage risk; Accept the moral and ethical responsibilities involved in providing care (e.g. demonstrate sound knowledge of confidentiality); know the principles of equality and diversity; Be able to adapt to changing circumstances throughout their professional life.

Wright&Carrese(2001) looked at what values and attitudes physicians tried to pass on to medical trainees to encourage their professional development and integrity was a key theme encompassing trust and honesty.

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year and found a key theme surrounded developing appropriate attitudes to ethics.

CopingwithPressure Capabilitytoworkunderpressureandremainresilient.Demonstratesabilitytoadapttochangingcircumstancesandmanageuncertainty.Remainscalmwhenfacedwithconfrontation.Developsandemploysappropriatecopingstrategiesanddemonstratesjudgementunderpressure.

Reports F1doctorsmust: Show initiative and deal effectively with pressure and/or challenge; Offer assistance in an emergency.

Schon(1983)argues that professional competence is the ability to manage ambiguous problems, tolerate uncertainty, and make decisions with limited information.

Lemppetal(2003)asked 16 Pre Registration House Officers (PRHOs) to comment on their specific experiences in the first few months as a PRHO. Many commented on the adoption of coping strategies to deal with heavy demands and clinical tasks e.g. prioritising work and asking for help when needed.

Brennanetal(2010)aimed to ascertain how 31 medical graduates, across five hospitals, found the transition from medical school to foundation year using semi-structured interviews and an audio diary approach. Key experiences included having to manage uncertainty and cope with feelings of stress and anxiety concerning their level of competence (particularly regarding prescribing).

EffectiveCommunication

Activelyandclearlyengagespatientsandcolleaguesinequal/opendialogue.Demonstratesactivelistening.Communicatesverbalandwritteninformationconciselyand

Reports F1doctorsmust: Be able to communicate clearly, sensitively and effectively with patients and their relatives (e.g. listen to patients, ask for and respect their views about their health; keep them informed about the progress of their care; make sure patients are informed about how information is shared within teams); Know how to develop and maintain successful relationships with patients in a range of situations (e.g. within a consultation, when breaking bad news, when dealing with complaints, when communicating with patients who have mental illness or mental and physical disabilities); be able to communicate in different ways (including spoken, written and electronic



26

withclarity.Adaptsstyleofcommunicationaccordingtoindividualneedsandcontext.Abletonegotiatewithcolleagues&patientseffectively.

methods); Be able to effectively interface with different specialties and with other professionals. Hoffmanetal(2009) - students who were rated as outstanding on a house officer potential scale had excellent

communication and presentation skills. Wright&Carrese(2001) looked at what values and attitudes physicians tried to pass on to medical trainees to

encourage their professional development and communication was a key theme encompassing body language, openness, sitting down when speaking with patients, silent observation, avoidance of confrontation and effective listening.

Stewartetal(1999)identified tasks of pre-registration doctors by asking a panel of experts who were clinical tutors who had at least 2 years experience of supervising PRHOs. The final tasks included those requiring communication, e.g. establishing and maintaining good working relationships with other staff; giving advice on individual patient care, communicating information between hospital and community, talking to patients and relatives and handling difficult patient interactions.

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year and found a key theme surrounded communication with patients, relatives and the healthcare team.

Katinkaetal(2005)interviewed 1150 junior doctors on the key competencies required of professional practice. All doctors rated communication skills as highly important in their current pre-registration year.

LearningandProfessionalDevelopment

Demonstratesdesireandenthusiasmforcontinuedlearning,takesresponsibilityforowndevelopment.Willingtolearnfromothersandfromexperience.Isopenandacceptingoffeedback.Demonstratesadesireandwillingnesstoteachothers.

Reports F1doctorsmust: Internalise the importance of CPD and self-directed learning (demonstrated through effective assessments); Keep up to date with the developments in their field; Be willing to respond constructively to the outcome of appraisal, performance review and assessment; Teach their peers and other students (if required to do so); Contribute to appraisal, assessment or review of students and other colleagues they work with; Develop the skills, attitudes and practices of a competent teacher.

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year and found a key theme surrounded personal development. This included recognising self education/personal development as a lifelong process, accepting/coping with increased responsibility, developing confidence, developing further competence from clinical experience on the job, and developing appropriate attitudes to personal health and well-being.

OrganisationandPlanning

Managesandplansworkloadeffectively,displayingefficienttimemanagementanddeliveringtasksontime.Abletoprioritiseeffectivelyandreprioritisewhereappropriate.Isconscientiousandmaintainsaccuraterecords.

Reports F1doctorsmust: Manage their own time under supervision; demonstrate good time management; maintain accurate record-keeping (e.g. medical notes, discharge letter/summaries, outpatient letters, prescriptions).

Hoffmanetal(2009) students who were rated as outstanding on a house officer potential scale had excellent preparation skills which included being accurate, having good attention to detail, good time management, being well organised, confident, resourceful and prepared.

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year and found a key theme surrounded personal development which included managing time well.

Boggetal(2001)90 PRHOs from three teaching hospitals in the Northwest of England completed a diary of work-based activities and 18 were then interviewed as a follow-up. mTime management was found to encompass 43% of their day to day activities.

Stewartetal(1999)identified tasks of pre-registration doctors by asking a panel of experts who were clinical tutors



27

who had at least 2 years experience supervising PRHOs. The final list of tasks included self management skills which encompassed time management, efficient use of resources, identifying priorities, for example when on call knowing who to attend to first and what to do first.

PatientFocus Ensurespatientisthefocusofcare.Demonstratesunderstandingandappreciationoftheneedsofallpatients,showingrespectatalltimes.Takestimetobuildrelationshipswithpatients,demonstratingcourtesy,empathyandcompassion.Worksinpartnershipwithpatientsabouttheircare.

Reports F1doctorsmust: Demonstrate that they are taking increasing responsibility for patient care (under supervision and with appropriate discussions with colleagues); Ensure effective relationships with patients are established and maintained (e.g. creating an environment where the doctor can encourage and support the patient to share all information relevant to the consultation); Introduce themselves to patients and colleagues with appropriate confidence and authority; Recognise that patients are knowledgeable about themselves and the effect their health has on their daily life (and they should be aware that relatives and carers often have to be included in the information given to patients); Respect patients regardless of their lifestyle, culture, beliefs etc; Work in partnership with patients give patients the information they want in a way they can understand and support patients in caring for themselves.

Hoffmanetal(2009) - students who were rated as outstanding on a house officer potential scale had excellent interpersonal skills which included being committed to patient care, good at building rapport, friendly, works well with patients and families, is compassionate, caring and has a good bedside manner.

Wright&Carrese(2001) looked at what values and attitudes physicians tried to pass on to medical trainees to encourage their professional development and both respect (encompassing patient dignity, patient preferences, being non-judgemental, respect, tolerance and confidentiality) and caring (encompassing empathy, compassion, caring, concern, understanding and consideration) were key themes.

ProblemSolvingandDecisionMaking

Demonstratesanabilitytoassimilatearangeofinformationandidentifykeyissues.Engageswiththewiderissuesandthinkscreativelytosolveproblemsandreachappropriatedecisions.Isproactiveanddemonstratesinitiative.Isabletoattendtodetail.

Reports F1doctorsmust: Prioritise tasks and information effectively; Solve problems, analyse and use numerical data; Have knowledge around diagnoses and clinical decision-making.

Hoffmanetal(2009) - students who were rated as outstanding on a house officer potential scale had excellent clinical skills which included problem solving skills

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year and found a key theme surrounded appropriate decision-making skills, clinical judgement and reasoning.

SelfAwarenessandInsight

Demonstratesawarenessoftheboundariesoftheirowncompetenceandwillingtoseekhelpwhenrequired,recognisingthatthisisnotaweakness.Exhibitsappropriatelevelofconfidenceandacceptschallengestoownknowledge.

Reports F1doctorsmust: Recognise personal and professional limitations and be willing to ask for help when necessary; Reflect on practice and be self critical; Be committed to self-directed life-long learning.

Hoffmanetal(2009) - students who were rated as outstanding on a house officer potential scale had excellent self directed learning skills which included accepting feedback, being a good listener, having intellectual curiosity, being an avid learner, bright and a thinker.

Stewartetal(1999)identified tasks of pre-registration doctors by asking a panel of experts who were clinical tutors who had at least 2 years experience supervising PRHOs. The final list of tasks included self management skills which encompassed knowing when to contact a more senior doctor for help, clear knowledge of ones own competencies and understanding his or her own role and responsibilities as doctor and employee.

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year



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and found a key theme surrounded personal development. This included being aware of limitations and seeking help. Brennanetal(2010)aimed to ascertain how 31 medical graduates, across five hospitals, found the transition from

medical school to foundation year using semi-structured interviews and an audio diary approach. Key experiences included knowing when to ask for help and learning from prior experiences.

WorkingEffectivelyasPartofaTeam

Capability&willingnesstoworkeffectivelyinpartnershipwithothersandinmultidisciplinaryteams.Demonstratesafacilitative,collaborativeapproach,respectingothersviews.Offerssupportandadvice,sharingtasksappropriately.Demonstratesanunderstandingofownandothersroleswithintheteamandconsultswithotherswhereappropriate.

Reports F1doctorsmust: Work effectively as a member of a team (supporting others and efficient handovers); Respect everyone they work with; Share information where necessary; Listen and take account of others health professionals and agencies; Be able to demonstrate effective teamworking and leadership skills; Be willing to lead when faced with uncertainty and change.

Hoffmanetal(2009) - students who were rated as outstanding on a house officer potential scale had excellent teamwork skills which included being hardworking, willing to help, having initiative, independence, leadership skills, positive to work with, dependable, reliable, mature and a key team player.

Stewartetal(1999)identified tasks of pre-registration doctors by asking a panel of experts who were clinical tutors who had at least 2 years experience supervising PRHOs. The final list of tasks included self management skills which encompassed understanding the roles of others and working as part of a multidisciplinary ward team.

Heskethetal(2003)interviewed 57 PRHOs throughout Scotland regarding learning outcomes of the PRHO year and found a key theme surrounded their role as doctor within the health service. This included working as a team, adapting to different levels of support, accepting principles of collective responsibility and adapting to different working protocols.

Katinkaetal(2005)1159 junior doctors responded to a survey on the key competencies required of professional practice. All doctors rated teamwork skills as highly important in their current pre-registration year.Brennanetal(2010)aimed to ascertain how 31 medical graduates, across five hospitals, found the transition from medical school to foundation year using semi-structured interviews and an audio diary approach. Key experiences included working with others particularly with senior doctors and the multidisciplinary team.



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5.3 Findingsfromtheinterviews

5.3.1 Examplequotesfromtheinterviewsareprovidedtoillustratetheprofessionalattributeandthebehaviouraldescriptors.

5.3.2 CommitmenttoProfessionalism

What you dontwant is someone who has said they have done somethingwhen theyhaventdoneit.Honestyiscrucial

HonestyabouttheirownhealthTheyneedtobeabletomakeajudgementcalltoseeiftheyfeeltheycanstillseepatientsappropriately

DrivenandenergeticItsmakingsureyoudoyourjobtothebestofyourability

TheywillbearolemodelforsocietyYouwantpeoplewhodontjustassumethattheyarestillstudentsandhaventtakenthatstepforward

Junior doctors often see the bad side of doctors and they are too scared to admit itadoctorshouldfeelempoweredtoreportonothersifneedsbe

Dont leave it forsomeoneelse todoyourwork...itsyour job todoasmuchasyoucan,takingthingsonforyourself

5.3.3 CopingwithPressure

Dealingwithstressfulsituationsanddealingwithpersonalanxietythendealingwith theoutcomesofdecisionsthatyouhavemade

Needtofunctioninarapidlychangingenvironment

Thegooddoctorremainscalmratherthangettingpanicked.Theyareabletomakesoundclinicaljudgement

Dealingwithconfrontationalareasdifficultcolleaguesandproblems

Someone who does itwell partially removes themselves from the situation and almostleavesthemoutsideanddoesntgetcaughtupintheemotionfromthepressure

The students who do well are not easily put off or are not easily frightened by thesituations



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5.3.4 EffectiveCommunication

Asking open questions...reflecting back...check back all the time that people areunderstandingwhatyouaresayingandthismaymeantailoringwhatyousaymaybeyoudontusetechnicaltermsBodylanguageisveryimportanttheyneedtopickuponsocialcues,bodylanguage

WhenrequestingaCTscan...youneedtoknowexactlywhatyouwantandwhyyouwantitand you need to have all the information they are going to ask you The capacity forpersuasionandnegotiationarequiteimportantskillsHandoversneedtobedonewell,socommunicationiscrucialimportantinformationneedstobegivenoutaboutthepatients.Youneed toknowwhat theappropriate information is to transfer,making sure that it istransferredaccuratelyandthat it isreceivedbythecorrectpeopleexpressyourselfclearlyandconciselyImportantthatkeepnursesinformed...attheendofawardroundsitdownwithanurseandgothrougheverything

ItisimportantthatyouaskquestionssoyoucanmakeaninformeddecisionaboutwhattodonextBeingabletotransferverbalthroughtowrittenandtoahighstandard

5.3.5 LearningandProfessionalDevelopment

Ableto...learnfrommistakes

Itsimportanttoreflect,thinkingaboutwhattheyaredoingsotheycanlearnfromit

Theycanlearnahugeamountfromnursingstaff

Theyneedadegreeofcuriosityandanacceptancethatnotall learningwilltakeplaceatwork

Asuccessfuldoctorhasadesiretogoonlearning...andthemotivationtodothat

Theyneedtoberesponsiblefortheirownlearning



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5.3.6 OrganisationandPlanning

Itsvitalfordoctorstobeabletoplan

Needtohavegoodrecordkeeping;everythingyousayanddoneedstobedocumented

Needtoknowwhatcanwaitormakingsurethatthingsgetdone

Beingabletoprioritise,especiallywhentherearecompetingpriorities

Needgoodtimemanagementskills

5.3.7 PatientFocus

Portrayingthereistimetotalkandhavingarelationshipwiththepatient

Beingpatientcentredandunderstandingwhatismoreimportantforthepatient

Recognisingwherethepatientiscomingfrom,age,emotionetc

Afriendlyandcompetentapproach,anopenmanner

Toengagewithcompassion

Importanttomaintaintheclinicaldistancewhilebeingempathetic

Establisharelationshipoftrust

5.3.8 ProblemSolvingandDecisionMaking

Toknowassoonaspossibleexactlywhatsgoingon,whatshappening...getup tospeedquicklyandefficiently

They can integratedifferentbitsof information fromdifferentdirectionsabout the samepatientandcomeupwithasensiblediagnosisandplan

Itsaboutaskingthebiggerquestions,thinkingoutsidethebox

Theyarebeingproactive,gettinginvolvedwithdifferentthings



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5.3.9 SelfAwarenessandInsight

IftheFY1isnotsure,theyneedtobeabletosayno...toadmitthattheyareunsure

Havinganappropriate levelofbeingable toaskpeople forhelpandunderstanding thatthisisaprofessionalattributeandnotaweakness

Beingabletoappearconfidentwithoutarrogance

Havingthehumilitytoacceptthatotherswillknowbetterthanyou

5.3.10 WorkingEffectivelyasPartofaTeam

Youhavetobeinclusive,youhavetotreatthemasanequalandvaluetheircontribution

Howyoudealwithpeoplewhoarestrugglingandhowyousupportthem

Workaspartofateam,recognisingtheirownroleandboundarieswithintheteam...andgoodatrecognisingboundariesofdifferentpeoplesroles

Needtoappreciatethepressurenursesareundere.g.numberofbeds,managementissues

Theyneedtobeabletomakefriends,theyworktogethersoiftheyareunfriendly...theworkoftheteamsuffers

Theyneedtobeabletoshareinformationandworkload

Theremaybeapointwhenyouneedtohelpoutwithsomeoneelsesjob

5.4 Findingsfromobservations

5.4.1 ThemajorityofbehavioursobservedduringtheobservationswereclassifiedwithinEffectiveCommunication(18)andWorkingEffectivelyaspartofaTeam(15).BehaviourswerealsoobservedinOrganisationandPlanning(5),PatientFocus(9),LearningandProfessionalDevelopment(5),CopingwithPressure(5),ProblemSolvingandDecisionMaking(2),SelfAwarenessandInsight(1)andCommitmenttoProfessionalism(1).Table6detailstheparticularbehavioursobservedinmoredetail.

5.4.2 ThemajorityofbehavioursfromtheProfessionalAttributesFrameworkwereobservedduringtheshadowingofFY1doctors,thusdemonstratingthattheattributesidentifiedintheinterviewscoveredthebreadthoftheFY1role.Thosebehavioursthatwerenotobservedduringtheshadowingarethosebehavioursthatarelesseasilyidentified,forexamplebehaviourswithinCommitmenttoProfessionalism(takesresponsibilityforownhealthandwellbeing,trustworthy)andSelfAwarenessandInsight(acceptancethataskingforhelpisnotaweakness,acceptsmistakeswillbemade.)



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5.4.3 Therewasnoobserveddifference intheprofessionalattributesdemonstratedbytheFY1sbetweenthefourlocationswheretheobservationswerecarriedout.

5.4.4 Table8belowprovidesexamplesofthebehavioursobserved.

Table8:IllustrativebehavioursfromFY1observations

ProfessionalAttribute Exampleobservations

EffectiveCommunication Introducesselftopatient,asksifitisoktotakebloodfromthem.Explainswhathewillbedoing.Apologisestopatientandtonursethathecouldnotgetblood.Checkswithnurseifthereisanythingelseheneedstodo


Speakstoanurseaboutsomebloodtestsrequests.Asksanurseifitisokifshedoesoneasheisquitebusy.Nurseapologisesaboutsomethingthathappeneddaybefore.Tellshernottoworryandjokesaboutit.


Checksbloodtestoncomputer.Documentsinpatientsnotestheirbloodresultsthatareonacomputerthatshouldhavebeendonebysomeoneelsethedaybefore.

PatientFocus Goestoseepatientandaskswhathappened.Examinespatientsandlistenstoconcerns.Sayssheunderstandshowdifficultitisandhowitmustbeaffectinghislifeandthattheywilltryanddoeverythingtheycantoresolvethesituation.

Learning&ProfessionalDevelopment

Afterexamination,askstheregistrar/consultantwhatshemissedandwhatshedidntdowhensheexaminedthepatient.

CopingwithPressure Speakstotheregistrarwherehefeltthattheyhadnotsupportedthemandhadgonebehindtheirback.Asksinfuturethattheycomedirectlytohimiftheyhaveaproblem.Remainedcalmwhendiscussingthesituation.


Nurseunsurewhethershouldgiveaspirintothepatient.Reassuresthenursethatitisoktogiveaspirin.

5.5 Findingsfromvalidationquestionnaire

5.5.1 ThefindingsfromthesurveyshowthatallnineprofessionalattributeswereseenasimportantforaFY1doctor.Table9outlinestheminimumandmaximumratings,themeanratingofimportance(1=littleimportance,6=extremelyimportant),thestandarddeviationandthepercentagescores.

5.5.2 CommitmenttoProfessionalism,CopingwithPressure,EffectiveCommunication,OrganisationandPlanning,PatientFocus,SelfAwarenessandInsightandWorkingEffectivelyasPartofaTeamwereallseenasveryimportantforaFY1doctor(meanrating>5).LearningandProfessionalDevelopmentandProblemSolvingandDecisionMakingwere



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seenastheleastimportantonthenineprofessionalattributes,butwerestillviewedasimportant.

Table9:MeanRatingofImportanceoftheProfessionalAttributes(n=230)

ProfessionalAttribute(inalphabeticalorder)

Min Max Mean SD Ratingofimportance(percentage)4

1 2 3 4 5 6


2 6 5.4 0.73 0 0 0 10% 36% 53%

CopingwithPressure 3 6 5.2 0.78 0 0 2% 16% 39% 43%


2 6 5.5 0.67 0 0 1% 4% 39% 56%


1 6 4.9 0.89 1% 0 3% 26% 46% 23%


3 6 5.2 0.70 0 0 1% 13% 49% 37%

PatientFocus 1 6 5.3 0.82 1% 0 2% 12% 36% 49%


2 6 4.9 0.92 0 0 7% 28% 37% 28%


3 6 5.2 0.78 0 0 3% 13% 43% 40%


3 6 5.4 0.69 0 0 2% 6% 42% 50%

5.5.3 Table10outlines theresultsfromthequestionwhichaskedrespondentstoratetheimportanceofevaluatingtheprofessionalattributesatselection.Thetabledetailstheminimumandmaximumratings,themeanratingofimportance(1=notatall,6=essential),thestandarddeviationandthepercentagescores.

5.5.4 ThefindingsshowthatCommitmenttoProfessionalism,EffectiveCommunication,PatientFocus,SelfAwarenessandInsightandWorkingEffectivelyasPartofaTeamwereallseenasimportanttoevaluateatselection(meanrating>5).CopingwithPressure,LearningandProfessionalDevelopment,OrganisationandPlanningandProblemSolvingandDecisionMakingwereseenaslessimportanttoevaluateatselection;howeverthesewerestillseenasdesirable.

4(1=littleimportance,6=extremelyimportant)



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Table10:MeanRatingofImportancetoEvaluateatSelection(n=230)

ProfessionalAttribute(inalphabeticalorder)

Min Max Mean SD Ratingofimportance(percentage)5

1 2 3 4 5 6


1 6 5.2 0.98 0 2% 3% 18% 31% 46%

CopingwithPressure 1 6 4.9 0.97 0 0 8% 22% 38% 31%


1 6 5.3 0.82 1% 0 1% 11% 37% 50%


1 6 4.6 1.03 1% 1% 9% 32% 37% 20%


1 6 4.9 0.92 1% 0 5% 27% 42% 25%

PatientFocus 1 6 5.1 1.10 1% 1% 4% 19% 30% 44%


1 6 4.8 0.97 0 0 8% 28% 37% 26%


1 6 5.1 0.90 0 0 6% 16% 41% 37%


1 6 5.1 0.90 1% 1% 2% 16% 44% 36%

5.5.5 Statisticalanalysiswascarriedouttoidentifywhethersomeattributeswereratedsignificantlymoreimportanttobeevaluatedatselectionthanothers.Althoughtheintentionofthissurveywasnottoranktheprofessionalattributes,theresultsfromthiscouldbeusedtoinformtheprofessionalattributestobetargetedintheSJT.

5.5.6 ArepeatedmeasuresANOVAwascarriedouttotestforsignificantdifferencesbetweenthemeanratingsoftheprofessionalattributes.AsalargenumberofstatisticaltestswerebeingcarriedoutsimultaneouslytheBonferronicorrectionwasapplied6.Theresultsshowedthattherewere21significantdifferencesinthemeanratingsoftheprofessionalattributes.

5.5.7 Specifically,theresultsshowthatEffectiveCommunicationwasratedasthemostimportantattributetoevaluateatselectionasitsmeanratingwassignificantlyhigherthanalloftheprofessionalattributeswiththeexceptionofCommitmenttoProfessionalism.LearningandProfessionalDevelopmentwassignificantlyratedtheleastimportanttobeevaluatedat

5(1=notatall,6=essential)6TheBonferronicorrectionisamultiplecomparisoncorrectionusedwhenseveraldependentorindependentstatisticaltestsarebeingperformedsimultaneously.Inordertoavoidalotofspuriouspositives(ashighas1in20),thesignificancelevelisloweredtoaccountforthenumberofcomparisonsbeingperformed.Thisconservativeanalysisstrategywasadoptedsoasnottooverinterprettheresults.



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selectionasitsmeanratingwassignificantlylowerthanalltheprofessionalattributeswiththeexceptionofProblemSolvingandDecisionMaking.

5.5.8 Thefactthatsomeattributeshavebeenratedbyrespondentsaslessimportanttobeevaluatedatselectionmayindicatethattheseattributesarelessabletobeassessedatselectionand/orareabletobelearnedintrainingandwilldevelopasFY1sprogressthroughtraining.Anumberofthecommentsprovidedonthesurveysupportedthisinterpretation(seetable11).

5.5.9 ParticipantsinthesurveywereofferedtheopportunitytocommentonthesurveyandaddanyfurtherattributesthattheyfeltwereimportantforaFY1doctor.Atotalof96commentswerereceivedthatwererelevanttotheroleofaFY1doctor.Theresearchercontentanalysedthecomments;aresultantsummaryofthecorethemesisprovidedbelowinTable11.

5.5.10 56ofthecommentsdiscussedpossiblefurtherprofessionalattributes.ReviewandanalysisbytheleadresearcheroftheadditionalattributesproposedrevealedthattheywerealreadycoveredaspartoftheProfessionalAttributesFramework,sononewthemesorattributeswereidentified.ThissuggeststhattheProfessionalAttributesFrameworkisacomprehensiveaccountoftheprofessionalattributesthatareexpectedintheFY1jobrole.

Table11:SummaryofValidationQuestionnaireComments

CommentTheme N

HighlightingattributesalreadycoveredintheProfessionalAttributesFramework

56

ConsiderationthattheFoundationProgrammeisalearningprocessandsomeoftheattributesaremorelikelytobelearnedanddevelopduringtheprogramme

19

Importanceofclinicalknowledgeandcompetence 6

DrawbackstothecurrentprocessforselectionintotheFoundationProgrammeandsuggestionsforalternatives

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5.6 Summaryoffindings

5.6.1 Broadlythesamesetsofbehaviourswerefoundfromeachofthethreeresearchmethodsinterviews,observationsandtheliteraturereview.ThisprovidesaclearindicationthattheprofessionalattributesoutlinedintheProfessionalAttributesFrameworkarerepresentativeoftheattributesthatwouldbeexpectedfromaFY1.Thisfindingisreplicatedinthevalidationsurvey.



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5.7 Mappingontoexistingmaterial

5.7.1 Aspartofthejobanalysis, it is importanttoensurethatthe informationobtainedandanyresulting frameworksmaponto existing relevantmaterial about the role, such aspersonspecificationsandcurriculums.Thishelpsassistwithensuringthattheinformationobtainedas a result of the job analysis is content valid i.e. that it is relevant and appears to berepresentativeofthejobrole.

5.7.2 Figure 3 below demonstrates how the Professional Attributes Framework maps to theexisting FY1 Person Specification. The current Person Specification is not intended toprovide detailed information and only provides a high level definition of each of theattributes.Mapping between the Professional Attributes Framework and the FY1 PersonSpecification is therefore unlikely to show a very high level of concordance as the twomodelsarenotdirectly comparable.Thehigh leveldefinitionof theattributes in the FY1PersonSpecificationalsomeansthatmappingisbasedonahighlevelinterpretationofthePersonSpecificationattributes.

5.7.3 The results of this mapping showed good concordance with the existing FY1 PersonSpecification. FourofthePersonSpecificationattributesmapdirectlyontooneofthe jobanalysisprofessionalattributes.TwoofthePersonSpecificationattributes(understandingofprinciplesofequalityanddiversityandinitiativeandabilitytocopeeffectivelywithpressure)eachmaponto threeof the jobanalysisprofessionalattributes.LearningandProfessionalDevelopment is theonlyprofessionalattribute identifiedby the jobanalysis thatdoesnotclearlymapontotheFY1PersonSpecification.

5.7.4 ItisthereforedemonstratedthatthecurrentFY1PersonSpecificationdoesnotcontainanyprofessional attributes that were not identified in the job analysis and the resultantProfessional Attributes Framework. However, the Professional Attributes Framework dididentifyprofessionalattributes thatarenotpresent in thePersonSpecification.ThereforetheProfessionalAttributesFrameworkappears to showagood levelofconcordancewiththeUKFPOFY1PersonSpecification.

5.7.5 Figure4displayshowtheProfessionalAttributesFrameworkmapsontotheFY1curriculum.MoreinformationaboutthesyllabuscanbefoundintheFoundationProgrammeCurriculum2007.